Lee-Tipping

Enhancing Access to Prescription Drug Monitoring Programs through

Health Information Technology

Kate Tipping, J.D. Office of the National Coordinator for Health Information Technology

Jinhee J. Lee, Pharm.D. Substance Abuse and Mental Health Services Administration

Disclosure Statement

The presenters for this continuing education activity report no relevant financial relationships.

True or False:

Prescription drugs obtained from a medicine cabinet or pharmacy are perceived to be less addictive and not as dangerous as illegal drugs obtained from a drug dealer.

Low Perception of Risk •  Prescription drugs obtained from a medicine

cabinet or pharmacy are perceived to be less addictive and not as dangerous as illegal drugs obtained from a drug dealer.

•  Teens’ perception of the risks associated with abusing prescription drugs is relatively low.

•  Low perception of risk, coupled with easy availability, is a recipe for an ongoing problem.

Source:  The  Partnership  A3tude  Tracking  Study  (PATS),  sponsored  by  MetLife  Founda@on  

Of those persons aged 12 or older who used pain relievers non-medically between 2009 and 2010, what % obtained them from a friend or relative?

A.  33% B.  66% C.  77% D.  88%

Source Where Pain Relievers Were Obtained for Most Recent Nonmedical Use among Past Year Users

Aged 12 or Older: 2009-2010

1The Other category includes the sources "Wrote Fake Prescription," "Stole from Doctor’s Office/Clinic/Hospital/Pharmacy," and "Some Other Way."

Free from Friend/Relative

(6.3%) Bought/Took from

Friend/Relative (6.5%)

Drug Dealer/ Stranger (2.3%)

One Doctor (79.4%)

More than One Doctor

(3.6%)

Bought on Internet (0.2%)

Other1 (1.7%)

Free from Friend/ Relative (55.0%)

Bought/Took from

Friend/Relative (16.2%)

Drug Dealer/ Stranger (4.4%)

Bought on Internet (0.4%)

Other1 (4.6%)

One Doctor (17.3%)

More than One Doctor (2.1%)

Source Where Respondent Obtained

Source Where Friend/Relative Obtained

Of the 36,500 drug poisoning deaths in 2008, what percentage involved opioid analgesics?

A. 10% B.  20% C. 30% D. 40%

Opioid analgesics involved in more than 40% of drug poisoning deaths in 2008.

1Opioid analgesics include natural and semi-synthetic opioid analgesics (for example, morphine, hydrocodone, and oxycodone) and synthetic opioid analgesics (for example, methadone and fentanyl). Some deaths in which the drug was poorly specified or unspecified may involve opioid analgesics.

SOURCE: CDC/NCHS, National Vital Statistics System

The Problem The CDC* has declared that the U.S. is in the midst of an epidemic of prescription painkiller overdose deaths. Deaths from these drugs now outnumber deaths from heroin and cocaine combined.

*Centers  for  Disease  Control    and  Preven2on

Challenges •  In 2010, an estimated 22.1 million persons– 8.7% of the U.S.

population aged 12 or older -- were classified with substance abuse or dependence.

–  2.2 million reported past year dependence or abuse of psychotherapeutics (non-medical use) – 1.9 million of them for pain relievers

•  20.4% persons reported non-medical use of psychotherapeutics at sometime during their lifetime – 13.7% reporting non-medical use of pain relievers, and

•  2 million people (12 or older) initiated illicit use of pain relievers during 2010, second only to those who initiated marijuana use (2.4 million)

Federal Strategy to Address the Problem of Prescription Drug Abuse

•  Prescription Drug Abuse Prevention Plan released by the White House in April 2011 announced Federal requirements that provide a national framework for reducing prescription drug abuse and the diversion of prescription drugs through education, tracking and monitoring, safe and appropriate disposal, and enforcement.

•  The response to prescription drug abuse requires the collaboration between Departments of Justice, Health and Human Services, Veterans Affairs, Defense, and others.

Four Major Areas of the 2011 Prescription Drug Abuse Prevention Plan

•  Educating patients and health care providers

•  Increasing use of prescription drug monitoring programs (PDMPs)

•  Implementing and promoting use of prescription drug disposal programs

•  Supporting law enforcement efforts against illegal prescribing

SAMHSA’s Strategic Initiatives

•  Prevention of Substance Abuse & Mental Illness •  Trauma and Justice •  Military Families – Active, Guard, Reserve, and

Veteran •  Health Reform •  Housing and Homelessness •  Jobs and the Economy •  Health Information Technology for Behavioral Health

Providers •  Data Quality and Outcomes – Demonstrating Results

ONC’s Strategic Plan Goals: •  Achieve adoption and information exchange through

meaningful use of health IT •  Support health IT adoption and information exchange

in long-term/post-acute care, behavioral health and emergency settings.

•  Improve care, improve population health, and reduce health care costs through the use of health IT

•  Inspire confidence and trust in health IT •  Empower individuals with health IT to improve their health and

health care system •  Achieve rapid learning and technological advancement

Learning Objectives: 1.  Explain the purpose and scope of

Prescription Monitoring Programs.

2.  Outline Prescription Monitoring Programs as an additional tool in the management of patients with substance-related disorders.

3.  Describe details about a current government initiative that aims to enhance access to Prescription Monitoring Programs.

What is a PDMP?

•  Prescription Drug Monitoring Program •  Established by State Law •  Requires Prescription dispensers to report PHI

to central State Database. •  Prescribers, dispensers, law enforcement (w/

restrictions) can access •  Solicited request – from prescriber, etc. •  Unsolicited – from system to prescriber

How Can PMPs Reduce Rx Drug Abuse

•  Providers can have access to timely patient information on prescribed drugs – Use during visit – Build into treatment plan – Screen, refer to treatment

Federal Programs

•  Harold Rogers Prescription Drug Monitoring Program (Department of Justice) • National All Schedules Prescription

Electronic Reporting Program (NASPER) (Substance Abuse and Mental Health Administration)

Issue

•  Currently data is trapped within PDMPs, creating a situation in which information is not going where it needs to go in time for it to be of use.

The Story So Far

Vendor Community

Organizations

White House Summit on Health IT

& Prescription Drug Abuse June 3, 2011

Federal & State Partners

State Participants

Action Plan

ONC-SAMHSA Project

•  Enhancing Access to Prescription Drug Monitoring Programs – Use health IT to increase timely access to

PDMP data in an effort to reduce prescription drug misuses and overdoses. •  Develop the standards and policies necessary

to connect existing health information technologies to increase timely use of PDMP data by providers, emergency department providers, and pharmacists.

Project Objectives

Connect PDMPs to health IT systems using existing technologies

Improve timely access to PDMP data

Establish standards for facilitating information

exchange

Reduce prescription drug misuses and overdoses in the United States

2-Part Project

•  Work groups will convene to develop and recommend the standards and policies necessary to carry out the pilot projects.

•  Pilot studies will test the feasibility of leveraging health information technology and HIEs to improve timely access to PDMP data.

Work Groups Number/Name Purpose

1: Data Content and Vocabulary

To determine the data content and vocabulary necessary to support data exchange between Prescription Drug Monitoring Programs (PDMP) and recipients.

2: Information Usability and Presentation

To determine how PDMP information will be presented in the user interfaces for pharmacy systems and provider and ED Electronic Health Records (EHR) to maximize the value of this data for the treatment and dispensing decision-making processes.

3: Transport and Architecture

To explore and develop the technical specifications for data transmission (e.g., REST, SOAP, Direct) between PDMPs and a variety of recipient systems and intermediaries.

4: Law and Policy To explore legal and policy issues in support of program objectives, including PDMP data access within various recipient settings, use of intermediaries to enable PDMP data exchange and specific Pilot Program scenarios in the context of specific state(s).

5: Business Agreements for Intermediaries

To analyze the current business environment relevant to the use of intermediaries (e.g., Switches, HIEs) to route transmissions between PDMPs and data recipients.

Recipients of PDMP Data •  Three communities have been identified that

have the potential to make clinical decisions about prescribing

Leveraging Health IT •  Improve access to PDMP information at the point of patient

care •  Use existing technologies to facilitate exchange of

information: –  Electronic Health Record Systems –  Unsolicited messaging (Direct) –  Query-based messaging –  Switches –  Health Information Exchanges –  Other intermediaries

•  We are also open to new approaches to enhancing access to PDMP data

Pilot: Concepts Overview

Data Access Point

• Provider • E-Rx • EHR • Emergency

Room (ER) • Dispenser

Trigger

• Registration • Insurance

• Eligibility Check • Claims Check

• E-Rx • Provider • Pharmacy

• Admission / Discharge / Transfer (ADT) Transaction Standard

• Other

Intermediary

• None • HIEs:

• State • Other

• PMP Hubs • RxCheck (PMIX) • PMP

Interconnect • Networks:

• Surescripts • Relay Health • Other

• Other

Sample Use Case: Provider

Sample Use Case: Emergency Department

Sample Use Case: Pharmacist

31

Project Structure and Objectives

Page 32

Projected Results

•  Recommendations on policies/law around the use of PDMP data by providers or dispensers

•  Feasible, vendor-independent, technical solutions that are scalable and useable by states

•  New levels of cooperation among health IT sectors around PDMP

•  Increased provider utilization of PDMPs

•  Reduced prescription drug misuse and overdose

Contact Information

ONC: •  Kate Tipping – [email protected] SAMHSA: •  Jinhee Lee – [email protected] MITRE: •  Jeffrey Hammer – [email protected]

Questions?