<s>
Telepharmacy	B-Application
is	O
the	O
delivery	O
of	O
pharmaceutical	O
care	O
via	O
telecommunications	O
to	O
patients	O
in	O
locations	O
where	O
they	O
may	O
not	O
have	O
direct	O
contact	O
with	O
a	O
pharmacist	O
.	O
</s>
<s>
It	O
is	O
an	O
instance	O
of	O
the	O
wider	O
phenomenon	O
of	O
telemedicine	B-Application
,	O
as	O
implemented	O
in	O
the	O
field	O
of	O
pharmacy	O
.	O
</s>
<s>
Telepharmacy	B-Application
services	O
include	O
drug	O
therapy	O
monitoring	O
,	O
patient	O
counseling	O
,	O
prior	O
authorization	O
and	O
refill	O
authorization	O
for	O
prescription	O
drugs	O
,	O
and	O
monitoring	O
of	O
formulary	O
compliance	O
with	O
the	O
aid	O
of	O
teleconferencing	O
or	O
videoconferencing	B-Application
.	O
</s>
<s>
Remote	O
dispensing	O
of	O
medications	O
by	O
automated	O
packaging	O
and	O
labeling	O
systems	O
can	O
also	O
be	O
thought	O
of	O
as	O
an	O
instance	O
of	O
telepharmacy	B-Application
.	O
</s>
<s>
Telepharmacy	B-Application
services	O
can	O
be	O
delivered	O
at	O
retail	O
pharmacy	O
sites	O
or	O
through	O
hospitals	O
,	O
nursing	O
homes	O
,	O
or	O
other	O
medical	O
care	O
facilities	O
.	O
</s>
<s>
The	O
term	O
can	O
also	O
refer	O
to	O
the	O
use	O
of	O
videoconferencing	B-Application
in	O
pharmacy	O
for	O
other	O
purposes	O
,	O
such	O
as	O
providing	O
education	O
,	O
training	O
,	O
and	O
management	O
services	O
to	O
pharmacists	O
and	O
pharmacy	O
staff	O
remotely	O
.	O
</s>
<s>
A	O
primary	O
appeal	O
of	O
telepharmacy	B-Application
is	O
its	O
potential	O
to	O
expand	O
access	O
to	O
pharmacy	O
care	O
in	O
smaller	O
rural	O
communities	O
,	O
some	O
of	O
which	O
cannot	O
support	O
a	O
full-time	O
pharmacist	O
or	O
cannot	O
easily	O
recruit	O
a	O
pharmacist	O
to	O
reside	O
in	O
their	O
region	O
.	O
</s>
<s>
Telepharmacy	B-Application
can	O
potentially	O
give	O
patients	O
in	O
remote	O
locations	O
access	O
to	O
professional	O
pharmacy	O
care	O
that	O
could	O
not	O
be	O
received	O
locally	O
,	O
which	O
can	O
lower	O
costs	O
and	O
improve	O
patient	O
safety	O
through	O
better	O
patient	O
counseling	O
,	O
drug	O
administration	O
monitoring	O
,	O
and	O
compliance	O
monitoring	O
.	O
</s>
<s>
The	O
potential	O
costs	O
of	O
telepharmacy	B-Application
are	O
broadly	O
the	O
same	O
as	O
those	O
associated	O
with	O
all	O
forms	O
of	O
telemedicine	B-Application
:	O
potentially	O
decreased	O
human	O
interaction	O
between	O
medical	O
professionals	O
and	O
patients	O
,	O
an	O
increased	O
risk	O
of	O
error	O
when	O
medical	O
services	O
are	O
delivered	O
in	O
the	O
absence	O
of	O
a	O
registered	O
professional	O
,	O
and	O
an	O
increased	O
risk	O
that	O
protected	O
health	O
information	O
may	O
be	O
compromised	O
through	O
electronic	O
information	O
storage	O
and	O
transmission	O
.	O
</s>
<s>
One	O
concern	O
is	O
whether	O
medication	O
adherence	O
is	O
affected	O
by	O
the	O
use	O
of	O
telepharmacy	B-Application
.	O
</s>
<s>
One	O
retrospective	O
cohort	O
study	O
that	O
examined	O
the	O
dispensing	O
records	O
of	O
a	O
low-income	O
Chicago	O
neighborhood	O
showed	O
that	O
medication	O
adherence	O
was	O
lower	O
among	O
users	O
of	O
telepharmacy	B-Application
than	O
users	O
of	O
a	O
traditional	O
pharmacy	O
in	O
some	O
but	O
not	O
all	O
drug	O
classes	O
examined	O
.	O
</s>
<s>
More	O
research	O
is	O
needed	O
to	O
see	O
whether	O
the	O
usage	O
of	O
telepharmacies	B-Application
coupled	O
with	O
other	O
interventions	O
could	O
improve	O
medication	O
adherence	O
.	O
</s>
<s>
The	O
implementation	O
of	O
telepharmacy	B-Application
varies	O
by	O
region	O
and	O
jurisdiction	O
.	O
</s>
<s>
A	O
form	O
of	O
telepharmacy	B-Application
has	O
been	O
in	O
use	O
by	O
Australia	O
's	O
Royal	O
Flying	O
Doctor	O
Service	O
since	O
1942	O
.	O
</s>
<s>
Another	O
application	O
of	O
telepharmacy	B-Application
in	O
Queensland	O
has	O
been	O
the	O
provision	O
of	O
pharmaceutical	O
reviews	O
in	O
rural	O
hospitals	O
that	O
lack	O
on-staff	O
pharmacists	O
.	O
</s>
<s>
Although	O
broader	O
use	O
of	O
telepharmacy	B-Application
could	O
help	O
alleviate	O
a	O
shortage	O
of	O
pharmacists	O
,	O
Australia	O
has	O
lagged	O
the	O
United	O
States	O
in	O
its	O
implementation	O
of	O
telepharmacy	B-Application
,	O
partly	O
because	O
doctors	O
,	O
nurses	O
,	O
and	O
other	O
health	O
care	O
workers	O
provide	O
pharmacy	O
services	O
in	O
rural	O
and	O
remote	O
areas	O
where	O
there	O
are	O
no	O
pharmacists	O
.	O
</s>
<s>
Implementation	O
of	O
telepharmacy	B-Application
in	O
the	O
United	O
States	O
began	O
in	O
the	O
2000s	O
.	O
</s>
<s>
In	O
response	O
to	O
the	O
need	O
for	O
alternative	O
means	O
of	O
delivering	O
pharmacy	O
in	O
services	O
in	O
rural	O
communities	O
lacking	O
a	O
full-time	O
pharmacist	O
,	O
several	O
midwestern	O
and	O
northwestern	O
states	O
with	O
extensive	O
rural	O
areas	O
have	O
led	O
much	O
of	O
the	O
development	O
of	O
policy	O
and	O
implementation	O
methods	O
for	O
telepharmacy	B-Application
.	O
</s>
<s>
The	O
next	O
year	O
,	O
state	O
agencies	O
and	O
grants	O
established	O
the	O
North	O
Dakota	O
Telepharmacy	B-Application
Project	O
,	O
which	O
now	O
supports	O
more	O
than	O
fifty	O
remote	O
retail	O
and	O
hospital	O
pharmacy	O
sites	O
throughout	O
North	O
Dakota	O
.	O
</s>
<s>
In	O
this	O
program	O
,	O
a	O
licensed	O
pharmacist	O
at	O
a	O
central	O
site	O
communicates	O
with	O
remote	O
site	O
pharmacy	O
technicians	O
and	O
patients	O
through	O
videoconferencing	B-Application
.	O
</s>
<s>
A	O
2004	O
study	O
of	O
the	O
program	O
found	O
that	O
telepharmacy	B-Application
delivered	O
the	O
same	O
quality	O
of	O
pharmacy	O
services	O
as	O
traditional	O
facilities	O
,	O
and	O
a	O
study	O
of	O
the	O
operation	O
of	O
one	O
North	O
Dakota	O
telepharmacy	B-Application
business	O
from	O
2002	O
through	O
2004	O
found	O
that	O
,	O
while	O
medication	O
inventory	O
turnover	O
was	O
lower	O
than	O
the	O
industry	O
average	O
,	O
the	O
remote	O
sites	O
were	O
able	O
to	O
be	O
operated	O
profitably	O
.	O
</s>
<s>
The	O
Community	O
Health	O
Association	O
of	O
Spokane	O
,	O
a	O
network	O
of	O
community	O
health	O
centers	O
in	O
Spokane	O
,	O
Washington	O
,	O
started	O
a	O
telepharmacy	B-Application
program	O
in	O
2001	O
.	O
</s>
<s>
The	O
program	O
delivers	O
remote	O
medication	O
dispensing	O
and	O
health	O
counseling	O
to	O
patients	O
at	O
six	O
urban	O
and	O
rural	O
clinics	O
;	O
remote	O
site	O
personnel	O
are	O
connected	O
to	O
pharmacists	O
at	O
the	O
base	O
site	O
by	O
videoconferencing	B-Application
.	O
</s>
<s>
The	O
Alaska	O
Native	O
Medical	O
Center	O
,	O
a	O
hospital	O
in	O
Anchorage	O
,	O
Alaska	O
,	O
providing	O
telehealth	O
services	O
to	O
Alaska	O
Native	O
populations	O
,	O
established	O
a	O
telepharmacy	B-Application
program	O
in	O
2003	O
to	O
improve	O
its	O
pharmaceutical	O
services	O
in	O
rural	O
native	O
settlements	O
.	O
</s>
<s>
The	O
American	O
Society	O
of	O
Health-System	O
Pharmacists	O
gave	O
the	O
program	O
its	O
2006	O
Award	O
for	O
Excellence	O
in	O
Medication-Use	O
Safety	O
,	O
concluding	O
that	O
the	O
use	O
of	O
telepharmacy	B-Application
had	O
improved	O
access	O
to	O
pharmaceutical	O
care	O
and	O
enabled	O
pharmacists	O
to	O
monitor	O
medication	O
safety	O
and	O
encourage	O
medication	O
adherence	O
,	O
as	O
well	O
as	O
making	O
pharmacy	O
care	O
more	O
cost-effective	O
.	O
</s>
<s>
The	O
U.S.	O
Navy	O
Bureau	O
of	O
Medicine	O
operates	O
a	O
large-scale	O
telepharmacy	B-Application
program	O
for	O
the	O
use	O
of	O
service	O
personnel	O
.	O
</s>
<s>
This	O
program	O
represents	O
the	O
largest	O
implementation	O
of	O
telepharmacy	B-Application
to	O
date	O
.	O
</s>
<s>
Iowa	O
's	O
first	O
telepharmacy	B-Application
opened	O
in	O
September	O
2012	O
after	O
receiving	O
a	O
three-year	O
waiver	O
from	O
the	O
Iowa	O
Board	O
of	O
Pharmacy	O
that	O
allows	O
the	O
facility	O
to	O
operate	O
without	O
a	O
pharmacist	O
on-site	O
.	O
</s>
<s>
A	O
2010	O
study	O
of	O
the	O
various	O
American	O
states	O
 '	O
rural	O
health	O
offices	O
found	O
that	O
telepharmacy	B-Application
in	O
rural	O
medical	O
facilities	O
varied	O
in	O
prevalence	O
across	O
the	O
United	O
States	O
but	O
was	O
still	O
not	O
widespread	O
,	O
and	O
that	O
many	O
states	O
had	O
not	O
yet	O
clearly	O
defined	O
regulations	O
for	O
telepharmacy	B-Application
in	O
hospitals	O
.	O
</s>
<s>
Adoption	O
and	O
implementation	O
of	O
telepharmacy	B-Application
methods	O
has	O
been	O
slow	O
compared	O
to	O
the	O
spread	O
of	O
the	O
basic	O
technologies	O
involved	O
(	O
internet	O
access	O
,	O
audio/video	B-General_Concept
compression	I-General_Concept
algorithms	O
,	O
microphones	B-Application
and	O
video	O
cameras	O
)	O
,	O
despite	O
periodic	O
predictions	O
of	O
a	O
forthcoming	O
boom	O
in	O
the	O
industry	O
.	O
</s>
<s>
Aside	O
from	O
more	O
intangible	O
factors	O
(	O
such	O
as	O
physicians	O
 '	O
and	O
pharmacists	O
 '	O
personal	O
uneasiness	O
with	O
the	O
lack	O
of	O
physical	O
interaction	O
with	O
patients	O
)	O
,	O
the	O
major	O
obstacles	O
to	O
telepharmacy	B-Application
implementation	O
appear	O
to	O
have	O
been	O
the	O
lack	O
of	O
clear	O
legal	O
regulations	O
for	O
telepharmacy	B-Application
,	O
and	O
the	O
lack	O
of	O
network	O
and	O
software	O
systems	O
to	O
manage	O
(	O
and	O
secure	O
)	O
all	O
of	O
the	O
data	O
used	O
in	O
a	O
professional	O
pharmacy	O
.	O
</s>
<s>
As	O
of	O
2010	O
,	O
many	O
of	O
the	O
telepharmacy	B-Application
facilities	O
in	O
active	O
operation	O
were	O
operating	O
as	O
pilot	O
programs	O
or	O
under	O
temporary	O
waivers	O
issued	O
by	O
state	O
regulators	O
because	O
many	O
states	O
still	O
had	O
no	O
clear	O
legal	O
framework	O
for	O
the	O
regulation	O
of	O
remote	O
pharmaceutical	O
sites	O
without	O
pharmacists	O
.	O
</s>
<s>
Even	O
in	O
states	O
that	O
had	O
regulated	O
retail	O
telepharmacy	B-Application
practices	O
,	O
regulations	O
were	O
often	O
not	O
in	O
place	O
to	O
permit	O
the	O
implementation	O
of	O
telepharmacy	B-Application
in	O
hospital	O
settings	O
.	O
</s>
<s>
For	O
some	O
pharmacy	O
facilities	O
that	O
might	O
otherwise	O
consider	O
telepharmacy	B-Application
,	O
the	O
cost	O
and	O
complexity	O
of	O
the	O
infrastructure	O
needed	O
to	O
manage	O
patient	O
data	O
across	O
multiple	O
sites	O
can	O
be	O
prohibitive	O
.	O
</s>
<s>
In	O
addition	O
to	O
the	O
computer	O
hardware	O
required	O
for	O
patient	O
data	O
storage	O
,	O
distribution	O
and	O
teleconferencing	O
,	O
telepharmacy	B-Application
programs	O
must	O
deploy	O
network	O
security	O
tools	O
and	O
procedures	O
adequate	O
to	O
protect	O
patient	O
medical	O
information	O
in	O
compliance	O
with	O
HIPAA	O
and	O
other	O
patient	O
privacy	O
regulations	O
.	O
</s>
<s>
In	O
2010	O
the	O
North	O
Dakota	O
Telepharmacy	B-Application
Project	O
estimated	O
that	O
the	O
computer	O
hardware	O
needed	O
for	O
a	O
typical	O
retail	O
installation	O
costs	O
US$	O
17,300	O
per	O
site	O
,	O
with	O
an	O
additional	O
cost	O
of	O
US$	O
5,000	O
to	O
buy	O
a	O
mobile	O
cart	O
for	O
a	O
hospital	O
installation	O
.	O
</s>
<s>
Adoption	O
of	O
telepharmacy	B-Application
in	O
Canada	O
began	O
as	O
a	O
response	O
to	O
a	O
nationwide	O
shortage	O
of	O
pharmacists	O
.	O
</s>
<s>
Canada	O
's	O
first	O
telepharmacy	B-Application
service	O
was	O
started	O
by	O
a	O
hospital	O
in	O
Cranbrook	O
,	O
British	O
Columbia	O
,	O
in	O
June	O
2003	O
in	O
order	O
to	O
assist	O
a	O
hospital	O
in	O
a	O
nearby	O
town	O
that	O
was	O
unable	O
to	O
hire	O
a	O
pharmacist	O
.	O
</s>
<s>
To	O
meet	O
the	O
need	O
for	O
service	O
,	O
a	O
hospital	O
pharmacist	O
in	O
Cranbrook	O
began	O
using	O
telepharmacy	B-Application
technology	O
to	O
oversee	O
pharmacy	O
technicians	O
at	O
the	O
other	O
hospital	O
.	O
</s>
<s>
Remote	O
dispensing	O
machines	O
for	O
medication	O
began	O
operation	O
in	O
Ontario	B-Architecture
,	O
Canada	O
,	O
in	O
2007	O
.	O
</s>
<s>
After	O
a	O
patient	O
inserts	O
a	O
prescription	O
into	O
the	O
dispensing	O
machine	O
,	O
the	O
prescription	O
is	O
scanned	O
and	O
the	O
patient	O
is	O
connected	O
by	O
telephone	O
videoconference	B-Application
to	O
a	O
pharmacist	O
at	O
a	O
remote	O
site	O
.	O
</s>
<s>
As	O
of	O
2009	O
,	O
a	O
hospital	O
in	O
Ontario	B-Architecture
,	O
Canada	O
,	O
was	O
using	O
telepharmacy	B-Application
services	O
in	O
addition	O
to	O
retaining	O
a	O
pharmacist	O
at	O
the	O
hospital	O
;	O
the	O
telepharmacist	O
reviews	O
medication	O
orders	O
,	O
while	O
the	O
on-site	O
pharmacist	O
works	O
with	O
patients	O
and	O
oversees	O
medication	O
safety	O
in	O
the	O
facility	O
.	O
</s>
<s>
Thus	O
telepharmacy	B-Application
support	O
allows	O
the	O
on-site	O
pharmacist	O
to	O
focus	O
on	O
the	O
more	O
sensitive	O
and	O
nuanced	O
tasks	O
for	O
which	O
physical	O
presence	O
is	O
most	O
helpful	O
.	O
</s>
<s>
In	O
2010	O
,	O
Mannings	O
drugstores	O
became	O
the	O
first	O
in	O
Hong	O
Kong	O
to	O
use	O
videoconferencing	B-Application
to	O
allow	O
patients	O
at	O
outlets	O
without	O
full-time	O
pharmacists	O
to	O
consult	O
with	O
pharmacists	O
at	O
other	O
sites	O
.	O
</s>
<s>
In	O
Malaysia	O
,	O
a	O
health	O
startup	O
called	O
Esyms	O
provides	O
a	O
telepharmacy	B-Application
service	O
that	O
has	O
a	O
live	O
chat	O
and	O
video	O
feature	O
which	O
allows	O
you	O
to	O
speak	O
to	O
a	O
licensed	O
pharmacist	O
.	O
</s>
