Stephen Smith, B.S. Pharm., Chief Pharmacy Officer Karmanos Cancer Institute, Detroit and MSHP Treasurer
We are creatures of habit. We enjoy the constancy and consistency of our normal day-in and day-out routine. Introduce any significant change into that routine and “Hey, you moved my cheese.” or “Why did you change something that wasn’t broke?”
We are in the middle of one of the biggest disruptors in our lifetimes, COVID-19. We are required to behave differently, to think differently, and to interact with each other differently. We are now routinely holding meetings where 20-30 of our colleagues interact through Microsoft Teams, ZOOM or other software platforms to hold those meetings where three months ago we had to have a face-to-face interaction. Professional organizations, including MSHP and MPA have held and are planning conferences where 100 – 200 people will interact electronically in various “rooms” deciding issues and formulating policy. What used to be our routine way of doing things is adjusting to our “new normal.”
How can a pharmacy exist without a pharmacist physically present? How can all paper prescriptions be totally eliminated safely? These are questions that are being asked and new solutions and new normal are being explored.
Telepharmacy: Public Act No. 4 of 2020; previously SB 340, Sen. VanderWall (R-Frankfort) defines the practice of telepharmacy. Provisions and definitions of remote pharmacy, parent pharmacy, use of audio and video tools to provide oversight and to interact with patients, minimum distances between sites, requirements for the pharmacists and technicians who work in these pharmacies, limits to the number of prescriptions and retention timelines for audio/video communications are all part of this Public Act. The bill was signed into law by Governor Whitmer on Jan. 24, 2020, and became effective April 26, 2020. Telepharmacy is definitely a new normal from our traditional models of direct face-to-face practice. A major hope for this law is to bring pharmacy services closer to the patients who live in more remote areas of Michigan. Pharmacists embracing this new technology will need to transfer all our normal safety and quality protocols to this electronic space. Time will tell if our hopes for this new technology are realized.
E-prescribing: HB 4217 / SB 248 / SB 254; Rep. Bellino (R-Monroe), Sen. Johnson (R-Holly) and Sen. Zorn (R-Ida) have submitted legislation which would require prescribers to electronically submit all prescriptions (including controlled substances). Currently, all three bills have been passed out of their respective chambers and are in the opposite chamber’s health policy committee. The bills were introduced to help align Michigan’s processes with upcoming Medicare rule changes regarding the use of electronic prescriptions. As pharmacists, our long time hope with e-prescribing is that information is transmitted clearly between the provider and the pharmacist. No messy writing to interpret; clear concise and accurate directions that are easily communicated between health professionals for the patient’s benefit. Those of us who work in hospitals/clinics realize that these tools have come a long way since their infancy but like any computerized system are subject to human error and incorrect information. The complete elimination of more traditional prescribing methods will continue to be challenging until many of the intrahospital/clinic rules (weight based dosing, drug interactions, dose range checking) are robustly incorporated into e-prescribing. Additionally, access to critical diagnostic information is another safety measure that needs to be available to the external practitioner. So while the concept of e-prescribing philosophically pushes us toward better, safer patient care, there are still some very real challenges that we must work to overcome.
Whether you support these new normals or believe another alternative is better, you need to be involved so that your voice is heard as these changes are being discussed and developed. Consider joining Pharmacy PAC, PART (Pharmacy Advocacy Response Team), participate in an MSHP or MPA committee (Public Affairs or Professional and Legal Affairs); you can explore the MPA website for options open to you.