October 11, 2013
For the second blog in our series about the Controlled Substance Epidemic and Crisis, I’d like to talk about an abbreviation that soon will have growing impact on the practice of medicine and in particular the way we prescribe controlled substances to our patients.
PDMPs or Prescription Drug Monitoring Programs (sometimes shortened to PMP) were created by individual state legislation a number of years ago. They are tools for reducing prescription drug abuse and diversion. They consist of statewide electronic databases which collect, monitor, and analyze electronically transmitted prescribing and dispensing data submitted by pharmacies and dispensing practitioners. The data is used to support states’ efforts in education, research, enforcement and abuse prevention.
By 1989 only nine states had PDMPs though Hawaii started collecting data in 1943 (before it was a US state). All of these early PDMPs were coordinated with paper and/or faxes. The aggregated reports and, where relevant, PDMP investigations focused on prescribers selling prescriptions, pharmacies selling controlled substances illegally, and organized doctor shopping rings. The only focus at that time was Schedule II drugs. Since then, an Alliance of numerous states has been formed, the program has become electronic and the schedules expanded, though each state may still incorporate some variations. The DEA has no role in managing these state programs.
In 2010, Brandeis University received a grant through a division of the Department of Justice to fund a PMP Center of Excellence at the Heller School in order to provide practice-‐relevant information, evaluation, and expertise to PDMPs and their stakeholders, including the development of best practices. By June 2012, 49 states and one territory had passed PDMP legislation and 41 states had an operating PDMP.
Evidence that the PDMPs have been effective – if properly funded and the relevant data is timely – is building a strong case for the PDMPs to grow in importance. Although PDMPs currently differ in their relative emphasis on improving medical care versus reducing drug diversion and abuse, they are well positioned to serve both objectives.
Pressure to consult PDMPs before writing and dispensing controlled substance prescriptions is growing and in fact the State of New York passed the I-STOP law last year to mandate the use of their PDMP by August 27th, 2013 and EPCS by the end of 2014.
Other states are also modifying current law to make PDMPs more likely to be used, though in some states, funding the operations to make them effective and timely has been a major barrier. Problems with standardizing data formats and sharing information across state lines are among several challenges still facing efficient use of these programs. The National Association of Boards of Pharmacy (NABP) has recently created PMP InterConnect to facilitate sharing data across state borders to authorized users. This offers some promise of more efficient use of resources.
Pioneering in Michigan
According to the Bureau of Justice Assistance (BJA), registration rates for state PDMPs are exceedingly low, with the number of registered users typically ranging from 5% to 39% of potential authorized users within most states. This consistently low usage rate presents a major problem for states interested in curtailing the problems associated with rampant prescription drug abuse. The small percentage of healthcare providers that are currently using PDMPs also runs in stark contrast with the much larger percentage of healthcare providers that are currently using EHRs, EMRs, or e-prescribing solutions. The question for many lawmakers, public health experts, and medical decision makers that are concerned about this problem has subsequently become: How is it possible to get healthcare professionals to begin using PDMPs with the same regularity that they are using other healthcare IT solutions?
Last year, DrFirst participated in a pilot program with the State of Michigan to demonstrate the value of linking PDMP access within an e-prescribing application, in order to enhance efficiency and workflow. The results of the program were very promising, demonstrating a significant increase in the percentage of physicians who chose to consult the state’s PDMP prior to prescribing medication to their patients over the duration of the test.
In addition to greatly increasing the number of physicians who chose to consult the state PDMP during our pilot program, we were also able to demonstrate added clinical benefits that came from directly connecting our e-prescribing/EPCS module with the state’s PDMP. Our infrastructure is able to draw from more sources than the state’s PDMP, making the data which physicians received through the pilot program significantly richer and more clinically impactful than the data they would otherwise have been able to gather from merely consulting with the state’s PDMP.
Once the State of Michigan’s PDMP was supplemented with medication history data from our e-prescribing platform, physicians were also able to see controlled substance prescriptions written and filled outside of the State of Michigan. Physicians were also able to view an up-to-date list of the legend drugs that the patient was taking which was assembled through input from pharmacy fill data, payer information, and Surescripts—the national clearinghouse used by e-prescribing platforms to submit their prescriptions to pharmacies. These benefits demonstrate why other states ought to follow Michigan’s lead and begin experimenting with allowing e-prescribing/EPCS platforms to interface directly with state PDMPs.