Pilot programs look to increase use of prescription drug monitoring databases

The aim is to make it easier to check on activity by embedding the tool into electronic health records systems.

By — Posted Sept. 12, 2012

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There is widespread agreement in the Health and Human Services Dept.’s Office of the National Coordinator for Health Information Technology and other departments in the federal government that prescription drug monitoring databases are an effective tool in combating prescription drug abuse, which the Centers for Disease Control and Prevention has called an epidemic.

But they acknowledge that getting physicians to use the tool has been challenging, especially in states where use of the database is voluntary. The ONC launched two pilot programs aimed at increasing use of the databases by making it easier for physicians to access them.

Forty-nine states have laws creating a prescription drug monitoring program, and 43 have a system up and running. In most states, use of the database is voluntary. But by the start of 2013, at least five states will require physicians to consult the databases every time they prescribe a controlled substance, or if certain conditions, such as suspected abuse, warrant a look. Physicians balked at being required to use the databases because of the disruption it would cause in workflow. Most prescription drug monitoring programs are set up as stand-alone systems that physicians must access separately from their EHRs using unique, secure log-in credentials.

The ONC pilot programs, in Ohio and Indiana, stemmed from the White House Round Table on Health IT and Prescription Drug Abuse held in June, which brought together experts from the private and public sectors. Participants examined ways use of the drug monitoring databases could be increased by connecting them to EHR systems though health information exchanges. Physicians would have one access point for all of the patient’s information, eliminating the extra steps involved with logging in to a separate system. Investigators will compare the number of times physicians accessed the databases before and after the pilot programs went live.

Although those numbers have not yet been compiled, John Finnell, MD, an investigator with the Regenstrief Institute, a health research and education organization based in Indianapolis, said he has seen anecdotal evidence that the improved access is having the intended effect. In Indiana, it’s voluntary for physicians to access the drug monitoring system.

“The more obstacles that are put in place to get access to the data, the more clinicians just use other things,” said Dr. Finnell, an associate professor of emergency medicine at Indiana University School of Medicine. “So we’ve tried to make it as easy as possible to get to the entire data set.”

He said the pilot program has resulted in the EHR becoming a one-stop shop for information, with more physicians taking advantage of the resource. In Indiana, 33% of the 38,275 physicians eligible to participate in the system are registered users of it. They access the database an average of 5,000 times per weekday.

The pilot program in Indiana is a collaboration among Wishard Health Services of Indianapolis; Indiana’s pharmacy board, which runs the prescription drug monitoring program in the state; and the Regenstrief Institute, which designed the Regenstrief Medical Record System used in the pilot.

Dr. Finnell said as soon as the program launched, other hospitals saw the potential benefits and wanted their EHR systems to have access to the database. Plans are under way to expand the program to all members of Indiana’s health information exchange, which Regenstrief helped launch.

Dr. Finnell said he has seen anecdotal evidence of the program helping to combat prescription drug abuse. A woman finally said she was an addict and needed help after physicians consulted the database and found she had received several prescriptions from multiple emergency departments for the same medical complaint.

In Ohio, a pilot program at the Springfield Center for Family Medicine, a six-physician practice, is testing the effectiveness of having a drug risk indicator sent to the EHRs of primary care physicians. The state medical board requires physicians to consult the database if they suspect drug diversion or addiction. The program being piloted will send an alert to a physician’s EHR if a risk has been identified.

Gil Kerlikowske, director of the White House Office of National Drug Control Policy, said he hoped the pilot projects helped to usher in an era of “prescription drug monitoring programs 2.0” to improve real-time data sharing, increase interoperability of data among states, and expand the number of people using the tools.

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Making drug monitoring easier

Participants in a prescription drug monitoring pilot program in Indiana are being surveyed on their use of a system that ties the state’s monitoring database to their electronic health record, and how their behaviors are affected. There are 134 physicians participating in the pilot program, and preliminary results are based on responses from 61 of them. The surveys are ongoing.

97% of doctors found the system easy to use.

68% said the prescription drug monitoring database gave them information they did not already have.

34% reduced a prescription dosage because of information they found in the database.

18% reduced the number of written prescriptions.

0% said they found the system harder to use than the original system.

Source: Indiana’s Scheduled Prescription Electronic Collection & Tracking (INSPECT)

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