LAWRENCE — Every time Rafael Valerio picks up a prescription at the Greater Lawrence Family Health Center at 700 Essex St., he stands in front of a black telephone with a small video screen attached to it so he can talk to a pharmacist located across town on Haverhill Street.
In a first-of-its-kind pilot program in Massachusetts, the health center is using video-phones, Webcams and advanced software to provide prescriptions to more patients around the city without requiring them to see a registered pharmacist in person.
"We're reducing barriers to health care," said Diane Gatchell, a pharmacist who ordinarily works at the health center's main pharmacy on Haverhill Street. In the past, after patients saw their doctor at the Essex Street health clinic, they would have to carry prescriptions to a pharmacy somewhere else in the city, or somehow get over to the GLFHC headquarters.
Frequently, said Gatchell, people would simply ignore the prescription.
"Up to 50 percent of patients don't get their prescriptions filled," she said, citing local and statewide statistics.
Now, after visiting their doctor at the clinic, they simply walk into the telepharmacy to get their medication.
By law, every pharmacy has to be staffed by a registered pharmacist — someone with the skill, training and experience to make sure that patients are getting the right drugs in the right dosages that won't conflict with any other medications they may be taking. The idea behind that law, said Gatchell, is not only to keep patients safe by making sure they get the right meds, but to allow patients to speak directly with a pharmacist to get counseling about their prescriptions and have any questions answered.
In an effort to trim costs and expand their services, however, the health center worked with the Mass. College of Pharmacy and Health Sciences in Boston to secure $125,000 in state grants to launch a telepharmacy that would comply with the law. The telepharmacy enables a pharmacist on Haverhill Street to review the prescription over a secure computer network, actually see the medications via Webcam, and then speak to the patient over a videophone.
Plans for expansion
So far, say health center officials, the program, which has been operating for about a year, has been a huge success.
"Patients love it," said Elena Jordan, a pharmacy technician who works at the 700 Essex St. clinic, which has doctors' offices, exam rooms and a large waiting area for the hundreds of mostly Latino patients who stream through the doors five days a week.
Many of the clinic's patients live in low-income housing just across the street from the Essex Plaza or in the neighborhood immediately around the plaza, she said.
Bob Ingala, CEO for the Family Health Center, noted that the technology is typically used in more rural areas, like Native American outposts where the closest pharmacist might be a five- or six-hour drive away. In fact, telepharmacies are allowed by state law in Wyoming, Texas, Alaska, North and South Dakota, Montana and several other sparsely populated states.
The technology is applicable to Lawrence, even though it is a small, congested city, because many people rely on public transportation or have to walk to get around.
"This way, the headquarters can act as a hub, while we still extend services to other sites," he said. The health center has four locations — 34 Haverhill St., which has a pharmacy as well as many other services, its North Site clinic at 150 Park St., South Site clinic 73D Winthrop Ave. (Route 114), and 700 Essex St. The agency also runs two smaller clinics for students at Lawrence High School and the Greater Lawrence Technical School in Andover.
Ingala hopes that if the pilot program is deemed a success, telepharmacies could be opened at all the agency's locations, benefitting even more patients.
But the health center also benefits — by not having to hire another registered pharmacist to staff a remote location. With the telepharmacy, pharmacy technicians like Jordan can get medicine into the hands of people who need it, with electronic supervision by a pharmacist.
There are other controls as well: No narcotics are dispensed from the remote sites.
How it works
In a demonstration this week, pharmacy technician Hillary Lennon showed how the system works. First, she logged into the computer system at the Essex Street clinic by pressing her index finger onto a lighted panel to get access to the system. The panel uses biometrics — confirming her identity using her thumbprint — which then allows her to log onto the computer to process the order.
The pharmacist on Haverhill Street, meanwhile, reviews the order and gives the OK to Lennon to print out the label with the patient's name on it. As the label is being printed out, a large, floor-to-ceiling locked metal box called the "automed" dispenses one pill bottle at a time — much like a vending machine — dropping it into a drawer that Lennon opens to retrieve the prescription.
She then opens the bottle and pours a few pills into the bottle top, placing both the bottle and the pills under a Webcam attached to the side of the computer. That image is transmitted, live, to the pharmacist on Haverhill Street, who can visually confirm that the correct drugs are being given out. Once the pharmacist gives the OK, Lennon affixes the label to the pill bottle, which is placed in a bag and put on a shelf behind the counter until the patient comes to pick it up.
When the patient does arrive, another process kicks into gear.
Thursday, when Valerio came in to pick up his prescription at the clinic, he had to stand in front of a videophone on the counter, where a live, video image of the pharmacist on duty at GLFHC headquarters — Stacey Robert — popped up on the screen. In the corner of the screen was an image of Valerio himself.
As Robert spoke about the prescriptions, Jordan listened on the phone and translated to Valerio so he could understand the pharmacist's orders.
Although he had heard it all before, Valerio, and other patients at the clinic, are required to go through the "counseling" process every time they pick up a prescription, something the state Department of Public Health is requiring during the two-year pilot program.
Ingala said he hopes that as the program progresses, the state will ease up on that requirement, since it adds time to the process, making it more inefficient for the pharmacist as well as the customer.
The program is being closely monitored by staff and students from the Mass. College of Pharmacy, who are trying to determine if the telepharmacy increases use of medications by patients in Lawrence, said Dr. Timothy Hudd, a professor at the college who is playing a leading role in the project.
The college team will give the results of its review to the Department of Public Health and the state Board of Registration and Pharmacy, the agencies ultimately responsible for permitting the telepharmacy. If they like the results, they could recommend telepharmacies are approved for statewide use. The pilot program ends in January, Hudd said, meaning that sometime next year the agencies will make a recommendation.
