Smarter Decisions, Superior Outcomes

Monitoring PDMP Effectiveness Now and in the Future

Posted by Denika Hockenhull on May 16, 2016 at 10:30 AM

HID had the honor of leading honored a Vision Session during the 5th Annual National Rx Drug Abuse & Heroin Summit that was held March 28-31 in Atlanta, Georgia.

Titled “Monitoring PDMP Effectiveness Now and in the Future,”  HID’s presentation focused on how data accessibility and enhancement are effective tools for protecting public health and safety while supporting sound clinical prescribing, dispensing, and use of controlled substances. Attendees discovered:

  • How collaborative partnerships support state PDMP goals and outcomes
  • Why public and private health plans will require PDMP data
  • How the ONC’s Interoperability Roadmap will change the way PDMP data is accessed

Program Manager Rebecca Poston, MPH, RPH, was on hand to speak on the tremendous success accomplished by E-FORCSE, the State of Florida’s PDMP. E-FORCSE has experienced real, tangible, positive outcomes since 2010 when the program began and HID’s RxSentry solution was implemented.

If you've missed this year's Summit, don't worry. Our team has provided the presentation slides and a brief recap after the jump!

Topics: Interoperability, state health, opioids, PDMP, population health, healthIT, data accessibility

  • Monitoring PDMP Effectiveness Now and in the Future
  • Who is HID?
    HID has a long history of PDMP partnership, service, and support.
  • HID Community
  • HID Mission & Goals
  • HID Mission & Goals
    HID has leveraged our clinical expertise to assist our clients meet the unique challenges of implementing and supporting a state PDMP.
  • Success in Florida
  • FL Background
    Florida's well-documented history of unregulated pain management clinics placed the state as the epicenter of the prescription drug abuse endemic. In 2011, FL PDMP adopted the HID solution, establishing new policies that have helped the state experience tangible outcomes.
  • FL Goals & Action Items
    Successful during the initial PDMP implementation and rollout, E-FORCSE continued to find ways to improve adoption and use with the following action goals:
    • Increase reporting accuracy, frequency, and compliance
    • Increase prescriber enrollment and utilization
    • Develop and enhance tools to determine the impact prescriber and dispenser has had on patient health outcomes and public health surveillance
  • FL Challenges
    All states, except Missouri, have enacted laws and implemented prescription monitoring programs to serve as an integral part of patient and public safety solutions addressing the national prescription drug epidemic. Looking forward, it is apparent that policy will play an important role in the utilization and sustainability of these programs.
    States are considering policy changes that address reporting more frequently, authorizing designees for health care professionals, mandating registration and use, sending proactive alerts, integrating data into the clinical work flow, and long-term funding.
     
     
    Status of Prescription Drug Monitoring Programs Map, PDMP TTAC, August 28, 2015. http://www.pdmpassist.org/pdf/PDMPProgramStatus2015_v5.pdf accessed November 3, 2015.
    Centers for Disease Control and Prevention. State Laws on Prescription Drug Misuse and Abuse. Retrieved November 3, 2015. http://www.cdc.gov/phlp/publications/topic/prescription.html
  • FL Outcomes: Increased Prescriber Use
    E-FORCSE uses an on line registration and verification process with the regulatory board. staff provided outreach and education to 150 stakeholders, 73,911 health care practitioners, and 3,002 law enforcement and investigative agency personnel. As a result, during the last year, there has been a 16.9 percent increase in health care practitioner registration and a 99.3 percent increase in the number of requests for Patient Advisory Reports (PARs).
  • FL Outcomes: Reduced MED Rates
    Identifying at-risk patients is a crucial first step toward improving patient safety and increasing prescriber awareness.  In an effort to assist prescribers and dispensers to identify at-risk patients, E-FORCSE implemented an enhancement to the PAR in January 2015, to include the morphine equivalent dosing (MED) for each opioid prescription dispensed to the patient.  It also provides a MED Summary section at the bottom of the report, which displays the cumulative MED values and the cumulative MED sustained for any 3 consecutive days during the date range requested. There has been a 34.2 percent reduction in the average morphine milligram equivalents (MMEs) prescribed between October 2011 and September 2015.
  • FL Outcomes: Reduced MPE Scores
    Through monitoring and analysis of multiple provider episodes (MPE), an increase in health care practitioner utilization, proactive notification to prescribers and law enforcement, Florida has seen a 65 percent reduction in the number of individuals having multiple provider episodes.
  • FL Outcomes: Reduced Mortality Rates
    A 2015 study by Delcher et al. found that utilization of the PDMP has played a role in reducing oxycodone-related deaths in Florida.Between 2010 and 2012, Florida saw more than a 50 percent decrease in oxycodone overdose deaths due to the regulation of pain clinics and the elimination of dispensing controlled substances from health care practitioners’ offices. According to the Centers for Disease Control and Prevention these changes may represent the first documented substantial decline in drug overdose mortality in any state during the past ten years. Occurrences of oxycodone have continued to decrease over the past five years (a 59 percent decrease from 2010). Oxycodone caused deaths have also continued to decrease over the past five years (a 69 percent decrease when compared with 2010).
    Florida Medical Examiner’s Commission. Drugs Identified in Deceased Persons, Annual Report 2014. Florida Department of Law Enforcement, Medical Examiner’s Commission, September 2015. https://www.fdle.state.fl.us/Content/Medical-Examiners-Commission/MEC-Publications-and-Forms/Documents/2014-Annual-Drug-Report-FINAL.aspx
    Delcher, C., et al., Abrupt decline in oxycodone-caused mortality after implementation of Florida’s Prescription Drug Monitoring Program. Drug Alcohol Depend. (2015), http://dx.doi.org/10.1016/j.drugalcdep.2015.02.010
    Centers for Disease Control and Prevention. Decline in Drug Overdose Deaths After State Policy Changes — Florida, 2010–2012. MMWR 2014; 63(26);569-574.
     
     
  • The Future of PDMP
  • Shifting Focus and Priorities
    PDMPs are shifting focus and priorites. Where are we heading next? What goals are they starting to set? We're seeing the following trends:
    • Having access to a wider data set within the PDMP – provider and pharmacy activity; treatment activity and completion/success rates; impact of integrated services on being impetus of seeking treatment
    • Ability to analyze data within the PDMP – which patients exhibit addiction behavior?  Of those patients, who has sought treatment of some kind?  Have Medicaid patients used MAT and to what extent?  Who is commercially insured and have they used treatment benefits?  Have a Case Mgr?
    • Proactively identifying risk and sharing that with providers, pharmacies, other states, commercial payers. Medicaid, etc.
    • Expectation of PDMPs to educate, make contact with  patients at community level, provide outcome-based information – data drives activity; more effective interventions and results
  • Interoperability is the Goal
    Interoperability describes the extent to which systems and devices can exchange data, and interpret that shared data. For two systems to be interoperable, they must be able to exchange data and subsequently present that data such that it can be understood by a user.
    PDMPs are working to apply the latest advances in health IT to incorporate PDMP data directly into the workflow of prescribers and dispensers, making PDMPs interoperable and integrated. This push will enable timely access to their patients’ controlled prescription drug history information at the point of care. Integrating with health IT makes PDMP data timelier and more easily accessible which encourages routine checking of the PDMP.
  • The Value of Interoperability
    An interoperable PDMP solution is valuable because it:
    • Goes beyond collecting data from pharmacies for compliance
    • Provides useful data to support EHR integration for providers
    • Grants opportunties for nalytics, performance metrics, and other measuring tools
    • Exhibits a wider range of education and intervention 
    • Uses Data to create a big picture view of health moving away from today's limited information
     
  • Measuring Outcomes
  • Preparing for the Future
    There is a paradigm shift occuring in our industry. Prepare for the future by:
    • Continuing pilot programs
    • Seeking legislation and guidance
    • Engaging in data interchange and interoperability
    • Providing education, training, and instruction to program users

Independent & Objective

Clinical expertise without the noise

Getting the facts matters. Following our corporate mission, we're committed to using this blog to enhance your knowledge of evolutionary events and discussions in the pharmacy services and technology arena. 

Here's what we're focused on right now:

  • Lowering ingredient cost
  • Enhancing the coverage determination process
  • Creating robust prior authorization criteria
  • Producing actionable drug trend analyses
  • Enhancing prescription drug monitoring 
  • Implementing interoperability efforts

Subscribe to Email Updates