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What is a Prescription Drug Monitoring Program, EHR Integration?
Prescription drug monitoring programs (PDMPs) are a game-changer for prescribers to help fight the opioid epidemic.
Prescribers use a prescription drug monitoring program (PDMP) each time they write a prescription as part of the industry’s efforts to stem the opioid crisis.
These EHR-integrated systems, which plug into a larger database, give prescribers a better understanding of a patient’s full prescription drug history.
PDMPs are state-run electronic databases utilized in every state across the country, outside of Missouri. The program assembles 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.
These efforts come as healthcare continues to stare down a significant opioid problem. Opioid overdose rates quadrupled between 1999 and 2015, but health IT experts say an integrated PDMP could help clinicians mitigate the epidemic.
Boosting PDMP Integration Through Enhanced Workflow
Now that PDMP and EHR-integration have become more common in recent years, providers are more likely to query their state database, allowing them to have a better understanding of the patient’s controlled substance utilization patterns.
Ultimately, these actions could help mitigate the opioid epidemic.
“Many states have developed and are in the process of developing more stringent rules requiring providers to check their state PDMP more frequently just for this reason,” Darren K. George, MD, AMR medical director at Community Health Systems, explained in an email to EHRIntelligence. “This will have the downstream effect of decreasing the over-utilization of controlled substances in our region, and in fact, every region.”
But while EHR-integration is becoming more common, there remains room for increased PDMP integration throughout health organizations.
According to a June 2020 JAMA Network Open research article, hospitals located in areas with high rates of opioid prescribing were less likely to have PDMPs integrated into the EHR. Only 10.8 percent of hospitals located within counties with high prescribing rates had PDMP EHR-integration.
Additionally, only one-in-three hospitals can access PDMP data within its EHR system.
ONC’s analysis of the 2017 American Hospital Association (AHA) Annual Survey was the first of its kind to highlight the integration between EHRs and PDMPs that provide hospitals with patient-specific prescription information.
Increased Interoperability Saves Lives
Interoperability within the workflow is crucial to making PDMPs work more effectively.
With increased interoperability, prescribers are better equipped to leverage patient and prescriber data between health organizations. With more hospitals connected through a single workflow, it increases the exchange of patient prescription information between health organizations.
For instance, The Los Angeles Network for Enhanced Services (LANES), a nonprofit health information exchange (HIE), recently connected a PDMP database into its workflow to connect more than 500 health systems.
Without integrated PDMPs, individuals could potentially gain access to prescription drugs when crossing state borders. However, increased interoperability allows providers to check prescribing practices across state lines.
“For years, it was standard practice to just scribble out a prescription and hand it to the patient at discharge,” Maura Dent Cash, a nurse and Director of Clinical Applications told EHRIntelligence. “They would fill it and go home and take all of them or take part of them, and put the rest in the cabinet, and no one would really follow up.”
“And if a patient just said, ‘Hey, I need some more,’ prescribers would write some more because no one really understood the epidemic and the proportion of the epidemic that was going on,” Cash added. “When I started in ASCs [ambulatory surgery centers] the prescription pads were still being used in ASCs, and nobody had electronic prescribing.”
EHR-Integration Reduces Clinician Burden
EHR implementation can decrease the strenuous process of checking the PDMP, thus reducing the cognitive workload and burden for the clinician.
“Providers had to go to their individual state PDMP website, log on, input patient-specific information, check multiple boxes for specific information relative to that patient, and check multiple boxes for additional states to be included in the query,” explained George, the medical director from Community Health Systems.
When his health system previously utilized an inefficient workflow, George explained that it was not uncommon for a query to take up to seven minutes to process, which ultimately put a significant strain on his team’s workflow.
“This process was tedious at best and extraordinarily inefficient. It required providers to access a completely different workflow.”
The goal of the PDMP is to fight the opioid epidemic, which ultimately leads to saving lives.
“In the end, the most effective measure of whether PDMPs are effective is going to be related to whether or not we are making an impact on the overutilization of controlled substances in our society,” concluded George. “Certainly, most providers, most states, and the federal government believe that by doing a better job, a more efficient job of monitoring patient's use of controlled substances, we are going to help the problem of addiction and overutilization in our culture.
“I personally believe that every time the PDMP allows a provider to make a more informed decision regarding a prescription for a controlled substance, the effectiveness of the PDMP is self-evident.”