Health IT helping to fight the prescription drug abuse epidemic

Connecting for Impact: Integrating Health IT and PDMPs to improve patient care and fight the prescription drug abuse epidemic

ONC pilot projects prove that health IT can improve clinicians’ access to important clinical resources like Prescription Drug Monitoring Programs (PDMPs), which are data sources doctors and other providers can use to help fight the prescription drug abuse epidemic.

There is, however, more work to do. On the heels of these successful pilots, ONC today is launching a new Standards & Interoperability (S&I) Framework Initiative – PDMP & Health IT Integration.

Our new S&I Framework Initiative seeks to tackle a number of existing challenges including the lack of common technical standards and vocabularies that would enable PDMPs to share computable information with health IT systems that clinicians can use to support clinical decision-making. This S&I Framework Initiative will bring together the PDMP and heath IT communities to establish a standardized approach to retrieve data stored in the PDMPs and deliver it to EHRs and HIEs.

Your participation is critical to the success of this initiative. If you would like to participate in the PDMP & Health IT Integration Initiative we encourage you to sign up.

The Prescription Drug Abuse Epidemic

Enhancing access to PDMP data can’t happen quickly enough, as clinicians across the country struggle to fight a growing national public health crisis. Opioid painkillers, such as hydrocodone and oxycodone, are typically the most abused drugs. Patients are prescribed these drugs to help manage pain from injury or surgery. When taken as prescribed, these medications are generally safe; but when misused or abused, they can be highly addictive—even deadly.

The Centers for Disease Control and Prevention (CDC) reports that the scope of the prescription drug abuse epidemic is growing. CDC estimates 15,000 people each year die from overdoses involving prescription pain killers.  This rate has more than tripled since 1999 – surpassing automobile accidents as the nation’s leading cause of accidental deaths.  In addition to overdose deaths, emergency department visits, substance treatment admissions and the costs associated with the prescription drug abuse epidemic have all shot up in recent years.

PDMPs as an Important Clinical Resource

PDMPs are one of the most promising resources available to help clinicians identify, intervene, and curb prescription drug abuse. PDMPs are state-run electronic databases – functioning in 47 U.S. states and territories – that track the prescribing and dispensing of controlled prescription drugs to patients.

In other words, pharmacists (and some dispensing physicians) report to a PDMP each time a prescription is filled for a controlled substance medication.

When available at the point of care, PDMP information can help clinicians distinguish between patients who legitimately need opioid medications for pain treatment and those who may be seeking to misuse these powerful drugs.  It also provides clinicians with an opportunity to intervene if there are signs of misuse and abuse. While PDMPs can serve as a valuable tool, most clinicians typically don’t use them.  This is largely because they have been cumbersome or time consuming to access (especially when outside of a clinician’s normal prescribing workflow).

Health IT can Enhance Clinicians Access to PDMPs

Our pilot projects have shown that health IT helps improve clinicians’ access to PDMPs.

For emergency department clinicians at Wishard-Eskenazi Health, a community health system in Indianapolis, infrequent PDMP access was due to workflow challenges and added work. To examine how health IT could optimize this process, ONC commissioned a pilot to use health IT to integrate PDMP data directly into the clinical workflow.  For Wishard, this pilot equipped emergency department staff with the ability to automatically search the state’s PDMP database without adding steps to the patient admission process and enabled PDMP data to be available in the patient’s EHR at the point of care.

Dr. John “JT” Finnell, an Indianapolis emergency physician who participated in the pilot, commented that “using health IT to connect clinicians to PDMP data saves time and energy. It’s a ‘one-stop shop’ for clinicians who are looking for the medical and prescribing history of patients. Instead of having to manually log on to multiple databases, the pilot’s connection provided seamless interaction with health data and quickly ‘fetched’ pertinent prescription information. For patients who suffer from substance abuse, PDMP data helps doctors spot drug-seeking behavior. It allows us to compare the prescribing record to the patient’s story, because sometimes they don’t match up,” Finnell said, adding that “PDMP data helps him make more informed decisions.”

Enhancing Access to PDMPs using Health IT Project

Wishard’s success story represents just one of the pilots ONC conducted as part of the Enhancing Access to PDMPs using Health IT project.  In 2011, ONC launched the project along with our federal partners at the Substance Abuse and Mental Health Services Administration, White House Office of National Drug Control Policy, and CDC. The results of the pilots demonstrate how health IT can help improve clinicians’ ability to access important PDMP data at the point of care and point of dispensing.

As part of this effort, pilots were conducted across the country to test various connections between state PDMPs and health IT systems including EHRs, HIEs, and pharmacy dispensing systems in a variety of health care settings –emergency departments, pharmacies, opioid treatment programs, and clinician practices. These innovative pilots increased interoperability of data among states, improved real-time data reporting to a PDMP, and expanded the number of clinicians using these important tools. Pilot results and personal anecdotes from pilot participants demonstrated the clinical value of PDMP and EHR integration.

Available ONC Resources

The Enhancing Access to PDMPs using Health IT project also involved creating communication materials for PDMP stakeholders, especially prescribers and dispensers, to raise awareness and drive demand for PDMP data. For those who may want to replicate or build on our results, here are a number of resources that grew out of this 18-month effort:

  • Enhancing Access” Pilot White Papers:  Eight papers detailing each pilot’s design, technical configuration, outcomes, and plans for expansion.  The white papers also highlight various personal anecdotes from the participants who wrote about how they integrated PDMP data into their clinical workflow and the success it had on their practice.
  • The Road to Connectivity:  A roadmap for connecting to PDMPs through health IT.
  • Work Group RecommendationsFinal Report:  Stakeholders identified challenges and recommended solutions to increase timely use of PDMP data by clinicians. More than 94 people across 53 organizations formed work groups to define barriers and rapidly finalize recommendations to address the problem.
  • Videos: Pilot participants detail their individual battles against prescription drug abuse, recalling the advantages of their state’s PDMP including real-time reporting and how they used health IT to connect clinicians to this important database.
  • PDMPConnect: A website providing a forum for connecting members of the PDMP community to share valuable experience, information, and resources wherever they are.

The Path Forward

The Enhancing Access to PDMPs using Health IT pilot results and personal anecdotes underscore the clinical value of PDMP and EHR integration. We hope the project’s results and resources will further drive the demand for greater clinical access to PDMP data and demonstrate a way forward to help clinicians faced with ever growing challenges.

Reducing prescription drug misuse and abuse and the devastating toll it takes on the public health and safety of our nation remains a top priority for ONC and our federal partners.

2 Comments

  1. I’m very excited to see progress in this area. Now that prescriptions and charts are elecronic, there is a lot we can do analytically in terms of (1) preventing prescription drug abuse, both by doctors and patients, (2) preventing antibiotic abuse, and (3) preventing Medicare & Medicaid fraud.

  2. NYOB says:

    What about an individuals right to privacy? There are other ways to prevent abuse of prescription medications without violating privacy.

    see: https://www.privacyrights.org/fs/fsC4/CA-medical-prescription-privacy#prescription-data-mining

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