The Impact of Telepharmacy Services on the Identification of Medication Discrepancies, High-Alert Medications, and Cost Avoidance at Rural Healthcare Institutions

Keywords: Pharmacist, Medication error, Rural health, telemedicine, Adverse drug reaction


Telepharmacy, remote reviewing and profiling of medication orders by an offsite pharmacist, has been shown to be an effective method for reducing medication order inaccuracy rates, but there is a lack in studies examining harm reduction and potential cost avoidance by such services. Methods: Retrospective data, collected over a one-year period, were examined for medication order deficiencies; a deficiency was defined as the telepharmacist being required to advocate for clinical action. Based on published rates of adverse drug reactions and expenses related to their treatment, a potential cost avoidance was calculated. Results: Over the course of the one-year study period over 218,000 orders were reviewed by a telepharmacist with 2,292 orders flagged as deficient which included 16,224 individual medication deficiencies. The most common deficiencies included patient allergy to medication, or class of medications, (31.2% of deficiencies) and medication dose adjustment via renal and/or hepatic guidelines (24.1% of deficiencies). There were also a number of deficiencies for specific medications found on the Institute for Safe Medication Practices’ high-alert medication list for ambulatory/community healthcare settings such as insulins and heparinoids. Based on adverse drug reaction incidence rates and treatment expenses, potential cost avoidance was calculated to be as high as over $1.4 million US dollars. Telepharmacists aided in enhancement of pharmacy services by continuing to review medication orders and provide clinical interventions even when an onsite pharmacist was unavailable. Conclusions: Use of the telepharmacist service provided a large cost avoidance by the prevention of potential adverse drug reactions.


Garrelts JC, Gagnon M, Eisenberg C, Moerer J, Carrithers J. Impact of telepharmacy in a multihospital health system. Am J Health Syst Pharm 2010;67(17):1456-1462. DOI: 10.2146/ajhp090670.

Casey MM, Sorensen TD, Elias W, Knudson A, Gregg W. Current practices and state regulations regarding telepharmacy in rural hospitals. Am J Health Syst Pharm 2010;67(13):1085-1092. DOI: 10.2146/ajhp090531.

Friesner DL, Scott DM, Rathke AM, Peterson CD, Anderson HC. Do remote community telepharmacies have higher medication error rates than traditional community pharmacies? Evidence from the North Dakota Telepharmacy Project. J Am Pharm Assoc (2003) 2011;51(5):580-590. DOI: 10.1331/JAPhA.2011.10115.

Scott DM, Friesner DL, Rathke AM, Peterson CD, Anderson HC. Differences in medication errors between central and remote site telepharmacies. J Am Pharm Assoc (2003) 2012;52(5):e97-e104. DOI: 10.1331/JAPhA.2012.11119.

Scott DM, Friesner DL, Rathke AM, Doherty-Johnsen S. Medication error reporting in rural critical access hospitals in the North Dakota Telepharmacy Project. Am J Health Syst Pharm 2014;71(1):58-67. DOI: 10.2146/ajhp120533.

Patterson BJ, Kaboli PJ, Tubbs T, et al. Rural access to clinical pharmacy services. J Am Pharm Assoc (2003) 2014;54(5):518-525. DOI: 10.1331/JAPhA.2014.13248.

Wakefield DS, Ward MM, Loes JL, O’Brien J, Sperry L. Implementation of a telepharmacy service to provide round-the-clock medication order review by pharmacists. Am J Health Syst Pharm 2010;67(23):2052-2057. DOI: 10.2146/ajhp090643.

Sankaranarayanan J, Murante LJ, Moffett LM. A retrospective evaluation of remote pharmacist interventions in a telepharmacy service model using a conceptual framework. Telemed J E Health 2014;20(10):893-901. DOI: 10.1089/tmj.2013.0362.

Schneider PJ. Evaluating the impact of telepharmacy. Am J Health Syst Pharm 2013;70(23):2130-2135. DOI: 10.2146/ajhp130138.

Baldoni S, Amenta F, Ricci G. Telepharmacy services: present status and future perspectives: a review. Medicina (Kaunas) 2019;55(7):327. DOI: 10.3390/medicina55070327.

Poudel A, Nissen LM. Telepharmacy: a pharmacist’s perspective on the clinical benefits and challenges. Integr Pharm Res Pract 2016;6(5):75-82. DOI: 10.2147/IPRP.S101685.

Institute for Safe Medication Practices (2011). ISMP list of high-alert medications in community/ambulatory healthcare. Available at: accessed 13 February 2020.

Classen DC, Pestotnik SL, Evans RS, Lloyd JF, Burke JP. Adverse drug events in hospitalized patients. Excess length of stay, extra costs, and attributable mortality. JAMA 1997;277(4):301-306. PMID: 9002492.

Bates DW, Cullen DJ, Laird N, et al. Incidence of adverse drug events and potential adverse drug events. Implications for prevention. ADE Prevention Study Group. JAMA 1995;274(1):29-34. PMID: 7791255.

Bates DW, Boyle DL, Vander Vliet MB, Schneider J, Leape L. Relationship between medication errors and adverse drug events. J Gen Intern Med 1995;10(4):199-205. DOI: 10.1007/bf02600255.

Jha AK, Kuperman GJ, Teich JM, et al. Identifying adverse drug events: development of a computer-based monitor and comparison with chart review and stimulated voluntary report. J Am Med Inform Assoc 1998;5(3):305-314. DOI: 10.1136/jamia.1998.0050305.

Bates DW, Spell N, Cullen DJ, et al. The costs of adverse drug events in hospitalized patients. Adverse Drug Events Prevention Study Group. JAMA 1997;277(4):307-311. PMID: 9002493.

Evans RS, Pestotnik SL, Classen DC, et al. Prevention of adverse drug events through computerized surveillance. Proc Annu Symp Comput Appl Med Care 1992:437-441. PMID: 1482913.

Naranjo CA, Busto U, Sellers EM. Difficulties in assessing adverse drug reactions in clinical trials. Prog Neuropsychopharmacol Biol Psychiatry 1982;6(4-6):651-657. DOI: 10.1016/s0278-5846(82)80162-0.

Berlin JA, Glasser SC, Ellenberg, SS. Adverse event detection in drug development: recommendations and obligations beyond phase 3. Am J Public Health 2008;98(8):1366–1371. DOI: 10.2105/AJPH.2007.124537.

How to Cite
Bindler, R. (2020). The Impact of Telepharmacy Services on the Identification of Medication Discrepancies, High-Alert Medications, and Cost Avoidance at Rural Healthcare Institutions. Journal of the International Society for Telemedicine and EHealth, 8, e5 (1-6).
Original Research