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Behavioral Health

Linking PDMPs to Health IT

Using Health IT to Combat Prescription Drug Abuse

The “Enhancing Access to Prescription Drug Monitoring Programs using Health Information Technology” Project

Nonmedical use of prescription drugs is a serious public health concern in the United States. The Centers for Disease Control and Prevention (CDC) reports that drug overdose deaths, most of which involve prescription drugs, now exceed deaths from motor vehicle crashes. The Enhancing Access to Prescription Drug Monitoring Programs using Health Information Technology (the “Enhancing Access project”)) project stems from joint efforts of the stakeholder experts who participated in the White House Roundtable on Health IT and Prescription Drug Abuse in June 2011 and the HHS Prescription Drug Abuse and Health IT Work Group that resulted in the “Action Plan for Improving Access to Prescription Drug Monitoring Programs through Health Information Technology (June 30, 2011) [PDF – 337 KB].”

The “Enhancing Access” project is managed by the Office of the National Coordinator for Health Information Technology (ONC) in collaboration with Substance Abuse and Mental Health Services Administration (SAMHSA), CDC, and the Office of National Drug Control Policy (ONDCP). ONC contracted with the MITRE Corporation to explore opportunities to use health IT to integrate critical prescription drug history information from prescription drug monitoring programs (PDMPs) into provider and pharmacy systems to empower more informed decision making at the point of care. The project seeks to demonstrate that improved access to PDMP data through the use of health IT can reduce prescription drug misuse and overdose in the United States.

“Enhancing Access” Work Groups

MITRE convened stakeholders representing all facets of the healthcare community to identify challenges and recommend solutions to increase timely use of PDMP data by providers, emergency department physicians, and pharmacies. More than 94 people across 53 organizations formed work groups to define barriers and rapidly finalize recommendations to address the problem. This work resulted in the report “Enhancing Access to Prescription Drug Monitoring Programs through Health Information Technology: Work Group Recommendations” which seeks to facilitate information sharing to help health care professionals make better informed clinical prescribing decisions.

“Enhancing Access” Pilots

Pilots were conducted across the country to test the use of health IT to enhance access to PDMPs and assess whether increased use of secure PDMP data would affect clinical decision-making during the care process. The pilots integrated existing technologies like electronic health records (EHRs) and pharmacy systems to securely connect to state PDMPs to make data available to physicians at the point of care as part of their normal workflow. The project tested various low-cost solutions in a variety of settings that showed real solutions, real results, and real stories.

As a result of this work, the following white papers (an executive summary paper and a paper for each pilot) were developed describing in detail each pilot’s design, technical configuration, and methods. The white papers also detail each pilot’s individual evaluation elements and specific results, which touch on findings across several themes, including clinical and technical impact, usability, and scalability. These details may be useful to PDMP stakeholders who wish to recreate the pilot conditions for broader implementation.

This summary document gives a high-level overview of the six pilot projects – detailing the participants and components, evaluation approach, technical configurations, and general findings.

The Indiana Regenstrief Emergency Department (ED) pilot demonstrated health IT’s value by making PDMP data readily available to ED physicians during patient encounters. The pilot integrated Indiana’s PDMP system with an ED management system by using an interstate PDMP data sharing hub. Prior to the pilot, PDMP data were rarely accessed because 1) it was not part of prescribers’ regular workflow; and 2) it was too time consuming. As a result of the pilot, a majority of participants reported that the new design was easier to use and reported changes in their prescribing.

The Indiana Direct Messaging pilot demonstrated how providing unsolicited reports for “at-risk” patients through secure electronic messaging could improve prescriber awareness of potential prescription drug abuse. The Indiana PDMP provided weekly “person of interest (POI)” alerts to prescribers at ambulatory clinics based on a defined “at-risk” threshold of prescription drugs obtained by a given patient. Prior to the pilot, POI alerts were sent to prescribers via regular email or postal mail if one of their patients exceeded a given threshold. The new design enabled patient information to be shared in a more secure and timely manner.

The Michigan pilot made PDMP data more readily available during patient encounters by enhancing existing electronic prescribing software to include PDMP data in patients’ medication history. The pilot streamlined PDMP access for ambulatory providers by using an interstate PDMP data sharing hub (even though the practice was located within the same state) to enable system-to-system integration. Prior to the pilot, the e-prescribing software did not have access to PDMP data and, thus, was missing an important source of controlled substance prescription history. The new design improved usability and workflow integration and gave providers access to controlled substance prescription history data that would not otherwise have been available.

The IHS pilot demonstrated how health IT could help make data more readily available during patient encounters within the pharmacy system. The pilot demonstrated that the existing process for checking insurance eligibility could also be used to automate a query to the state PDMP. This process eliminated the need for pharmacists to perform manual checks. Pilot participants indicated that the new approach made it easier to look up patients which also resulted in a substantial increase in queries to the PDMP.

The Opioid Treatment Program (OTP) pilot demonstrated how health IT could be used to implement a simple, low-cost approach to accessing PDMP data. The pilot streamlined access to the state PDMP by adding a hyperlink within an EHR that allowed physicians to directly access the state’s PDMP portal without leaving the EHR. This approach optimized an existing operational policy that required all physicians to check the state PDMP (through a separate workflow) for the prescription drug history of all their patients. Once the new process was implemented, results showed an unexpected increase in the use of the PDMP – a result of the convenient location of the hyperlink within the clinical workflow making access easier.

The Ohio pilot improved ambulatory care providers’ access to PDMP data by connecting the EHR system to the PDMP using a Health Information Exchange (HIE) and presenting patient “at-risk” scores (for prescription drug abuse) in the EHR to be used during patient encounters. Before pilot implementation, the physicians rarely accessed the PDMP because doing so required them to leave the EHR workspace and separately log-in to the state PDMP website. The new pilot configuration streamlined this process by allowing the technology to perform the querying and processing tasks – resulting in an easier to use process, more information on patients at risk at the point of care, and improved workflow integration.