A four-year-old Spokane company that helps hospitals, pharmacies, and long-term care facilities meet state and federal pharmacy regulations and improve pharmacy procedures has now begun offering what's called "telepharmacy" services to rural hospitals that can't afford to have their own pharmacists on staff.

The company, Medication Review Inc., received approval from the Washington state Board of Pharmacy on July 30 to provide to hospitals automated dispensing of medications and off-site supervision of hospital pharmacy technicians, says K. Douglas Crafton, the company's president and owner.

Crafton says Medication Review already has signed contracts to provide those services to four rural hospitals around the state and adds that he expects the company to be providing telepharmacy services to as many as 15 hospitals within the next 12 months.

Currently, the company employs six licensed pharmacists, and it plans to hire up to three more pharmacists in the next year as that new business segment grows, he says.

The state pharmacy board allows through specific arrangements the automated dispensing of medication when hospitals don't have on-site pharmacists, Crafton says. Some small, rural hospitals can't afford to have a pharmacist on the payroll, since pharmacists these days earn around $120,000 per year, he says. A hospital would have to have multiple full-time pharmacists to provide round-the-clock service.

"For the cost of less than one pharmacist, we can provide that service for them," Crafton says.

In such cases, rural hospitals maintain automated drug-dispensing devices, have available the drugs they need to treat patients, and also sometimes employ pharmacy technicians on staff, he says. Via a secure Internet connection, patient information and digital images of physician's orders are transmitted by the hospital to Medication Review, which provides remote review and order entry of physician's orders and, in some cases, remote monitoring of pharmacy technicians, he says. Medication Review can communicate with nurses and physicians through live videoconferencing to resolve complex medication issues, Crafton says.

The Medication Review pharmacists review medications for proper dosage, possible interactions with other drugs a patient might be taking, and other health issues affecting the patient. When they're satisfied that such questions have been answered, the pharmacists here can give nurses or other care providers at rural hospitals access to drugs from the secure dispensing machines.

Medication Review occupies 1,200 square feet of leased space in the Tapio Office Center, at 104 S. Freya here, and employs seven people overall, Crafton says.

Susan Boyer, executive director of the Washington state Board of Pharmacy, says telepharmacy services in Washington are delivered by three other providers, including Envision Telepharmacy, of Alpine, Texas; Bellgrove Pharmacy, of Bellevue, Wash.; and Community Health Care, of Tacoma. She says some larger hospitals also provide telepharmacy services for smaller hospitals.

The four rural Washington hospitals that Medication Review is now serving are: Quincy Valley Medical Center, in Quincy; Columbia Basin Hospital, in Ephrata; Coulee Medical Center, in Grand Coulee; and Odessa Memorial Healthcare Center, in Odessa, says Crafton.

Mark Barglof, administrator at Odessa Memorial, says that small hospital and a long-term care unit there must have telepharmacy service because they have no on-site pharmacist. They had been receiving telepharmacy services from Providence Sacred Heart Medical Center & Children's Hospital previously, he says.

At about $4,000 per month, "it's a smart business decision" for Odessa Memorial to contract for telepharmacy services, Barglof says. At more than $100,000 per year in annual salary for one pharmacist, Odessa Memorial can't afford such an expense, and definitely couldn't afford multiple pharmacists on site, he says.

"It's working very well," Barglof says of the hospital's arrangement with Medication Review. The company "did a great job with the setup and educating our nurses," who distribute medication at Odessa Memorial.

Before adding telepharmacy services this summer, Medication Review focused solely on providing pharmacy consulting services, mainly helping hospitals, pharmacies, and long-term care facilities meet state and federal pharmacy regulations and perform procedures better, says Crafton.

Currently, about half of the company's revenues come from those consulting services, and the other half come from telepharmacy, but Crafton anticipates much of Medication Review's future growth will come in telepharmacy.

Crafton says he made the move to begin offering telepharmacy services partly because of a shortage of pharmacists, which he predicts could be long lasting and says has hurt rural hospitals because they have limited resources. The health-care needs of the large baby-boomer generation have contributed to the demand for pharmacists, he says.

"Because we know the national pharmacy shortage is expected to last until roughly 2018, we anticipate our telepharmacy services to expand in rural hospitals," Crafton says. "We are planning for that growth by recruiting administrative staff and additional health-care professionals, including pharmacists, pharmacy technicians, pharmacy assistants, and ancillary personnel."

Crafton is a licensed pharmacist in both Washington and Idaho. He started his career working at a retail pharmacy in the early 1980s, spent 15 years in medical equipment sales, and later became the chief executive officer of Inland Orthopedic Institute PLLC, of Spokane, eventually leaving that post in 2001. He became part owner of an independent retail pharmacy here until 2005, when he sold his half of the business and started Medication Review, he says.