The Smilow Cancer Hospital is preparing to incorporate Lawrence and Memorial Healthcare into its telepharmacy system, which uses video, audio and photo surveillance to supervise technicians preparing chemotherapy drugs from a central location in Smilow.
The system, which has cut down the turnaround time for cancer drugs by more than half since its launch, was developed in 2012. At the time, Smilow was preparing to acquire nine physician oncology practices across Connecticut, said Howard Cohen, associate director of oncology pharmacy services at Yale-New Haven Hospital. Smilow wanted to integrate the practices so the same level of care would be provided at any Smilow location.
Telepharmacy allows a central team of pharmacists stationed in Smilow to supervise multiple technicians across Connecticut as they prepare chemotherapy drugs. The pharmacists not based in New Haven are able to counsel patients and advise physicians about drug dosage concerns. Before it was piloted in 2012, the turnover for a single drug order took more than an hour and a half. With the system, it now takes roughly 45 minutes. Telepharmacy speeds up drug turnaround by eliminating the need for technicians to wait for drug order verification from the pharmacist in their specific location. Instead, any pharmacist in the network can review and approve orders.
Now, as Smilow’s network grows larger, the hospital is looking to expand the reach of its telepharmacy system.
“From a patient perspective, [telepharmacy] enhances their ability to deliver treatment in a cost-effective way that is close to home,” said Executive Director of Patient Care Services at Smilow Cancer Hospital Catherine Lyons.
Smilow’s model uses digital photography, audio and video connectivity to monitor technicians in real time as they prepare cancer drugs for patients. Cohen said telepharmacy streamlines the drug turnover process.
After a health care provider in Smilow’s network enters a drug order into Epic, the hospital’s electronic patient portal, any pharmacist in Smilow’s central New Haven location can view and verify the order.
Technicians in each practice prepare the drugs while being monitored from afar. The distance, Cohen said, actually enhances the amount of supervision they receive. Pharmacists in the central location can talk to the technicians preparing the drug through telephone systems and send technical instructions telling them step by step how to prepare the drugs.
The technician photographs the drug preparation throughout each stage of the process. As a final fail-safe, pharmacists verify the therapy and review the photos taken by the technician before they allow the drug to be administered.
Cohen said this remote supervision system has decreased the number of errors at the hospital. After the 2012 pilot, Smilow recorded 1.7 percent fewer errors. The improvement prompted the state to change a law that required pharmacists to be physically present to supervise technicians, Cohen added.
“We’re not opposed to challenging regulations if they don’t make sense,” Cohen said. “My word of wisdom is ‘don’t let regulation be a brick wall.’”
Telepharmacy has also allowed Smilow to double its patient base. With a cost-effective system in place, Smilow can now acquire oncology practices across the state without worrying about the money it may lose transporting drug treatments, Lyons said.
“With telepharmacy, [pharmacists] wouldn’t be tied to the computer,” said Cohen. “They can be out educating patients. They can use telepharmacy as an enabler.”
Cohen said the benefits of telepharmacy reach the patient through shorter wait times for orders. With the new system, orders can be processed as soon as they are submitted by a provider.
Cohen added that as Smilow’s network grows, efficient care will become more important.
As part of Yale New Haven Health System’s affiliation with L+M, the Epic electronic medical record system will be implemented throughout the L+M Healthcare system, allowing it to access and share drug orders and other medical information.
L+M will also become a corporate member of YNHHS, joining Bridgeport, Greenwich and Yale-New Haven Hospital as a full member of the system, and becoming the first hospital since 1998 to join YNHHS.
Correction: Sep. 24
A previous version of this article suggested Smilow introduced telepharmacy to avoid hiring more staff. Smilow later clarified that telepharmacy was not put in place to eliminate the need for staff.