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New	  PDMP	  Developments	  	          LCDR	  Chris	  Jones,	  PharmD,	  MPH	  Prescrip3on	  Drug	  Overdose	  Team,	  Div...
Learning	  Objec3ves	  	  1.  Explain	  a	  Prescrip3on	  Drug	  Monitoring	  Program	      (PDMP)	  2.  Inves3gate	  the	...
Prescrip;on	  Drug	  Monitoring	  Programs	         The	  Na;onal	  Perspec;ve	                 Christopher	  M.	  Jones,	...
Learning	  Objec;ves	  •  Describe	  the	  current	  PDMP	  landscape	  in	  the	     US	  •  Discuss	  the	  role	  of	  ...
Presenta;on	  overview	  •  PDMP	  background	  and	  role	  •  PDMP	  best	  prac;ces	  Overview	  of	  Presenta;on	  •  ...
Prescrip;on	  Drug	  Abuse	  Preven;on	  Plan	   •  Blueprint	  for	  Federal	      Agency	  efforts	  on	      prescrip3on...
What	  are	  PDMPs?	  •  State	  databases	  that	  collect	  informa3on	  on	  controlled	     prescrip3ons	  drugs	  dis...
How	  can	  PDMPs	  be	  Used?	  •    Clinical	  •    Regulatory	  Oversight	  	  •    Surveillance	  and	  Evalua;on	  To...
Current	  Status	  of	  PDMPs	      49	  States	  have	  legisla;on	  authorizing	  a	  PDMP	      Opera;onal	  in	  43	...
Presenta;on	  Overview	  •  PDMP	  background	  and	  role	  •  PDMP	  goals	  and	  best	  prac;ces	  Overview	  of	  Pre...
PDMP	  Goals	  •  All	  states	  have	  PDMPs	  •  Mechanisms	  in	  place	  for	  communica3on	  between	     states	  (i...
PDMP	  Best	  Prac;ces	  •    Outlines	  a	  set	  of	  best	  prac;ces	  	  •    Research	  agenda	  •    PDMP	  Funding	...
Presenta;on	  Overview	  •  PDMP	  background	  and	  role	  •  PDMP	  goals	  and	  best	  prac;ces	  Overview	  of	  Pre...
PDMP	  Effec;veness	                                                            peer-­‐reviewed	  literature	              ...
PDMP	  Effec;veness	                                              peer-­‐reviewed	  literature	  •           2012	  analysi...
PDMP	  Effec;veness	                                                                                 grey	  literature	    ...
PDMP	  Effec;veness	  	                                                                                grey	  literature	  ...
Presenta;on	  Overview	  •    PDMP	  background	  and	  role	  •    PDMP	  goals	  and	  best	  prac;ces	  •    PDMP	  effe...
Current	  PDMP	  Ini;a;ves	  •    Interoperability	  •    Health	  Informa;on	  Technology	  and	  PDMP	  Pilot	  programs...
Conclusions	  •    PDMPs	  can	  be	  very	  useful	  for	  clinical,	  surveillance,	       evalua;on,	  and	  regulatory...
Thank	  You	                         Christopher M. Jones, PharmD, MPH                                cjones@cdc.govThe fi...
Josh BolinGovernment Affairs Director
PMIX	  Architecture 	  	  •  Harold	  Rogers	  Prescrip3on	  Drug	  Monitoring	     Program	  Grants	  	  •  Sponsored	  b...
Problems	  with	  PMPs:	  •  Persons	  engaging	  in	  doctor	  shopping	  don’t	  stay	  in	  one	  state,	     par3cular...
•  Creates	  interoperability	  for	  individual	  state	  PMPs	  via	  a	     hub	  system	  •  Authorized	  users	  log	...
•  All	  protected	  health	  informa3on	  is	  encrypted	  and	  not	  visible	  to	  the	     hub,	  secure,	  and	  HIP...
Cost	  for	  States	  to	  Par3cipate	  •  $0	  par3cipa3on	  costs,	  although	  may	  incur	     some	  costs	  by	  the...
•  14	  PMPs-­‐-­‐Arizona,	  Connec3cut,	  Illinois,	  Indiana,	  Kansas,	     Michigan,	  New	  Mexico,	  North	  Dakota,...
Integra3on	  Projects	  •  Leveraging	  our	  growing	  “na3onal	  network”	  •  Guidance	  from	  PMP	  InterConnect	  St...
MAPS/Electronic	  Prescribing	  Sovware	  
MAPS/Electronic	  Prescribing	  Sovware	  
PDMP	  Workshop:	   Data	  Integra;on	       April	  2	  –	  4,	  2013	     Omni	  Orlando	  Resort	  	      at	  Champion...
Topics	  for	  Discussion	  	  •  Status	  of	  Indiana	  PDMP	  pre-­‐data	     integra3on	  and	  mo3va3on	  to	  increa...
LICENSE	  TYPE	                         UNREGISTERED	     REGISTERED	     TOTAL	  	     %	  REGISTERED	  CLINICAL	  NURSE	...
Username:MallainPassword:27%9874M
Workflow	  Ready	  	                       	  
Pilot	  I	  Survey	  Results	  •  There	  was	  a	  58%	  reduc;on	  in	  either	  prescrip3ons	  wrigen	  or	  number	  o...
#	  Pts.	  w/	  8+	  Rxs.	  in	  60	  days	          WEEK END     START                           8+                      ...
Patient, Dummy, DOB: 25-Apr-1973 (39 yrs) Male
Patient, Dummy, DOB: 25-Apr-1973 (39 yrs) Male
Patient, Dummy, DOB: 25-Apr-1973 (39 yrs) Male
Patient, Dummy, DOB: 25-Apr-1973 (39 yrs) Male
Patient, Dummy, DOB: 25-Apr-1973 (39 yrs) Male
Pilot	  II	  Preliminary	  Findings	  	  
New pdmp developments_final
New pdmp developments_final
New pdmp developments_final
New pdmp developments_final
New pdmp developments_final
New pdmp developments_final
New pdmp developments_final
New pdmp developments_final
New pdmp developments_final
New pdmp developments_final
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New pdmp developments_final

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PDMP Workshop: New PDMP Developments
National Rx Drug Abuse Summit
April 2-4, 2013
Presentation by LCDR Chris Jones,

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New pdmp developments_final

  1. 1. New  PDMP  Developments     LCDR  Chris  Jones,  PharmD,  MPH  Prescrip3on  Drug  Overdose  Team,  Division  of  Uninten3onal  Injury  Preven3on,  Centers   for  Disease  Control  and  Preven3on     Josh  Bolin     Government  Affairs  Director,  Na3onal   Associa3on  of  Boards  of  Pharmacy     Marty  Allain     Director,  INSPECT    
  2. 2. Learning  Objec3ves    1.  Explain  a  Prescrip3on  Drug  Monitoring  Program   (PDMP)  2.  Inves3gate  the  efficiency  and  effec3veness  of   state-­‐level  programs  to  make  improvements.  3.  Outline  strategies  to  enhance  collabora3ons   with  law  enforcement,  prosecutors,  treatment   professionals,  the  medical  community,   pharmacies,  and  regulatory  boards  to  establish  a   comprehensive  PDMP  strategy.  
  3. 3. Prescrip;on  Drug  Monitoring  Programs   The  Na;onal  Perspec;ve   Christopher  M.  Jones,  PharmD,  MPH   LCDR,  US  Public  Health  Service     Centers  for  Disease  Control  and  Preven3on   April  2  –  4,  2013   Omni  Orlando  Resort     at  ChampionsGate  
  4. 4. Learning  Objec;ves  •  Describe  the  current  PDMP  landscape  in  the   US  •  Discuss  the  role  of  PDMPs  in  reducing   prescrip3on  drug  abuse  and  overdose  •  Describe  the  evidence-­‐base  suppor3ng  PDMPs  •  Describe  PDMP  best  prac3ces  •  Discuss  new  opportuni3es  for  PDMPs  
  5. 5. Presenta;on  overview  •  PDMP  background  and  role  •  PDMP  best  prac;ces  Overview  of  Presenta;on  •  PDMP  effec;veness  •  Current  ini;a;ves   5  
  6. 6. Prescrip;on  Drug  Abuse  Preven;on  Plan   •  Blueprint  for  Federal   Agency  efforts  on   prescrip3on  drug  abuse   •  4  focus  areas   –  Educa3on   –  Prescrip3on  Drug   Monitoring  Programs   –  Proper  Medica3on   Disposal   –  Enforcement  
  7. 7. What  are  PDMPs?  •  State  databases  that  collect  informa3on  on  controlled   prescrip3ons  drugs  dispensed  by  pharmacies  (and  dispensing   physicians  in  some  states)    •  Data  Collected     –  CII-­‐CIV  drugs  (some  CV)   –  Prescriber   –  Dispenser   –  Pa3ent   –  Date  dispensed   –  Drug   –  Strength   –  Quan3ty   –  Refills     –  Method  of  payment  •  Varia3on  in  state  programs  
  8. 8. How  can  PDMPs  be  Used?  •  Clinical  •  Regulatory  Oversight    •  Surveillance  and  Evalua;on  Tool  •  Law  Enforcement  •  Passive  vs  Proac;ve   8  
  9. 9. Current  Status  of  PDMPs    49  States  have  legisla;on  authorizing  a  PDMP    Opera;onal  in  43  states   9  
  10. 10. Presenta;on  Overview  •  PDMP  background  and  role  •  PDMP  goals  and  best  prac;ces  Overview  of  Presenta;on  •  PDMP  effec;veness  •  Current  ini;a;ves   10  
  11. 11. PDMP  Goals  •  All  states  have  PDMPs  •  Mechanisms  in  place  for  communica3on  between   states  (interoperability)  •  Incorporated  in  to  normal  workflow  by  leveraging  HIT   (EHRs/HIEs)  •  High  u3liza3on  among  healthcare  providers  •  Improved  clinical  care  and  reduced  misuse,  abuse,   and  overdose  from  controlled  substances  
  12. 12. PDMP  Best  Prac;ces  •  Outlines  a  set  of  best  prac;ces    •  Research  agenda  •  PDMP  Funding  •  A  few  best  prac;ces   •  Allow  access  to  prescribers  and  dispensers   •  Allow  access  to  regulatory  boards,  state   Medicaid  and  public  health  agencies,  Medical   Examiners,  and  law  enforcement  (under   appropriate  circumstances)   •  Provide  real-­‐3me  data     •  Share  data  with  other  states  (interoperability)   •  Integrate  with  other  health  informa3on   technologies  to  improve  use  among  health   care  providers   •  Have  ability  to  send  unsolicited  reports   •  Use  PDMP  data  to  iden3fy  high-­‐risk  pa3ents     •  Use  PDMP  data  to  iden3fy  outlier  prescribers   12  
  13. 13. Presenta;on  Overview  •  PDMP  background  and  role  •  PDMP  goals  and  best  prac;ces  Overview  of  Presenta;on  •  PDMP  effec;veness  •  Current  ini;a;ves   13  
  14. 14. PDMP  Effec;veness   peer-­‐reviewed  literature   •  Research  consistently  suggests  PDMPs   reduce  prescribing  of  schedule  II  opioid   analgesics.     •  One  study  found  compensatory  increases  in   schedule  III  opioids.   •  2009  study  found  states  with  PDMPs  had   lower  opioid  substance  abuse  treatment   rates  compared  to  states  without  PDMPs.   •  A  recent  randomized  trial  of  use  of  proac;ve   repor;ng  by  an  insurer  rather  than  a  PMDP   suggests  such  repor;ng  reduces  the  number   of  prescribers  and  prescrip;ons.      1.  Simeone  R,  Holland  L.  Washington,  D.C.:  U.S.  Dept.  of  Jus3ce,  Office  of  Jus3ce  Programs2006  2006.  hgp://www.simeoneassociates.com/simeone3.pdf    2.  Cur3s  LH,  Stoddard  J,  Radeva  JI,  Hutchison  S,  Dans  PE,  Wright  A,  et  al.  Geographic  varia3on  in  the  prescrip3on  of  schedule  II  opioid  analgesics  among  outpa3ents  in  the  United  States.  Health  Serv  Res.  2006  2006;41:837-­‐55.  3.  Paulozzi  L,  Kilbourne  E,  Desai  H.  Prescrip3on  drug  monitoring  programs  and  death  rates  from  drug  overdose.  Pain  Medicine.  2011;12:747-­‐54.  4.  Reisman  RM,  Shenoy  PJ,  Atherly  AJ,  Flowers  CR.  Prescrip3on  opioid  usage  and  abuse  rela3onships:  an  evalua3on  of  state  prescrip3on  drug  monitoring  program  efficacy.  Substance  Abuse:  Research  and  Treatment.  2009;3(SART-­‐3-­‐Shenoy-­‐et-­‐al):41.  5.  Gonzalez  A,  Kolbasovsky  A.  Impact  of  a  managed  controlled-­‐opioid  prescrip3on  monitoring  program  on  care  coordina3on.  Am  J  Manag  Care.  2012;18(9):516-­‐24.   14  
  15. 15. PDMP  Effec;veness   peer-­‐reviewed  literature  •  2012  analysis  of  Poison  Control  Center  data  concluded  states  with   PDMPs  had  lower  annual  increases  in  opioid  misuse  or  abuse  from   2003-­‐2009    •  Use  of  PDMP  data  in  an  ED  suggests  it  can  change  prescribing.     PDMP  data  review  changed  prescribing  in  41%  of  cases     •  61%  received  fewer  or  no  opioids   •  39%  received  more  opioid  medica3on  than  previously  planned  •  Impact  on  overdose  mortality  has  not  been  found,  at  least  based   on  data  through  2005.      1.  Reifler  L,  Droz  D,  Bailey  J,  Schnoll  S,  Fant  R,  Dart  R,  et  al.  Do  prescrip3on  monitoring  programs  impact  state  trends  in  opioid  abuse/misuse?  Pain  Medicine.  2012;3(3):434-­‐42.  2.  Baehren  DF,  Marco  CA,  Droz  DE,  Sinha  S,  Callan  EM,  Akpunonu  P.  A  statewide  prescrip3on  monitoring  program  affects  emergency  department  prescribing  behaviors.  Ann  Emerg  Med.  2009  2009;doi:10.1016/j.annemergmed.2009.12.011.  3.  Paulozzi  L,  Kilbourne  E,  Desai  H.  Prescrip3on  drug  monitoring  programs  and  death  rates  from  drug  overdose.  Pain  Medicine.  2011;12:747-­‐754.   15  
  16. 16. PDMP  Effec;veness   grey  literature   •  Surveys  indicate  prescribers  find  PDMPs  to  be  a  useful   clinical  tool.   •  Surveys  find  clinicians  in  many  cases  report  altering  their   prescribing  a]er  reviewing  a  PDMP  report.   •  Proac;ve  repor;ng  reduces  doctor  shopping  by  increasing   awareness  among  providers  about  at-­‐risk  pa;ents  leading  to   changes  in  prescribing  behaviors.  1.  PMP  Center  of  Excellence,  “ Trends  in  Wyoming  PMP  prescrip3on  history  repor3ng:  evidence  for  a  decrease  in  doctor  shopping?”  2010,  hgp://www.pmpexcellence.org/sites/all/pdfs/NFF_wyoming_rev_11_16_10.pdf    2.  PMP  Center  of  Excellence,  “Nevada’s  Proac3ve  PMP:  The  Impact  of  Unsolicited  Reports”  October,  2011.  hgp://www.pmpexcellence.org/sites/all/pdfs/nevada_nff_10_26_11.pdf    4.  Alliance  of  States  with  Prescrip3on  Monitoring  Programs,  “An  Assessment  of  State  Prescrip3on  Monitoring  Program  Effec3veness  and  Results”  Version  1,  11.30.07,  hgp://pmpexcellence.org/pdfs/alliance_pmp_rpt2_1107.pdf  5.  Kentucky  Cabinet  for  Health  and  Family  Services  and  Kentucky  Injury  Preven3on  and  Research  Center,  2010  KASPER  Sa3sfac3on  Survey.    6.  Lambert  D.  Impact  evalua3on  of  Maine’s  prescrip3on  drug  monitoring  program.  Muskie  School  of  Public  Service,  University  of  Southern  Maine:  Portland,  Maine,  March,  2007.  7.  Communica3on  from  LA  PMP  to  PMP  Center  of  Excellence.   16  
  17. 17. PDMP  Effec;veness     grey  literature   •  Public  safety  officials  have   endorsed  the  u3lity  of  PDMPs.   •  A  2010  survey  found  73%  of  KY  law   enforcement  officers  who  used   PDMP  data  strongly  agreed  that     the  PDMP  was  an  excellent  tool  for   obtaining  evidence  in  the   inves3ga3ve  process.   •  2002  GAO  report  concluded  that   PDMPs  are  a  useful  tool  to  reduce   drug  diversion.    1.  PMP  Center  of  Excellence.  Perspec3ve  from  Kentucky:  using  PMP  data  in  drug  diversion  inves3ga3ons.  May,  2011.    hgp://www.pmpexcellence.org/sites/all/pdfs/NFF_kentucky_5_17_11_c.pdf  2.  U.S.  General  Accoun3ng  Office.  Prescrip3on  Drugs:  State  Monitoring  Programs  Provide  Useful  Tool  to  Reduce  Diversion.  Washington,  DC:  U.S.  General  Accoun3ng  Office;  2002.  Report  No.  GAO-­‐02-­‐634   17  
  18. 18. Presenta;on  Overview  •  PDMP  background  and  role  •  PDMP  goals  and  best  prac;ces  •  PDMP  effec;veness  •  Current  ini;a;ves   18  
  19. 19. Current  PDMP  Ini;a;ves  •  Interoperability  •  Health  Informa;on  Technology  and  PDMP  Pilot  programs  •  PDMP  Interoperability  and  Electronic  Health  Record   Integra;on  Project  •  Interagency  Working  Group  subcommi^ee  on  PDMP   integra;on  •  Providing  technical  assistance  to  states  and  others  to:   •  Focus  efforts  on  pa3ents  at  highest  risk  of  abuse  and  overdose     •  Focus  on  prescribers  devia3ng  from  accepted  medical  prac3ce   •  Maximize  surveillance  and  evalua3on  capabili3es  of  PDMPs  •  PDMP  evalua;ons   19  
  20. 20. Conclusions  •  PDMPs  can  be  very  useful  for  clinical,  surveillance,   evalua;on,  and  regulatory  purposes  •  Best  prac;ces  need  to  be  implemented  to  maximize  u;lity  of   PDMPs  •  Incorpora;on  into  clinical  workflow  can  increase  u;liza;on   among  health  care  providers  •  Public  health  and  public  safety  must  partner  to  make  the   most  use  of  PDMP  data   20  
  21. 21. Thank  You   Christopher M. Jones, PharmD, MPH cjones@cdc.govThe findings and conclusions in this report are those of the author and do not necessarily represent the views of the Centers for Disease Control and Prevention.
  22. 22. Josh BolinGovernment Affairs Director
  23. 23. PMIX  Architecture    •  Harold  Rogers  Prescrip3on  Drug  Monitoring   Program  Grants    •  Sponsored  by  the  Bureau  of  Jus3ce  Assistance  •  Prescrip3on  Monitoring  Program  Informa3on   Exchange  (PMIX)  Architecture  is  an   interoperability  infrastructure  that  seeks  to   facilitate  interstate  data  sharing  between   PMPs  or  “Hubs”  
  24. 24. Problems  with  PMPs:  •  Persons  engaging  in  doctor  shopping  don’t  stay  in  one  state,   par3cularly  areas  that  border  other  states  •  Querying  the  state  PMP  may  not  give  a  complete  picture  to  a   physician  or  pharmacist  of  the  controlled  substances  a  person  is   obtaining    •  Low  U3liza3on/Lack  of  Integra3on  •  PMPs  lack  func3on  and  Analy3cal  Tools  
  25. 25. •  Creates  interoperability  for  individual  state  PMPs  via  a   hub  system  •  Authorized  users  log  into  their  own  state  PMP  and  check   boxes  for  other  par3cipa3ng  states  from  which  they   want  data  •  The  hub  routes  the  requests  to  the  various  states  and   the  informa3on  back  to  the  authorized  user  in  one   collated  report  
  26. 26. •  All  protected  health  informa3on  is  encrypted  and  not  visible  to  the   hub,  secure,  and  HIPAA  compliant   –  No  protected  health  informa3on  stored  by  the  hub,  just  a  pass  through   from  one  state  to  the  authorized  requestor  in  another  state  •  Easy  for  states   –  Only  sign  one  memorandum  of  understanding  (MOU)/contract  with   NABP  –  do  not  have  to  sign  one  for  every  other  state  to  exchange  data   –  Each  state’s  rules  about  access  are  enforced  automa3cally  by  the  hub  •  Governed  by  states  via  PMP  InterConnect  Steering  Commigee  •  July  2011  went  live  and  today…since  launch,  PMP  InterConnectTM  has   processed  nearly  1.5  million  requests  in  an  average  of  7.8  seconds  to   process  a  request.      
  27. 27. Cost  for  States  to  Par3cipate  •  $0  par3cipa3on  costs,  although  may  incur   some  costs  by  their  own  PMP  sovware   companies  •  NABP  paying  from  its  own  revenues  (exams/ accredita3ons)  •  Harold  Rogers  Prescrip3on  Monitoring   Program  Grants  •  NABP  Founda3on  Grants  
  28. 28. •  14  PMPs-­‐-­‐Arizona,  Connec3cut,  Illinois,  Indiana,  Kansas,   Michigan,  New  Mexico,  North  Dakota,  Ohio,  South   Carolina,  South  Dakota,  and  Virginia  are  ac3vely  sharing   data  •  Colorado,  Delaware,  Louisiana,  Tennessee  and  West   Virginia  should  all  be  connected  and  sharing  data  by  the   end  of  Q2  •  Arkansas,  Idaho,  Minnesota,  Mississippi,  Nevada  and   Utah  have  executed  agreements  to  par3cipate  
  29. 29. Integra3on  Projects  •  Leveraging  our  growing  “na3onal  network”  •  Guidance  from  PMP  InterConnect  Steering   Commigee  •  ONC  Pilots  •  3rd  Party  Inquiries   –  Networks   –  Electronic  Medical  Records   –  Pharmacy     –  Health  Informa3on  Exchanges  
  30. 30. MAPS/Electronic  Prescribing  Sovware  
  31. 31. MAPS/Electronic  Prescribing  Sovware  
  32. 32. PDMP  Workshop:   Data  Integra;on   April  2  –  4,  2013   Omni  Orlando  Resort     at  ChampionsGate  
  33. 33. Topics  for  Discussion    •  Status  of  Indiana  PDMP  pre-­‐data   integra3on  and  mo3va3on  to  increase   use;  •  Challenges  to  using  program  via  Web;  •  Integra3on  efforts  and  INPC  partner;  •  Pilot  I  results;  •  Integra3on  efforts  +  NarxCheck;  and  •  Pilot  II  results.  
  34. 34. LICENSE  TYPE   UNREGISTERED   REGISTERED   TOTAL     %  REGISTERED  CLINICAL  NURSE  SPECIALIST   61   73   134   54%  CSR-­‐CERTIFIED  NURSE  MIDWIFE   42   16   58   28%  CSR-­‐OSTEOPATHIC  PHYSICIAN   680   524   1204   44%  CSR-­‐PHYSICIAN   10885   5256   16141   33%  DENTIST   2030   1149   3179   36%  NURSE  PRACTITIONER   1599   1382   2981   46%  PHARMACIST   7002   2903   9905   29%  PHYSICIAN  ASSISTANT   362   250   612   41%  PODIATRIST   229   101   330   31%  RESIDENT   1204   95   1299   7%  VETERINARIAN   1360   34   1394   2%  TOTALS   25454   11783   37237   32%  
  35. 35. Username:MallainPassword:27%9874M
  36. 36. Workflow  Ready      
  37. 37. Pilot  I  Survey  Results  •  There  was  a  58%  reduc;on  in  either  prescrip3ons  wrigen  or  number  of   pills  prescribed.  •  In  72%  of  cases  there  was  more  informa;on  in  the  report  than  the   physician  was  aware  of.  •  100%  reported  that  integrated  report  was  easier  to  use.  •  2  out  of  3  accessing  report  in  INPC  not  registered  w/  INSPECT  •  Worst  offenders  are  less  ac3ve  •  Requests  increased  from  5,000  to  9,000  daily  •  “I  have  to  say  that  this  is  probably  one  of  the  more  genius  moves  of  the   21st  century.    Having  easy  access  to  INSPECT  without  going  to  a  totally   different  website  and  have  it  pop  up  instantly  has  taken  a  lot  of  Eme  off   of  decision  making  for  me.    Thanks  for  spearheading  it.”                      Wishard  ER  Physician  
  38. 38. #  Pts.  w/  8+  Rxs.  in  60  days   WEEK END START 8+ 8+ 9+ 10+ START 9+ END 8+ 10+9+ 10+ DATE DATE DATE DATE 1 -23 -20 -121 2 1/8/2012 11/9/2011 -13 146 66 33 -24 -322 3 11/16/2011 1/15/2012 134 -19 67 37 2 -27 11/14/2012 1/13/2013 116-42 51 253 4 11/23/2011 1/22/2012 135 -21 71 38 3 -49 11/21/2012 1/20/2013 109-26 52 224 5 11/30/2011 1/29/2012 136 -14 59 39 4 -25 11/28/2012 1/27/2013 107-37 30 295 6 2/5/2012 12/7/2011 125 -21 63 41 5 -36 12/5/2012 2/3/2013 107-46 47 266 7 12/14/2011 2/12/2012 133 -22 61 35 6 -46 12/12/2012 2/10/2013 105-62 39 197 8 12/21/2011 2/19/2012 -29 130 71 37 7 -33 12/19/2012 2/17/2013 -59 101 38 148 12/28/2011 2/26/2012 143 64 32 8 12/26/2012 2/24/2013 102 43 13
  39. 39. Patient, Dummy, DOB: 25-Apr-1973 (39 yrs) Male
  40. 40. Patient, Dummy, DOB: 25-Apr-1973 (39 yrs) Male
  41. 41. Patient, Dummy, DOB: 25-Apr-1973 (39 yrs) Male
  42. 42. Patient, Dummy, DOB: 25-Apr-1973 (39 yrs) Male
  43. 43. Patient, Dummy, DOB: 25-Apr-1973 (39 yrs) Male
  44. 44. Pilot  II  Preliminary  Findings    

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