"An integrated workflow solution to provide a streamlined, standard communication process would enhance the ability of the health care provider to address the epidemic and mitigate patient care risks," reads an action plan to adopt standards for prescription drug monitoring programs, detailed in a white paper from the National Council for Prescription Drug Programs (NCPDP). "The current prescription monitoring communication process is outside the workflow process and systemically burdensome. It does not effectively provide information in a timely manner or evaluations across all state lines and across all pharmacies."
The recommendation for standardization includes a call for a "nationally recognized clinical risk score" to help prescribers and pharmacies assess whether a patient might be abusing prescription drugs.
[ Find out how pharmacies are working toward interoperability. Read EHR Vendors, Pharmacy Chains Pump Up Surescripts Network . ]
The paper grew out of an NCPDP focus group held in October 2012 that included representatives of pharmacies, pharmacy benefit managers, health IT vendors, the U.S. Department of Justice's Drug Enforcement Agency (DEA), state and federal regulators, and the Mitre Corp., a research and systems engineering organization. NCPDP subsequently convened a task group, wrote the paper, and delivered the report to the Office of the National Coordinator for Health Information Technology (ONC) within the U.S. Department of Health and Human Services (HHS).
NCPDP published the document in March but just started publicizing it.
Law enforcement agencies in particular are concerned about the safety consequences of diversion of addictive prescription drugs, while HHS and other payers want to cut down on unnecessary expenditures related to illegal or excessive prescribing. "It's widely publicized that more people are overdosing on prescription drugs than are overdosing on illegal drugs," NCPDP board chairman Charlie Oltman told InformationWeek Healthcare. He added that more die from overdoses of prescription medications than from street drugs.
For the most part, when pharmacies tell authorities about medications they dispense, they send the information in batch reports, as infrequently as once a month in some states. "We get zero feedback about what we're reporting," said Oltman, who also is manager of government programs and standards compliance for Target Corp., although he said he was referring to retail pharmacies in general because he is not authorized to speak on behalf of Target on this issue. "Pharmacies don't know if there is a problem."
If there were a standard system, pharmacies could run checks in real time and doctors who write electronic prescriptions could know immediately if there was a pattern to be concerned about, Oltman said. About two-thirds of physicians in the U.S. now write at least some of their prescriptions electronically, according to Black Book Market Research. With e-prescribing, pharmacies can have access to real-time transactions, including insurance claims.
"This is not something that's in the future," Oltman said. "This is proven." The NCPDP Telecommunications Standard has helped verify patient insurance eligibility and process claims for nearly every outpatient prescription dispensed in the U.S. for more than a decade, he said. Another NCPDP creation, the SCRIPT Standard, is Medicare's preferred format for electronic transmission of new prescriptions.
"These are already standards that have been incorporated into the workflows of physicians and pharmacists," said Steve Mullenix, senior VP for communications and industry relations at Scottsdale, Ariz.-based NCPDP.
As of mid-February, all states except Missouri had established prescription drug monitoring programs, although eight of the programs, including those in the District of Columbia and Guam, were not operational, according to Brandeis University research cited in the NCPDP report. But data transmission standards and report frequency vary from state to state, making communication difficult if not impossible.
About a year ago, NCPDP and others in the pharmacy business decided that "there needed to be sharing across state boundaries," Mullenix said. "Some of the perceived abusers were jumping back and forth across state lines," added Mullenix, a registered pharmacist. "This screamed for a national standard."
Adopting de facto national standards would help spread the burden for stopping prescription drug abuse, according to the NCPDP. Mullenix said the DEA is asking pharmacies to assist in efforts against drug diversion. "We just don't have the best tools in place to make that happen," Mullenix said.
But Oltman said prescribers also should have a role in preventing diversion. "Physicians and pharmacists should be working together," he said when asked whether the onus should be on the prescriber or the dispenser to stop drug abuse.
Mullenix said ONC will consider standardizing the monitoring of prescriptions as part of the forthcoming Stage 3 regulations for Meaningful Use of electronic health records (EHRs) that apply to care providers.