Department of Pharmacy Practice

College of Pharmacy
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UIC Pharmacists enter into Telemedicine

                                            

By Daniel P.Smith       

Each week, Juliana Chan takes a seat in a nondescript room at the Benjamin Goldberg Research Center  on UIC’s West Campus and begins reviewing notes. In a moment, a video screen before her brightens and a live image flashes. A patient enters the picture; a nurse stands at his side. Moments later, a physician pops onto the screen.
Enabled by the wonders of 21st Century technology, the three parties, located miles and seemingly worlds apart, exchange greetings. Then, the questions begin flying. A medical examination and consultation process is underway. Far less sci-fi and far more modern-day reality, this is the growing field of telemedicine. Utilizing technology much like Skype, telemedicine allows medical personnel to visit patients “face-to-face” from a live video feed.
The emerging field is adding a new dimension to the work of pharmacists across the nation, including clinicians like Chan and her UIC colleague Melissa Badowski, who are leading multi-disciplinary telemedicine teams at UIC to address Hepatitis C and HIV, respectively, in Illinois’ prisons.
“It’s an opportunity many never imagine existing until they see it with their own eyes,” Chan says of telemedicine. Thanks to technology’s ever-quickening pulse, pharmacists are increasingly entering this new frontier in medical care, eliminating gaps in service, expanding their clinical role and serving oft-overlooked populations in more cost-effective and results-oriented ways.
“This is more than just innovative,” UIC professor of pharmacy practice and medicine Keith Rodvold says of Badowski and Chan’s telemedicine efforts. “This is truly telemedicine: medical professionals sitting side by side and working as a team to deliver cohesive care for the patient.”

Telemedicine defined
The Washington, DC-based American Telemedicine Association defines telemedicine as “the use of medical information exchanged from one site to another via electronic communications to improve patients’ health status.” Electronic communications can include videoconferencing, transmission of still images and remote monitoring of vital signs – tech-driven elements that can develop healthcare in areas with limited access to specialized care.
Telemedicine services include: specialist referral services from almost 50 different medical subspecialties; patient consultations utilizing audio, still or live imagery to render a diagnosis and design a treatment plan; remote patient monitoring using devices to remotely collect and send data to a monitoring station for interpretation; and even continuing education credits for health professionals.
Equipment and staffing needs, meanwhile, are relatively minimal: computers and DSL lines, firewalls and videoconferencing equipment, technological diagnostic tools and trained staff on the opposite side of the live feed.
The telemedicine field has developed as healthcare institutions look to expand their offerings of products and services. As a result of telemedicine’s innovative momentum, patients receive the expert care that might elude them.
“We’re counseling in real time and managing side effects,” says Badowski, an HIV expert who serves as a clinical assistant professor in the Department of Pharmacy Practice.

UIC’s leading role
When Badowski arrived at UIC in 2010, with fresh experience setting up an HIV inpatient service, leadership  tabbed her to establish pharmacy services in telemedicine, an arena UIC wanted to enter. “There was a loose framework in place, but not much beyond that,” Badowski recalls.
Within months of her arrival, Badowski had the HIV telemedicine clinic up and running with one Illinois correctional facility immediately on board. Badowski sees every HIV patient when they first enter prison and, alongside a physician and case manager, has routine follow-up meetings with prisoners. Just as Badowski was launching the HIV telemedicine clinic, Chan was opening UIC’s Hepatitis C telemedicine clinic.
Chan, a clinical associate professor in the Department of Pharmacy Practice and Medicine who’s been at UIC for 13 years, says the school had been in talks with the Illinois Department of Corrections (IDOC) about telemedicine programs, specifically in the areas of HIV and Hepatitis C, since the mid-2000s . IDOC stood eager to find a partner who could not only provide direct patient care, but also secure government pricing on drugs under the 340B Drug Pricing Program, a move IDOC leaders said would save $4 million annually.
“The fact of the matter is that patients in prison were not being taken care of by specialists, which wasn’t the most productive or cost-effective process,” Chan says. For years, in fact, the issue of HIV and Hepatitis C in Illinois prisons had been a persistent and costly one. According to the United States Bureau of Justice, more than 450 Illinois prisoners, about one percent of the state’s incarcerated population, were living with HIV as of 2008.
In October 2007, Illinois released its “Viral Hepatitis Strategic Plan” and announced that “although [Hepatitis C] prevalence among prison inmates is three to five times greater than that in the general population, access to viral hepatitis screening and prevention services are not routinely available in Illinois prisons.”
Prior to UIC’s telemedicine efforts, most of the state’s prisons had one doctor overseeing a patient’s care. Well-intentioned and professional as the doctors might have been, none were HIV or Hepatitis C experts. This not only meant health challenges for those Illinois prisoners infected with HIV or Hepatitis C, but also posed a health risk to correctional staff and, upon a prisoner’s release, the general population as well.
UIC’s telemedicine clinics changed that for hundreds of Illinois inmates, providing care from a team of specialists – a physician who directs the diagnostic decision-making and a pharmacist who leads decisions on medications. Today, Badowski and Chan’s telemedicine teams serve more than two-dozen Illinois correctional facilities. Most inmates have a nurse with them on the telemedicine feed. The nurse will take the patient’s vitals and provide the direct examination. When necessary, the UIC physician or pharmacist can utilize high-tech tools, including stethoscope equipment and an exam camera,  to gain further insights.
“We bring in high-quality subspecialty care,” Badowski says. “We’re improving quality of life as well as efficacy, safety and care of treatment.”
Both Badowski and Chan also utilize their clinics for training. UIC residents and fellows gain their introduction to telemedicine’s unique environment through Badowski and Chan, while pharmacy students can participate in a telemedicine rotation as well.

The future for telemedicine
When Badowski first got involved with telemedicine, she feared she would lose the “hands on” aspect of patient care. Two years in, however, she sees that telemedicine retains the humanistic approach she so enjoys.
“You’re giving specialty care where there otherwise would be none and still doing it face to face,” she says.
At UIC, Badowski and Chan’s efforts are only the beginning of pushing the limits of innovative, off-site care.
The university currently maintains telemedicine efforts in dermatology as well as a pediatric ENT telemedicine clinic that serves rural areas on a quarterly basis. Plans to establish a telemedicine psych clinic have also been discussed internally, a clear sign that UIC embraces its mission to establish new methods of patient care, instruct and prepare future medical professionals and engage in scholarly activity.
“Many of us are looking to do research on how telemedicine can expand,” says Badowski, adding that she believes telemedicine will eventually expand into nursing homes and other venues in which patients require quick access to medical specialists. While still a relatively new, emerging field, Chan says telemedicine can no longer be labeled “futuristic.” In addition to UIC’s clinics, there are dozens of telemedicine clinics across the U.S. serving residents in rural areas, patients in VA hospitals and other immobile or distant populations.
“Developments in technology and telemedicine are giving a lot of people the specialized care they couldn’t have accessed before,” Chan says. “It’s saving time, money and lives.” Such favorable components, Rodvold contends, will continue to drive telemedicine’s advancement in the years ahead, thereby giving pharmacists an opportunity to embrace a more clinical perspective.
“As telemedicine grows, pharmacists will have an opportunity to expand their role in patient care,” Rodvold confirms.

Sidebar
Telepharmacy develops as a branch of telemedicine

Under the telemedicine umbrella stands telepharmacy.
Much like its parent discipline, telepharmacy embraces professional service from an off-site location.
Generally storefront shops, even closed Main Street pharmacies, these remote sites – essentially surrogates for the “home pharmacy” – are staffed by trained non-pharmacist personnel and carry medication and electronic systems just as a traditional pharmacy would. Courtesy of a live video feed, the supervising pharmacist directs the fulfillment process and counsels the patient.
Telepharmacy first began making headlines around the turn of the century, largely driven by the closing of small-town drugstores and a well-documented shortage of pharmacists.
Championing telepharmacy as a way to address labor cost components and make a single pharmacist more efficient, telepharmacies have sprouted in recent years as entrepreneurial pharmacists and ambitious companies explore financially savvy ways to deliver medications with convenience and speed, but without concern about having enough customer volume to fulfill business objectives.
In recent years, various studies have supported the implementation of telepharmacy services in multi-hospital health systems, specifically citing expanded hours of service, improved speed in the processing of medication orders and increased clinical pharmacy services and cost avoidance.

Sources:

Keith A. Rodvold, Pharm.D.
Professor of Pharmacy Practice and Medicine
Colleges of Pharmacy and Medicine
University of Illinois at Chicago
312-996-3341
kar@uic.edu

Melissa Badowski, PharmD, BCPS, AAHIVP
Clinical Assistant Professor, Section of Infectious Diseases Pharmacotherapy
University of Illinois at Chicago, College of Pharmacy
773 909 3671
badowski@uic.edu

Juliana Chan

Clinical Associate Professor
Clinical Pharmacist – GI/Hepatology and HCV Telemedicine
Departments of Pharmacy Practice and Medicine
Colleges of Pharmacy and Medicine
312-413-8282
jchan@uic.edu




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