Pharmacist Technicians Can Play Key Role in Push Toward Telemedicine During COVID-19 Pandemic

It’s noontime in Connecticut. I type at my dining room table surrounded by 2 laptops and my cell phone, pausing to glance up through the window at the hazy spring sky. Normally, the tinted industrial pane of my office window would save my eyes from distraction during working hours, but it’s day 13 of isolation from the coronavirus disease 2019 (COVID-19) pandemic and I’m working from home.

This morning has been terrible. I had 15 WebEx meetings scheduled with students needing to remediate a practical today, but met each with a “Can you hear me?....No, I can’t see you, but I can hear you.”

My university is being as supportive as possible, giving us faculty training and resources for tele-teaching, but there’s nothing to overcome the e-traffic issues. Eventually I gave up, canceled all the meetings, and asked each student to just write out their answers.

My frustration adapting to changes in daily life isn’t novel, as a third of the global population is on imposed lockdown.¹ It’s likely some of these changes will be perpetual (if not semi-permanent) as waves of COVID-19 are projected to last many months, even with mitigation strategies enacted, and other, subsequent global pandemics predicted from increased international travel and rising antibiotic resistance rates.²

Recently, the White House expanded Medicare’s coverage for telemedicine, allowing clinicians to deliver health care services remotely, directly to a patient via digital devices.³ The lack of federal direction on telemedicine typically forces practices to navigate various and inconsistent state-laws; however, the recent and upcoming guidance from the federal government suggests that the nation is placing its bets on telemedicine. As such, pharmacists need to be at the table as part of virtual care teams.

The question now is not should pharmacists be on virtual care teams, because vast evidence of pharmacists’ positive impact already exists. Rather, we should be asking how pharmacists can be on virtual care teams.

Because even if all federal guidance were updated to allow clinicians to practice and bill across state lines, we would still face many other barriers to telemedicine implementation.⁴ For the sake of clarity, “clinician” refers not only to prescribers, but to all professions that provide patient care, including pharmacists. Pharmacists are clinicians who provide health care. Indeed, technical challenges are the most recognizable and common barriers to telemedicine delivery.⁴

This raises the question of whether is it reasonable to expect us clinicians—we who are trained in patient care and not technology—to operate telemedicine technology? This has certainly been the case with other technology, such as electronic medical records (EMRs). Although EMRs have drastically improved countless variables, the expectation that clinicians operate EMRs has produced unintended consequences, including severe burnout and reduced patient satisfaction.⁵

In this light, I argue that clinicians, including pharmacists, should not be expected to operate our own use of telemedicine systems because we run the risk of compounding these unintended consequences. Instead, lessons learned from EMR implementation should be heeded by allowing clinicians to focus on patient care and by delegating the management and interfacing of telemedicine technology to support staff, such as telemedicine technicians.

It's important to make a distinction here: pharmacy technicians already regularly participate in telemedicine, but in doing so, usually act as clinician-extenders rather than technology managers.^6,7 For example, they may perform preliminary medication reconciliations for pharmacists’ review or practice in telepharmacy, a subset of telemedicine in which a pharmacist remotely provides supervision of technician preparing prescriptions.

Here, pharmacy technicians use technology to help pharmacists deliver services, but they are not readily facilitating, implementing, or operating the technology itself.

Conversely, telemedicine technicians are trained in IT and are responsible for day-to-day operation and interface of telemedicine services’ hardware and software. These support staff set up, troubleshoot, maintain, and run the technology (eg, microphones, conferencing programs, privacy safeguards), and in doing so, assures that the technology does not interfere with delivering quality services.

Telemedicine technicians could improve patient/clinician satisfaction through streamlined telemedicine delivery, but would likely also save health-systems financially as clinicians could spend time seeing more patients instead of battling technology. Indeed, these positive outcomes have already been documented with comparable, existing support roles, such as scribes.

As technically trained workers, scribes often operate and interface with EMRs on behalf of a clinician, and scribes have been known to reduce burnout and improve health care service delivery and efficiency.⁵ It is also important to note that professional pharmacy organizations have long believed in the ability of pharmacy technicians to support informatics; however, these roles have not been widespread.⁸

Examples of hybrid pharmacy-telemedicine technicians are few but promising, as these support staff could simultaneously act as care-extenders, assist in billing, and optimize technical aspects of service delivery.⁹ Further, hybrid pharmacy-telemedicine technicians provide patients with IT training and ongoing support, thus improving patients’ comfort with technology—a known facilitator to telemedicine implementation.

During the COVID-19 pandemic, telemedicine may provide the safest option for patients and health care workers alike, but without a nationwide push to train support staff, successful efforts to scale and sustain telemedicine programs could be limited to large, well-funded health centers. This would be particularly unfortunate as telemedicine could fail to achieve some of its most exciting promises by extending access to rural and underserved populations.

Dedicated telemedicine technician support staff could likely improve clinicians’ acceptance of telemedicine programs by removing IT barriers.

Taken a step further, it is reasonable to believe that some pharmacy technicians could be trained to operate telemedicine systems, allowing us clinicians to practice at the top of our licenses. The COVID-19 crisis may be the final push needed to make these support roles a reality, leading to higher quality care and improved integration of pharmacists into virtual care teams.

References

• Kaplan J, Frias L, McFall-Johnsen M. A third of the global population is on coronavirus lockdown - here's our constantly updated list of countries and restrictions. Business Insider. 3/28/2020. Accessed 3/30/2020 from: [https://www.businessinsider.com/countries-on-lockdown-coronavirus-italy-2020-3].
• Ferguson NM, Laydon D, Nedjati-Gilani G, et al. Report 9: Impact of non-pharmaceutical interventions (NPIs) to reduce COVID19 mortality and healthcare demand. Imperial College COVID-19 Response Team. 3/16/2020. doi: https://doi.org/10.25561/77482.
• U.S. Centers for Medicare & Medicaid Services. Medicare telemedicine health care provider fact sheet. 3/17/2020. Baltimore, MD. Accessed 3/25/2020 from: [https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet].
• Scott Kruse C, Karem P, Shifflett K, et al. Evaluating barriers to adopting telemedicine worldwide: A systematic review. J Telemed Telecare. 2018 Jan; 24(1):4-12. doi: 10.1177/1357633X16674087.
• DeChant PF, Acs A, Rhee KB, et al. Effect of organization-directed workplace interventions on physician burnout: a systematic review. Mayo Clin Proc Innov Qual Outcomes. 2019 Sep; 26;3(4):384-408. doi: 10.1016/j.mayocpiqo.
• Gernant SA, Nguyen MO, Siddiqui S, Schneller M. Use of pharmacy technicians in elements of medication therapy management delivery: A systematic review. Res Social Adm Pharm. 2018 Oct;14(10):883-890. doi: 10.1016/j.sapharm.2017.
• Rural Health Information Hub. Telehealth models for increasing access to pharmacy services. Accessed 3/30/2020 from: [https://www.ruralhealthinfo.org/toolkits/telehealth/2/care-delivery/pharmacy-services].
• American Society of Health- System Pharmacists. ASHP statement on the pharmacy technician's role in pharmacy informatics. Am J Health Syst Pharm. 2014 Feb 1;71(3):247-50.
• Singh LG, Accursi M, Korch Black K. Implementation and outcomes of a pharmacist-managed clinical video telehealth anticoagulation clinic. Am J Health Syst Pharm. 2015 Jan 1;72(1):70-3. doi: 10.2146/ajhp130750.