EHR Integration Boosts Primary Care Clinician PDMP Query Rate

EHR integration of a prescription drug monitoring program (PDMP) increased primary care clinician adherence to recommended prescribing practices for controlled substances such as opioids, according to a study published in JAMA Health Forum.

PDMPs are state-run electronic databases that assemble pharmacy and patient data from Drug Enforcement Agency (DEA) controlled substances and prescription drugs. PDMPs help prescribers keep track of patients at high risk of becoming opioid-dependent.

Researchers randomized access to an intervention that directly integrated the Minnesota PDMP into the EHR. Of the 43 participating clinics, 21 clinics received the PDMP EHR integration.

The intervention potentially alleviated the hassle of querying the PDMP in two ways: by removing the need to log into a separate web portal for every query and by lowering the attention cost of remembering to query the PDMP.

Baseline monthly PDMP query rates for the average clinician were 6.6 vs 8.8 queries in the control and PDMP integration groups, respectively.

During the intervention, PDMP query rates for the average clinician were 6.9 vs 14.8 among the control and the PDMP integration group, respectively.

The researchers found that the effect of the intervention was more significant for less experienced clinicians.

“This may reflect a less inflexible practice style and/or faster uptake of new features in the EHR; however, the opposite finding could also have been expected if more senior clinicians feel a greater time cost of logging into the web-based PDMP portal for each query,” the study authors explained.

Approximately four months into the study’s intervention period, Minnesota rolled out a statewide mandate requiring clinicians to query the PDMP before prescribing opioids.

Researchers observed an uptick in PDMP query counts at both intervention and control clinics when the mandate went into effect. However, the increase in PDMP query count was more significant for clinicians at intervention clinics, suggesting a potential reinforcing interaction between the EHR integration and the mandate.

“Notably, the uptick following the adoption of the PDMP mandate appeared to be considerably smaller than the changes resulting from the EHR-integrated PDMP tool,” the authors pointed out.

The researchers said that the PDMP-use mandate could have possibly increased the information available to clinicians, which may have led to fewer prescriptions. However, PDMP-use mandates may also increase the hassle cost of prescribing opioids and other controlled substances, they added.

“The present study did not directly assess opioid prescribing, but the finding of a larger increase in PDMP queries among clinicians with access to the EHR-integrated tool after Minnesota’s mandated query law was enacted is consistent with what to our knowledge is the only other study available on this topic, and supports the idea that mandates increase the hassle cost of opioid prescribing,” the authors wrote.

The study had several limitations, including a limited geographic range because findings were based on a single healthcare delivery system and its affiliates. However, the researchers noted that the system and its affiliates included urban, suburban, and rural areas, so the results are likely generalizable.

Additionally, the researchers could not distinguish between clinically appropriate and inappropriate queries in their PDMP querying outcome measures. The study authors also lacked data from the Minnesota Board of Pharmacy on the number of opioid prescriptions, so we could not quantify changes in opioid prescribing as a function of access to the EHR-integrated PDMP tool.

However, the researchers plan to address this limitation in subsequent analyses by linking ePrescribing information derived directly from the EHR.