How identity management can aid efforts involving PDMP databases

As healthcare systems focus on promoting public health, the benefits of accurately matching patients to their records will improve patient safety and outcomes.

Now that opioid overdoses are the fifth leading cause of deaths in the U.S., state health authorities must improve their prescription drug monitoring programs PDMPs with identity management solutions that can improve patient data accuracy, reduce fraud and match patients to their medication records.

As an electronic database that tracks and monitors controlled substance prescriptions, state PDMPs rely on electronically transmitted patient data such as prescription logs, billing records, patient profiles and counseling records.

During the past decade, managing millions of patients’ digitized medication records has been a significant problem, according to PDMP administrators, health IT developers and representatives from pharmacies who gathered earlier this month to discuss patient matching efforts at a one-day symposium hosted by the Office of the National Coordinator for Health Information Technology (ONC) in Washington.

Among the challenges, pharmacy systems receive and maintain patient information that contain errors such as multiple variations in the spelling of names, incomplete information, and inaccuracies in addresses, birth dates and phone numbers.

Additionally, records aren’t always updated when an individual moves or remarries. Further, issues arise when patients visit multiple providers in the same community, creating duplicate records. Many patients also receive care in different states which increases the need to exchange patient data across state lines.

As healthcare systems focus more intently on promoting public health, many healthcare stakeholders say the benefits of accurately matching patients to their records will improve patient safety and outcomes and create greater efficiency across pharmacy systems.

The need to build a comprehensive PDMP database with integrated patient identification and matching solutions like enterprise master patient indexes (EMPIs) has grown in importance in recent years. Adding fuel to this trend is the introduction of several types of analytical software tools that provided public health officials, clinicians, pharmaceutical companies and other stakeholders the opportunity to gain insights that drive clinical decisions that impact everything from recommending treatment to reducing hospital readmissions and mortality rates.

PDMP databases can be utilized for predictive analytics that elevates public health initiatives. A comprehensive, accurate and up-to-date PDMP that is integrated with electronic health records and is easy to use and access can identify patient behaviors, create alerts when patients begin to slip toward addiction and provide health authorities with the information they need to intervene and save lives.

Still, many states are far behind in their efforts to improve the quality of patient medication records, according to the results of a 2019 state-by-state survey from the PDMP Training and Technical Assistance Center presented during the ONC Symposium.

Out of 51 PDMPs who responded to the question of whether their state has a process for patient clustering or matching records, 41 PDMPs said yes, but 10 state PDMPs said they didn’t have such a process in place.

Of the 43 respondents who answered the question, "Identify the barriers to patient matching within your PDMP," the majority (53 percent) cited both data quality issues and the lack of insight into matching methodology in use as the biggest barriers to patient matching. Some 30 percent said there is a lack of understanding of the matching process, and 23 percent said there are limited data elements used in the matching process, and 19 percent said there is a lack of available resources.

These results also suggest that many state PDMP databases don’t have a comprehensive longitudinal view of patients’ medication history, which further implies that they need EMPI solutions to improve data quality, reduce errors, eliminate duplicate records and provide a longitudinal view of a patient across their clinical, financial and demographic information.

As the demand to share data across states increases, and standards like FHIR facilitate the exchange of patient medication information between state health organizations, PDMPs must address how their systems will accommodate the interstate data sharing process, but the data shows there’s a lot of work to do.

In identifying issues that hinder interstate patient matching, 55 percent of 42 respondents cited both data quality issues and the lack of insight into matching methodology in use. Additionally, a lack of understanding of the matching process was cited by 36 percent of respondents, and 21 percent cited a lack of available resources.

At a time when healthcare organizations are marching toward value-based care, population health initiatives, interoperability of disparate healthcare systems and the strengthening of health information exchanges, PDMP managers will be forced to increase their patient matching efforts to meet the healthcare modernization moment.

As PDMPs look to aggregate information and derive more value from medication records, technology breakthroughs and the pivot toward value-based care have created fresh opportunities for PDMP managers to raise the efficiency of their control substance surveillance systems to new levels.

PDMP administrators that are creating an accurate control substance surveillance system and are hard pressed to manage large volumes of data can turn to enterprise identity management platforms to manage and organize data. EMPIs and related patient identification tools can help PDMP administrators improve data accuracy, as well as reconcile patient records and reduce duplicates.

Using enterprise identity solutions in conjunction with prescriptive analytics and machine learning can help organizations leverage prescription data to anticipate risk and identify patterns with a high probability of abuse. Experts can then focus their time evaluating actionable insights rather than sifting through mines of data to intervene with personalized treatment plans.

Other technologies like identity verification tools to cross-check individuals against billions of public records, and blockchain to aggregate patient records into a single longitudinal entity can also support PDMP systems and safeguard against fraud.

As PDMPs design their databases for the future, the hope is they’ll utilize identity management platforms to help them aggregate disparate data, elevate their patient matching efforts, and provide a complete and accurate view of the patient’s total healthcare experience.

That said, enterprise identity solutions promise to bring value to PDMP systems that will benefit the entire control substance surveillance systems nationwide.

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