EHRs Can Thwart Prescription Drug Abuse, Says Study
New government-sponsored report suggests embedding access to state-level substance abuse data in physician and pharmacy systems.
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State prescription drug monitoring programs (PDMPs) should harness the latest advances in health IT to make their data more accessible and incorporate it into the workflow of prescribers and dispensing pharmacists, according to a new report prepared for the Office of the National Coordinator for Health IT (ONC), in partnership with the Substance Abuse and Mental Health Services Administration (SAMHSA).
Concerned about the epidemic of prescription drug abuse, the White House in June 2011 convened a roundtable discussion on the subject. That led to ONC contracting with Mitre Corp. to identify ways to leverage health IT to improve access to PDMP data. With the percentage of physicians saying they had electronic health records passing 50%, ONC believed that these EHRs could be used to place the PDMP monitoring info in front of doctors when they were prescribing.
According to the Mitre report, 43 states have PDMPs that collect data electronically on the prescribing of controlled substances and other drugs with a potential for abuse. (Another six states have enacted PDMP legislation but don't yet have operational programs.) Because of various barriers, however, the data is not used as much as desired, cannot readily be exchanged across states, and is difficult for providers to find when they need it. Only 5% to 39% of providers use PDMP data, depending on the state, because of low awareness and system registration, and because the data is not current or real time.
Other barriers to PDMP data usage, according to the report, include:
-- Limitations on authorized users. Members of care teams supporting prescribers and dispensers often are not permitted access to PDMP systems.
-- Current processes do not support clinical workflows. Standalone Web portals and unsolicited reports don't support clinical practices and workflows.
-- Low technical maturity to support interoperability. Prescribers and dispensers don't have good access to the PDMP data. Existing e-tools are inflexible and lack support for automated queries and reporting.
-- Lack of business agreements. Potential exists to exchange PDMP data using health information exchanges and other intermediaries, but strong model business agreements are needed to protect PDMP information.
The report makes these recommendations to increase use of PDMP data:
-- Require automatic or mandatory registration to access the data.
-- Create a common application programming interface (API) for PDMP system-level access to allow other systems to query and retrieve data.
-- Integrate PDMP information in EHR and pharmacy systems to provide access to the data in the clinical workflow.
-- Define a standard set of data that should be available in PDMP reports.
-- Adopt the National Information Exchange Model (NIEM) Prescription Monitoring Program specification as the standard for PDMP data exchange.
-- Implement an agreement framework and model business agreements with third-party intermediaries to facilitate PDMP data sharing.
"ONC, through a contract with Mitre, is piloting ways to integrate PDMP information into EHRs, making it easier to access PDMP data to inform clinical decision-making. We'll be making the results of the pilots available soon," Jodi Daniel, director of ONC's office of policy and planning, said in a statement given to InformationWeek Healthcare.
Meanwhile, a workgroup of ONC's Health IT Policy Committee, an external advisory body, is looking at whether the stage 3 Meaningful Use requirements should include a provision dealing with prescription drug abuse. Among other things, there might be a clinical quality measure related to an eligible professional's use of PDMP data.
Clinical, patient engagement, and consumer apps promise to re-energize healthcare. Also in the new, all-digital Mobile Power issue of InformationWeek Healthcare: Comparative effectiveness research taps the IT toolbox to compare treatments to determine which ones are most effective. (Free registration required.)