Hospital pharmacists play an often invisible but vital role in the healthcare system. They primarily work behind the scenes, experiencing fewer direct patient interactions than other providers. Nonetheless, they help to ensure that the right medications are promptly delivered to the right patients. Given the vast number of patients who rely on medication, the impact that hospital pharmacists make is far-reaching and invaluable.

Unfortunately, the rural healthcare landscape is facing a deep workforce shortage, and licensed pharmacists are not an exception. It is easier for large hospitals in urban centers with immense resources to recruit and retain the multiple pharmacists they need. However, smaller rural hospitals are often unable to hire even one full-time pharmacist. Lack of adequate pharmacy expertise can have many negative consequences, including: delays in medication delivery for patients, increased potential for medication errors, and overburdened physicians who must step in and handle aspects of what a pharmacist would normally manage. These outcomes have a domino effect and ultimately have one thing in common: reduced quality of care for patients who are depending upon it.

As an organization committed to improving access to and quality of care in the rural Upper Midwest, Helmsley knew something needed to be done. In 2009, Helmsley’s Rural Healthcare Program joined forces with telehealth pioneer Avera Health to determine how to combat this issue. That year, the organizations began to transform rural healthcare by funding an innovative solution to the plight of many rural small hospitals. This life-saving service is called Avera eCare Pharmacy.

eCare Pharmacy makes the impossible possible on a daily basis. It empowers hospitals to deliver medications to patients 24 hours a day, 7 days a week. Providers share the services of a pharmacist through a hub-and-spoke system pioneered by Avera and Helmsley (also being used for emergency room and intensive care). Through an online platform, pharmacists at Avera’s “hub” in Sioux Falls, South Dakota consult with “spokes,” or healthcare professionals at hospitals near and far. Every facility has a legal requirement to label a local pharmacist as the “pharmacist-in-charge.” Avera’s pharmacists work alongside them, completing a variety of tasks to increase safety and efficiency. Pharmacists at the hub stay on top of all medications that are ordered, analyze patients’ electronic medical records, verify that medications are appropriate for patients, and consult with hospital staff. They can even have virtual discussions with patients to ensure they know how to use their medications once they return home.

The number one goal of ePharmacy, as stated by Avera eCare Pharmacy Officer Andrea Darr, PharmD, BCPS, is to improve patient safety. “The ideal is to have each medication reviewed and approved by a pharmacist before the very first dose is given to the patient. That’s what we’re able to accomplish – to make sure that there’s no interactions, contraindications, allergies, all of those things that are harmful, because you can never pull back that dose once it’s been given,” she said.

Darr described the service as a “closed-loop.” Once a medication is approved by a pharmacist at the hub, a message is transmitted to automated dispensing equipment at the hospital. This guards against delivery errors by ensuring that the only medications accessible to hospital staff are those that have been reviewed and approved.

Avera’s hub requires minimal staffing to make a large impact: two to three people working an overnight shift can cover the 100-plus live sites using the service. eCare Pharmacy is also incredibly effective because it speaks nine different “languages” of electronic medical records that can vary from one hospital to the next. Most remote pharmacy services are only comfortable with one type of record, but Avera can serve more hospitals thanks to the adaptability of its team.

eCare Pharmacy’s former Service Line Manager and current Director of Quality and Innovation Integration, Rebecca Olson, had a memorable experience when implementing eCare Pharmacy at a hospital. She shared, “One of the first pharmacy implementations that I worked on, they actually had a full-time pharmacist, and when we were finishing up the implementation, the pharmacist said that she was really looking forward to a vacation that was coming up in the next couple weeks. She grabbed my arm and said that this was the first time she’s ever been able to take a vacation and truly be on vacation. She said, ‘Those people that work in the hospital and the patients, those are my friends, those are my neighbors…I’ve never been able to disengage because there was never anyone to hand it off to.’ She was so excited and grateful to be able to actually have vacation where she wasn’t constantly working.” This stuck with Olson: pharmacists at small hospitals made sacrifices to avoid putting colleagues in a position where they might make a mistake.

When uniting a decade ago, Helmsley and Avera initially enabled over 25 rural Upper Midwestern hospitals to enhance their quality of care through eCare Pharmacy. Helmsley’s support to rural hospitals to implement eCare Pharmacy has in part enabled the service to reach a recent milestone – there are now over 100 live sites benefiting from it. Its growth has made Avera the largest not-for-profit provider of remote pharmacy services to facilities beyond the Avera system. By maintaining true partnerships with its clients, eCare Pharmacy is improving patient safety, one prescription at a time.