Databases that help states track controlled substance prescriptions are vital to reducing opioid prescribing. However, these systems are not well integrated with the electronic health records that clinicians use, according to Andrew Gettinger, MD, chief clinical officer in the Office of the National Coordinator for HIT.
Gettinger contends that—when clinicians are in the “fluid workflow” of caring for a patient and go into their EHR to prescribe—one of the challenges with prescription drug monitoring programs (PDMPs) is that “in many cases, not all, they have to leave that workflow and log into their state’s PDMP.”
In addition, he says clinicians must identify the patient found in the PDMP to ensure that they are the same one for whom they are considering prescribing.
“It is a process that is fraught with both frustration on the part of prescribers and challenges—it’s very easy to make an error looking at the wrong patient,” adds Gettinger. “We currently do not have a 100 percent accurate, reliable way to identify patients.”
Making matters worse, Gettinger observed that “some of the states have requirements for their PDMP that are different than their requirements for EHRs in terms of authenticating the user—and, if you have those different requirements, it’s then hard to integrate them.”
A similar message of concern was delivered on Tuesday to members of the Senate health committee during a hearing on the opioid crisis and the role of technology and data in preventing opioid addiction.
EHRs and PDMPs “need to efficiently and seamlessly talk to one another so that the data can be transferred in a timely manner to proactively monitor patient and prescriber behavior, which will allow for us to intervene at an early point to address any problems,” testified Sherry Green, co-founder of the National Alliance for Model State Drug Laws and CEO of Sherry L. Green & Associates.
Facilitating widespread integration of PDMP data into EHRs is critical, according to Green. However, she told lawmakers that some states “do not allow the PDMP report to actually be placed into the electronic medical record and they have different standards for access and use of that data once it’s actually in the medical record.”
As a result, Green made the case that the governance rules for PDMP data must have consistent standards for access, use, and disclosure that are in alignment with those for medication history traditionally maintained by health IT. “Those are the kinds of standards we now need to be reconciling and making more uniform” to ensure the effective use of PDMP data in the clinical workflow, she added.
On Tuesday, eight senators introduced bipartisan legislation to help combat the opioid epidemic, including a provision that would require physicians and pharmacists to use their state-run PDMPs when prescribing or dispensing opioids. Yet, EHR-PDMP integration challenges remain.
Last year, the President’s Commission on Combating Drug Addiction and the Opioid Crisis recommended in its final report that PDMP data should be integrated with EHRs, overdose episodes, and substance use disorder-related decision support tools for providers to increase their effectiveness.
“Data can mean helping prevent more people from sliding down the slope of addiction,” remarked Sen. Lamar Alexander (R-Tenn.), chairman of the Senate health committee, during Tuesday’s hearing. “Integrating the data from PDMPs into electronic health record systems—so that providers don’t have to log into different systems to see all of a patient’s records—will make it easier for doctors to have better information and reduce the time they spend looking at screens instead of seeing the patient.”
Likewise, Sen. Tina Smith (D-Minn.) commented that providers in Minnesota find that the state’s PDMP is “cumbersome” requiring them to log in and log out of the database irrespective of their EHRs.
“PDMPs have been around for 10 years,” testified Westley Clark, MD, professor of public health at Santa Clara University. “We’ve known the limitations—we just haven’t done much about them.”
However, Green noted in her testimony before the Senate committee that ongoing federal and state enhancement initiatives are working to integrate PDMP data into health and pharmacy IT. “Millions of public dollars are being spent on integration technology,” she said. “This integration removes barriers to easy access of PDMP data and allows healthcare professionals to efficiently rely upon the data to inform patient care decisions.”
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