PDMPs, or prescription drug monitoring programs (sometimes shortened to PMP), were created by individual state legislation years ago to reduce prescription drug abuse and diversion. PDMPs consist of electronic databases that collect, monitor, and analyze electronically transmitted prescribing and dispensing data submitted by pharmacies. The data is used to support states’ efforts in education, research, enforcement, and abuse prevention.
History of Prescription Monitoring Programs
The first programs have been in place in some states longer than you may think. As early as 1918, New York mandated that pharmacists report prescriptions for cocaine, codeine, heroin, morphine, and opium to the health department within 24 hours. California began a PDMP in 1939, and other states developed similar programs throughout the 1940s and ’50s. By 1989, only nine states had PDMPs, though Hawaii started collecting data in 1943 (before it was a state). All of these early PDMPs were coordinated with paper and/or faxes. The aggregated reports and, where relevant, PDMP investigations, focused on prescribers selling prescriptions, pharmacies selling controlled substances illegally, and organized doctor-shopping rings. The only focus at that time was Schedule II drugs.
Since then, an Alliance of State Prescription Monitoring Programs was formed, the program has become electronic, and the schedules have expanded, though each state may still incorporate some variations. The Drug Enforcement Administration (DEA) has no role in managing these state programs.
States Pioneer Modern PDMPs
In 2010, Brandeis University received a grant through a division of the Department of Justice to fund a PMP Center of Excellence at the Heller School for Social Policy and Management to provide practice-relevant information, evaluation, and expertise to PDMPs and their stakeholders, including the development of best practices. By June 2012, 49 states and one territory had passed PDMP legislation and 41 states had an operating PDMP.
The state of New York passed the I-STOP law (Internet System for Tracking Over-Prescribing) to mandate PDMP use by August 2013, and electronic prescribing of controlled substances (EPCS) by the end of 2014.
Today, most states are mandating use of PDMPs, though in some, funding the operations to make them effective and timely has been a barrier. Problems with standardizing data formats and sharing information across state lines are among several challenges still facing efficient use of these programs. The National Association of Boards of Pharmacy (NABP) created PMP InterConnect to facilitate sharing data across state borders to authorized users, offering some promise of more efficient use of resources.
Evidence that PDMPs have been effective—when properly funded and if the relevant data is timely—has built a strong case for PDMPs to grow in importance. Although PDMPs currently differ in their relative emphasis on improving medical care versus reducing drug diversion and abuse, they are well-positioned to serve both objectives.
The good news is, over the last seven years, the wider use of buprenorphine and methadone along with other treatments, technology and understanding of the importance of these programs has improved significantly. This is part of the reason the curve of opioid deaths is beginning to bend—ever so slightly. While the problem is by no means solved, we are also seeing some stabilization based on reducing fraud, abuse, and diversion of controlled substances.
Promoting PDMP adoption
According to the Bureau of Justice Assistance (BJA), registration rates for state PDMPs are still low, with the number of registered users typically ranging from 5% to 39% of potential authorized users within most states.
This consistently low usage rate presents a major problem for states interested in curtailing the problems associated with rampant prescription drug abuse. The percentage of healthcare providers that are currently using PDMPs also runs in stark contrast with the much larger percentage of healthcare providers that are currently using EHRs, EMRs, and e-prescribing solutions.
The question for many lawmakers, public health experts, and medical decision-makers who are concerned about this problem has subsequently become: How is it possible to get healthcare professionals to begin using PDMPs with the same regularity that they are using other healthcare IT solutions? The quick and simple answer: Make it much easier for the physician and trained, authorized staff to access the appropriate state-controlled database.
In 2012, DrFirst participated in a pilot program with the state of Michigan to demonstrate the value of linking PDMP access within an e-prescribing application to enhance efficiency and workflow. The results of the program were very promising, demonstrating a significant increase in the percentage of physicians who chose to consult the state’s PDMP prior to prescribing medication to their patients over the duration of the test. We were also able to demonstrate added clinical benefits that came from directly connecting our e-prescribing/EPCS module with the state’s PDMP. Our infrastructure is able to draw from more sources than the state’s PDMP, making the data that physicians received through the pilot program significantly richer and more clinically impactful than the data they would otherwise have been able to gather from merely consulting with the state’s PDMP.
Streamlining Provider Workflow
Now, as many states have followed Michigan’s lead and are allowing e-prescribing/EPCS platforms to interface directly with state PDMPs, it’s time to streamline the process. Every state has a different vendor that takes raw data from the Department of Public Health and then figures out how to display that data. At DrFirst, we’ve worked with those vendors to display information in a meaningful way, without requiring providers to sign in and out of different systems and switch from one website to another.
As this is being written, the Drug Enforcement Agency (DEA) is reevaluating its March 2010 interim final rule on EPCS and soliciting feedback from industry stakeholders. Having pioneered the technology for EPCS, DrFirst is uniquely qualified to weigh in on requirements that are excessively rigid for healthcare providers, contributing to low adoption rates of EPCS, even though it’s the best practice for patient safety and convenience, while avoiding drug diversion. We are urging the DEA to recognize the technology advancements that make it possible to maintain security and fraud prevention while also recognizing providers’ needs for a seamless e-prescribing workflow. (See DrFirst Urges DEA to Modernize Solutions for EPCS.)