Lee-Tipping

Enhancing Access to PrescriptionDrug Monitoring Programs through Health Information TechnologyKate Tipping, J.D.Office of the National Coordinator for HealthInformation TechnologyJinhee J. Lee, Pharm.D.Substance Abuse and Mental Health ServicesAdministration

Disclosure StatementThe presenters for this continuingeducation activity report no relevantfinancial relationships.

True or False:Prescription drugs obtained from amedicine cabinet or pharmacy areperceived to be less addictive and notas dangerous as illegal drugs obtainedfrom a drug dealer.

Low Perception of Risk •  Prescription drugs obtained from a medicine cabinet or pharmacy are perceived to be less addictive and not as dangerous as illegal drugs obtained from a drug dealer. •  Teens’ perception of the risks associated with abusing prescription drugs is relatively low. •  Low perception of risk, coupled with easy availability, is a recipe for an ongoing problem.Source: The Partnership A3tude Tracking Study (PATS), sponsored by MetLife Founda@on

Of those persons aged 12 or olderwho used pain relievers non-medically between 2009 and 2010,what % obtained them from a friendor relative? A.  33% B.  66% C.  77% D.  88%

Source Where Pain Relievers Were Obtained for Most Recent Nonmedical Use among Past Year Users Aged 12 or Older: 2009-2010 Source Where Respondent Obtained More than One Doctor (2.1%) One Doctor (17.3%) Source Where Friend/Relative Obtained Other1 More than (4.6%) Free from One Doctor Bought on Friend/ (3.6%) Internet Relative Free from (0.4%) (55.0%) Friend/Relative (6.3%) Drug Dealer/ Bought/Took from Stranger (4.4%) One Doctor Friend/Relative (79.4%) (6.5%) Bought/Took Drug Dealer/ Stranger (2.3%) from Bought on Internet Friend/Relative (0.2%) (16.2%) Other1 (1.7%)1The Other category includes the sources "Wrote Fake Prescription," "Stole from Doctor’s Office/Clinic/Hospital/Pharmacy," and "Some Other Way."

Of the 36,500 drug poisoning deathsin 2008, what percentage involvedopioid analgesics? A.  10% B.  20% C. 30% D.  40%

Opioid analgesics involved in more than 40% of drug poisoning deaths in 2008. 1Opioid analgesics include natural and semi-synthetic opioid analgesics (for example, morphine, hydrocodone, and oxycodone) and synthetic opioid analgesics (for example, methadone and fentanyl). Some deaths in which the drug was poorly specified or unspecified may involve opioid analgesics.SOURCE: CDC/NCHS, National Vital Statistics System

The ProblemThe CDC* has declared that the U.S. is in the midst of anepidemic of prescription painkiller overdose deaths. Deathsfrom these drugs now outnumber deaths from heroin andcocaine combined.*Centers for Disease Control and Preven2on

Challenges•  In 2010, an estimated 22.1 million persons– 8.7% of the U.S. population aged 12 or older -- were classified with substance abuse or dependence. –  2.2 million reported past year dependence or abuse of psychotherapeutics (non-medical use) – 1.9 million of them for pain relievers•  20.4% persons reported non-medical use of psychotherapeutics at sometime during their lifetime – 13.7% reporting non-medical use of pain relievers, and•  2 million people (12 or older) initiated illicit use of pain relievers during 2010, second only to those who initiated marijuana use (2.4 million)

Federal Strategy to Address the Problem of Prescription Drug Abuse•  Prescription Drug Abuse Prevention Plan released by the White House in April 2011 announced Federal requirements that provide a national framework for reducing prescription drug abuse and the diversion of prescription drugs through education, tracking and monitoring, safe and appropriate disposal, and enforcement.•  The response to prescription drug abuse requires the collaboration between Departments of Justice, Health and Human Services, Veterans Affairs, Defense, and others.

Four Major Areas of the 2011 Prescription Drug Abuse Prevention Plan•  Educating patients and health care providers•  Increasing use of prescription drug monitoring programs (PDMPs)•  Implementing and promoting use of prescription drug disposal programs•  Supporting law enforcement efforts against illegal prescribing

SAMHSA’s Strategic Initiatives•  Prevention of Substance Abuse & Mental Illness•  Trauma and Justice•  Military Families – Active, Guard, Reserve, and Veteran•  Health Reform•  Housing and Homelessness•  Jobs and the Economy•  Health Information Technology for Behavioral Health Providers•  Data Quality and Outcomes – Demonstrating Results

ONC’s Strategic PlanGoals:•  Achieve adoption and information exchange through meaningful use of health IT •  Support health IT adoption and information exchange in long-term/post-acute care, behavioral health and emergency settings.•  Improve care, improve population health, and reduce health care costs through the use of health IT•  Inspire confidence and trust in health IT•  Empower individuals with health IT to improve their health and health care system•  Achieve rapid learning and technological advancement

Learning Objectives:1.  Explain the purpose and scope of Prescription Monitoring Programs.2.  Outline Prescription Monitoring Programs as an additional tool in the management of patients with substance-related disorders.3.  Describe details about a current government initiative that aims to enhance access to Prescription Monitoring Programs.

What is a PDMP?•  Prescription Drug Monitoring Program•  Established by State Law•  Requires Prescription dispensers to report PHI to central State Database.•  Prescribers, dispensers, law enforcement (w/ restrictions) can access•  Solicited request – from prescriber, etc.•  Unsolicited – from system to prescriber

How Can PMPs Reduce Rx Drug Abuse•  Providers can have access to timely patient information on prescribed drugs –  Use during visit –  Build into treatment plan –  Screen, refer to treatment

Federal Programs•  Harold Rogers Prescription Drug Monitoring Program (Department of Justice)•  National All Schedules Prescription Electronic Reporting Program (NASPER) (Substance Abuse and Mental Health Administration)

Issue•  Currently data is trapped within PDMPs, creating a situation in which information is not going where it needs to go in time for it to be of use.

The Story So Far Federal & State Partners Action Plan State Participants Vendor CommunityWhite House Summit on Health IT& Prescription Drug Abuse Organizations June 3, 2011

ONC-SAMHSA Project•  Enhancing Access to Prescription Drug Monitoring Programs –  Use health IT to increase timely access to PDMP data in an effort to reduce prescription drug misuses and overdoses. •  Develop the standards and policies necessary to connect existing health information technologies to increase timely use of PDMP data by providers, emergency department providers, and pharmacists.

Project Objectives Connect PDMPs to health IT systems using existing technologies Improve timely access to PDMP data Establish standards for facilitating information exchangeReduce prescription drug misuses and overdoses in the United States

2-Part Project•  Work groups will convene to develop and recommend the standards and policies necessary to carry out the pilot projects.•  Pilot studies will test the feasibility of leveraging health information technology and HIEs to improve timely access to PDMP data.

Work GroupsNumber/Name Purpose1: Data Content and To determine the data content and vocabulary necessary to supportVocabulary data exchange between Prescription Drug Monitoring Programs (PDMP) and recipients.2: Information Usability To determine how PDMP information will be presented in the userand Presentation interfaces for pharmacy systems and provider and ED Electronic Health Records (EHR) to maximize the value of this data for the treatment and dispensing decision-making processes.3: Transport and To explore and develop the technical specifications for dataArchitecture transmission (e.g., REST, SOAP, Direct) between PDMPs and a variety of recipient systems and intermediaries.4: Law and Policy To explore legal and policy issues in support of program objectives, including PDMP data access within various recipient settings, use of intermediaries to enable PDMP data exchange and specific Pilot Program scenarios in the context of specific state(s).5: Business Agreements To analyze the current business environment relevant to the use offor Intermediaries intermediaries (e.g., Switches, HIEs) to route transmissions between PDMPs and data recipients.

Recipients of PDMP Data•  Three communities have been identified that have the potential to make clinical decisions about prescribing

Leveraging Health IT•  Improve access to PDMP information at the point of patient care•  Use existing technologies to facilitate exchange of information: –  Electronic Health Record Systems –  Unsolicited messaging (Direct) –  Query-based messaging –  Switches –  Health Information Exchanges –  Other intermediaries•  We are also open to new approaches to enhancing access to PDMP data

Pilot: Concepts Overview Data Access Point Trigger Intermediary• Provider • Registration • None • E-Rx • Insurance • HIEs: • EHR • Eligibility Check • State • Emergency • Claims Check • Other Room (ER) • E-Rx • PMP Hubs• Dispenser • Provider • RxCheck (PMIX) • Pharmacy • PMP • Admission / Interconnect Discharge / • Networks: Transfer (ADT) • Surescripts Transaction • Relay Health Standard • Other • Other • Other

Sample Use Case: Provider

Sample Use Case: Emergency Department

Sample Use Case: Pharmacist 31

Project Structure and Objectives Pag e 32

Projected Results•  Recommendations on policies/law around the use of PDMP data by providers or dispensers•  Feasible, vendor-independent, technical solutions that are scalable and useable by states•  New levels of cooperation among health IT sectors around PDMP•  Increased provider utilization of PDMPs•  Reduced prescription drug misuse and overdose

Contact InformationONC:•  Kate Tipping – Kate.Tipping@hhs.govSAMHSA:•  Jinhee Lee – Jinhee.Lee@samhsa.hhs.govMITRE:•  Jeffrey Hammer – jmhammer@mitre.org

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