PDMP Workshop-2 New Focuses for PDMP's Efforts National Rx Drug Abuse Summit April 2-4, 2013 Jennifer Frazier, Jinhee Lee, Len Young and Mike Small

1. New
Focuses
for
PDMP’s
Efforts
Jennifer
Frazier,
MPH
Office
of
the
Na7onal
Coordinator
for
Health
Informa7on
Technology
Jinhee
Lee,
PharmD
Substance
Abuse
and
Mental
Health
Services
Administra7on
Len
Young
Epidemiologist,
MassachuseIs
Department
of
Public
Health
Mike
Small
Department
of
Jus7ce
Administrator
II,
California
Department
of
Jus7ce

2. Learning
Objec7ves
1. Outline
strategies
to
enhance
exis7ng
programs’
abili7es
to
analyze
and
use
collected
data
to
iden7fy
drug
abuse
trends.
2. Explain
how
to
enhance
exis7ng
programs’
ability
to
analyze
and
use
collected
data.
3. Outline
new
opportuni7es
for
PDMP
to
effec7vely
iden7fy
doctor
shoppers.

3. Disclosure
Statement
• Jennifer
Frazier
has
no
financial
rela7onships
with
proprietary
en77es
that
produce
health
care
goods
and
services.
• Jinhee
Lee
has
no
financial
rela7onships
with
proprietary
en77es
that
produce
health
care
goods
and
services.
• Len
Young
has
no
financial
rela7onships
with
proprietary
en77es
that
produce
health
care
goods
and
services.
• Mike
Small
has
no
financial
rela7onships
with
proprietary
en77es
that
produce
health
care
goods
and
services.

4. FEDERAL
HEALTH
IT
INTERVENTIONS
TO
COMBAT
PRESCRIPTION
DRUG
ABUSE
&
OVERDOSE
Jennifer Frazier, MPH
Office of the National Coordinator for Health Information
Technology
Jinhee Lee, PharmD
Substance Abuse and Mental Health Services
Administration

5. Outline
• PDMPs:
The
Context
• SAMHSA
PDMP
RFA
• ONC-­‐SAMHSA
Project
–Phase
I
• ONC-­‐SAMHSA
Project
–Phase
II
• Next
Steps

6. 1.
PDMPS:
THE
CONTEXT

7. The
Problem
• The
Centers
for
Disease
Control
and
Preven7on
(CDC)
declared
that
deaths
from
prescrip7on
painkillers
now
outnumber
deaths
from
heroin
and
cocaine
combined
• Prescrip7on
drug
abuse
deaths
is
one
of
the
fas7ng
growing
public
health
epidemics,
outpacing
deaths
from
traffic
fatali7es

8. Past
Month
Illicit
Drug
Use
among
Persons
Aged
12
or
Older:
2011
Illicit
Drugs
1
22.5
(8.7%)
Marijuana
18.1
(7.0%)
PsychotherapeuXcs
6.1
(2.4%)
Cocaine
1.4
(0.5%)
Hallucinogens
1.0
(0.4%)
Inhalants
0.6
(0.2%)
Heroin
0.3
(0.1%)
0
5
10
15
20
25
Numbers
in
Millions
1
Illicit
Drugs
include
marijuana/hashish,
cocaine
(including
crack),
heroin,
hallucinogens,
inhalants,
or
prescrip7on-­‐type
psychotherapeu7cs
used
nonmedically
(pain
relievers,
s7mulants,
tranquilizers,
seda7ves).
Source:
2011
NSDUH

9. Past
Year
IniXates
of
Specific
Illicit
Drugs
among
Persons
Aged
12
or
Older:
2011
Numbers
in
Thousands
3,000
2,617
2,500
2,000
1,888
1,500
1,204
1,000
922
719
670
670
500
358
178
159
48
0
Pain
Relievers
Ecstasy
Cocaine
LSD
SedaXves
Marijuana
Tranquilizers
Inhalants
SXmulants
Heroin
PCP
Note:
Numbers
refer
to
persons
who
used
a
specific
drug
for
the
first
7me
in
the
past
year,
regardless
of
whether
ini7a7on
of
other
drug
use
occurred
prior
to
the
past
year.
Source:
2011
NSDUH

10. Received
Most
Recent
Treatment
in
the
Past
Year
for
the
Use
of
Pain
Relievers
among
Persons
Aged
12
or
Older:
2002-­‐2011
Numbers
in
Thousands
800
761
736
726
700
604
600
547
565
500
466+
415+
424+
400
360+
300
200
100
0
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
+
Difference
between
this
es7mate
and
the
2011
es7mate
is
sta7s7cally
significant
at
the
.05
level.
Source:
2011
NSDUH

11. Federal
Strategy
to
Address
the
Problem
of
PrescripXon
Drug
Abuse
• In
2011
ONDCP
released
the
Prescrip7on
Drug
Abuse
Preven7on
Plan,
which
includes
4
major
areas
of
ac7on
to
reduce
prescrip7on
drug
abuse:
– Educa7on,
– Monitoring,
– Proper
Disposal,
and
– Enforcement
• PDMPs
are
at
the
core
of
the
Monitoring
ac7vi7es.
Source:
Epidemic:
Responding
to
America’s
Prescrip7on
Drug
Abuse
Crisis,
(2011),
retrieved
from
hIp://www.whitehouse.gov/sites/default/
files/ondcp/policy-­‐and-­‐research/rx_abuse_plan.pdf

12. SAMHSAs
Strategic
Ini7a7ves
• Preven7on
of
Substance
Abuse
&
Mental
Illness
• Trauma
and
Jus7ce
• Military
Families
• Recovery
Support
• Health
Reform
• Health
Informa7on
Technology
• Data,
Outcomes,
and
Quality
• Public
Awareness
and
Support

13. ONC’s
Strategic
Plan
Goals:
• Achieve
adopXon
and
informaXon
exchange
through
meaningful
use
of
health
IT
• Support
health
IT
adop7on
and
informa7on
exchange
in
long-­‐
term/post-­‐acute
care,
behavioral
health
and
emergency
sehngs.
• Improve
care,
improve
popula7on
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
13

14. 2.
SAMHSA
PDMP
GRANT
PROGRAM

15. PDMP
EHR
Coopera7ve
Agreements
• Provided
two
year
funding
for
9
states
(FL,
IN,
IL,
KS,
ME,
OH,
TX,
WA,
WV)
• Purpose
–
1)improve
real-­‐7me
access
to
PDMP
data
by
integra7ng
PDMPs
into
exis7ng
technologies
like
EHRs
and
2)
strengthen
currently
opera7onal
state
PDMPs
by
increasing
interoperability
between
states
• Evaluate
whether
these
enhancements
have
an
impact
on
prescrip7on
drug
abuse

16. Enhancing
Access
to
Prescrip<on
Drug
Monitoring
Programs
3.
ONC/SAMHSA
PROJECT:
PHASE
1

17. The
Story
So
Far
Federal & State Partners
Action Plan
State Participants
Stakeholders
White
House
Roundtable
on
Health
IT
&
PrescripXon
Drug
Abuse
Organizations
June
3,
2011

18. Situa7on
Today
• Providers
and
dispensers
need
prescrip7on
drug
history
informa7on
to
improve
clinical
decision
making
– They
don’t
receive
the
data
they
need
from
PDMPs
• Health
IT
is
the
link
to
connect
prescribers
and
dispensers
with
the
valuable
data
in
PDMPs
• From
the
local
to
na7onal
level
–
never
a
greater
7me
of
ac7on
centered
around
PDMPs
and
their
value
• Increasing
number
of
projects
centered
on
PDMPs
and
health
IT
connec7vity

19. Project
Structure
and
Objec7ves
Improve
clinician
workflow
by
connecXng
Provide
recommenda7ons
PDMPs
to
health
IT
and
pilot
input
Support
Xmely
decision-­‐making
at
the
point
of
care
Test
the
feasibility
Establish
standards
for
of
using
health
IT
to
facilita7ng
informa7on
enhance
PDMP
access
exchange
Reduce
prescrip<on
drug
misuse
and
overdose
in
the
United
States
19

20. PDMP
Impediments
Low
Usage
Emergency
Department
Prescriber
Limita7ons
on
Authorized
Users
Current
Processes
Do
Not
Support
Clinical
Workflows
Ambulatory
Prescriber
Low
Technical
Maturity
to
Support
Interoperability
Lack
of
Business
Agreements
Dispenser

21. Work
Groups
Number/Name
Purpose
1:
Data
Content
and
To
determine
the
data
content
and
vocabulary
necessary
to
support
data
exchange
Vocabulary
between
Prescrip7on
Drug
Monitoring
Programs
(PDMP)
and
recipients.
2:
Informa7on
Usability
and
To
determine
how
PDMP
informa7on
will
be
presented
in
the
user
interfaces
for
Presenta7on
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
specifica7ons
for
data
transmission
(e.g.,
REST,
Architecture
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
objec7ves,
including
PDMP
data
access
within
various
recipient
sehngs,
use
of
intermediaries
to
enable
PDMP
data
exchange
and
specific
Pilot
Program
scenarios
in
the
context
of
specific
state
(s).
5:
Business
Agreements
for
To
analyze
the
current
business
environment
relevant
to
the
use
of
intermediaries
Intermediaries
(e.g.,
Switches,
HIEs)
to
route
transmissions
between
PDMPs
and
data
recipients.
21

22. Work
Group
Recommenda7ons
Summary
PEOPLE
DATA
AGREEMENTS
Automate/streamline
registra7on
process
Standard
set
of
data
Business
Agreements
Expand
authorized
user
pool
Adopt
data
exchange
Business
Associate
standard
(NIEM-­‐PMP)
Agreements
Appoint
delegates
Increase
protec7on
Real-­‐7me
transmission
USEFULLNESS
INTEGRATION
Info
for
clinical
decisions
Integrate
access
with
EHR
Workflow-­‐based
System-­‐level
access
Improve
unsolicited
Standardize
PDMP
repor7ng
interfaces
48
Findings
and
11
Products

23. Pilot
States
and
Summary
23

24. Pilot
States
and
Summary
Automated
query
to
PDMP
upon
Indiana
Emergency
pa7ent
admission
to
ED
Automated
query
and
response,
(IN1)
Department
streamlined
workflow
for
physicians
PDMP
data
integrated
into
EHR
Indiana
Safer,
more
secure
transmission
of
Provider
Unsolicited
PDMP
reports
sent
via
Direct
(IN2)
unsolicited
reports

25. Pilot
States
and
Summary
(cont.)
Automated
query
to
PDMP
to
create
Michigan
Provider
integrated
prescrip7on
history
and
Partnered
with
e-­‐prescribing
(MI)
alerts
Automated
query
to
PDMP
using
an
North
exis7ng
benefits
management
switch
Leveraged
exis7ng
benefits
Dakota
Pharmacy
and
return
results
to
Indian
Health
transmission
technology
(ND)
Service
pharmacy

26. Pilot
States
and
Summary
(cont.)
Automated
query
to
PDMP
upon
appointment
scheduling
and
pa7ent
Automated
query
and
response,
Ohio
(OH)
Provider
check-­‐in;
pa7ent
risk
score
displayed
in
streamlined
workflow
for
physicians
EHR
Opioid
Washington
Treatment
Hyperlink
to
PDMP
within
EHR
Streamlined
access
to
PDMP
(WA)
Program

27. Pilot
Results
 Immediate improvement to the In their own words…
patient care process after  “I have to say that this is probably one of the
more genius moves of the 21st century . . .
connection having easy access to [the PDMP] without
going to a totally different website and have it
pop up instantly has taken a lot of time off of
 Streamlined the user workflows decision making for me.”
by leveraging technology to – Emergency Department Physician
enable PDMP query and
processing tasks.  “Yes, much easier. Especially like being able
to click on the report and be taken directly to
the patient’s report without having to enter
the patient’s name, date of birth, and zip code
 Prescribers and dispensers were (this was very time consuming and
the most satisfied with their new sometimes prevented me from looking up the
information in the past).”
workflows when technology
– Ambulatory Family Physician
automated the majority of
workflow tasks.

28. Enhancing
Access
to
Prescrip<on
Drug
Monitoring
Programs
4.
ONC/SAMHSA
PROJECT:
PHASE
2

29. Phase 2 Overview
EQUIP
Pilots
LEARN
Technology
Framework
CHANGE
From
Phase
I
By
empowering
others
Share
the
News
Build
the
Evolve
the
community
vision
29

30. Phase 2 Pilots - Overview
State
End
User
Pilot
Summary
• Automated
query
via
intermediary
and
interstate
hub
to
PDMP
upon
pa7ent
Emergency
Illinois
admission
to
ED
Department
• PDMP
data
integrated
into
EHR
as
a
PDF
via
a
Direct
message
Emergency
• Automated
query
via
HIE
to
mul7ple
states’
PDMPs
upon
pa7ent
admission
to
ED
Indiana
Department
• Pa7ent
risk
score
and
PDMP
data
integrated
into
EHR
Kansas
Providers
• Unsolicited
report
of
at-­‐risk
pa7ents
sent
via
Direct
to
EHR-­‐integrated
mailboxes
• Automated
query
via
e-­‐Prescribing
sopware
to
mul7ple
states’
PDMPs
and
result
Michigan
Providers
integrated
in
pa7ent’s
medica7on
history
• Automated
query
via
HIE
to
PDMP
upon
pa7ent
admission
to
ED
Emergency
Nebraska
Department
• Easy
access
to
PDMP
with
SSO
• PDMP
data
integrated
into
EHR
• Established
PDMP
access
directly
though
an
HIE
Emergency
Oklahoma
Department
• Developed
a
SSO
from
the
EHR
through
the
HIE
to
the
PDMP
• Alert
flag
represen7ng
the
PDMP
data
• Real-­‐7me
repor7ng
of
dispensing
controlled
substance
data
to
the
PDMP
using
an
Tennessee
Pharmacy
exis7ng
network

31. Technical Framework

32. PDMP S&I Community Focus/Scope
Needs
for
standards
(data
format
and
content;
transport
and
security
protocols)
NCPDP
Script
Pharmacy EHR System
EHR System
EHR System
ASAP
Data
Out
NCPDP
Telecom
Portal
PDMP
Provider
Switches Provider
Provider
NIEM-­‐PMP
NIEM-­‐PMP
Pharmacy PMPi /
Benefits Mgmt RxCheck PDMP
Other
State
PDMPs

33. Compelling Vision

34. Articulating a Compelling Vision
Evidence
and
Roadmaps
AnalyXcs
Workflows
Building
a
COMMUNITY
through
development
of
a
resource
center
that
includes:
User
Stories
Pilot
Progress
EducaXon
Tech
Development

35. Oklahoma & Indiana Videos

36. Roadmap Workflows
• Goals
– To
connect
and
engage
stakeholders
– Accelerate
adop7on
and
use
of
PDMPs
• Key
features
– Models
the
connec7on
– Technology
workflows
– Project
plan
– Implementa7on
– Evalua7on
and
op7miza7on

37. PDMP Resource Center
About
PDMPConnect
PDMPConnect
seeks
to
inform
and
unite
the
community
of
physicians,
providers,
pharmacists,
and
health
IT
organiza7ons
and
professionals
in
one
forum
to
discuss
and
share
ideas
about
enhancing
access
to
pa7ent
prescrip7on
drug
informa7on
stored
in
PDMPs
using
health
IT
technologies
at
the
point
of
care.

39. 1. “Map Filter”
Filter by interest:
• Federal Govt, Grants, PDMPS,
etc "
2. “Featured Contributors”
“Tear drop” icons =
• Key PDMP players
• Pilot participants
• Others
3. “Other Contributors” info
“Small bubble” icons =
• State PDMP specific information
• FY2012 pilots

40. “Featured Contributors” Page
• Displays custom content and resources
from these contributors
• Includes information that is relevant to
that individual or group
• Conversation feed is sorted based on
tweets from the individual/group
• Individually follow each of these
contributors on Twitter

41. 5.
NEXT
STEPS

42. Collabora7on
and
Funding
• Coordinate
with
BJA
Harold
Rogers
PDMP
Grants
• Con7nue
collabora7on
with
other
federal
partners
(i.e.
ONC,
ONDCP,
CDC,
BJA,
NIDA,
FDA,
etc.)
• Future
funding
to
extend
project
goals

43. Looking
toward
the
Future…
• Prescrip7on
drug
misuse
and
abuse
con7nues
to
be
a
challenge
in
the
U.S.
• A
balance
must
be
maintained
between
the
benefits
of
properly
managed
pain
medica7on
and
the
poten7al
for
abuse
of
that
medica7on.
• A
holis7c
response
must
include
a
combina7on
of
educa7on,
monitoring,
control,
and
enforcement.

44. THANK
YOU.

45. The
Team
Jennifer
Frazier,
ONC,
Jennifer.Frazier@hhs.gov
Jinhee
Lee,
SAMHSA,
Jinhee.Lee@samhsa.hhs.gov
Kate
Tipping,
SAMHSA,
kate.7pping@samhsa.hhs.gov
Chris
Jones,
CDC,
cjones@cdc.gov
Cecelia
Spitznas,
ONDCP,
Cecelia_M_Spitznas@ondcp.eop.gov
Lisa
TuIerow,
MITRE,
ltuIerow@mitre.org
Jeffrey
Hammer,
MITRE,
jmhammer@mitre.org

46. Outreach
to
Prescribers
Who
Have
a
High
Number
of
Doctor/Pharmacy
Shopper
PaXents
April
2
–
4,
2013
Omni
Orlando
Resort
at
ChampionsGate

47. Massachusejs
PrescripXon
Monitoring
Program
Massachusejs
Department
of
Public
Health
Bureau
of
Health
Care
Safety
and
Quality
Drug
Control
Program

48. Disclosure
Statement
• All
presenters
for
this
session
have
disclosed
no
relevant,
real
or
apparent
personal
or
professional
financial
rela7onships.

49. OVERVIEW
• MA
PMP
Background
• Individual
(Pa7ent)
Level
Analysis
• Electronic
Alerts
• Prescriber
Level
Analysis

50. BACKGROUND
MA
PRESCRIPTION
MONITORING
PROGRAM
(MA
PMP)
• MA
PMP
 promotes
safe
prescribing
and
dispensing,
 helps
prevent
drug
diversion
and
abuse.
• MA
PMP
collects
data
on
Schedule
II-­‐V
prescrip7ons
dispensed
in
MA
ambulatory
pharmacies
and
from
out-­‐
of-­‐state
pharmacies
delivering
to
pa7ents
in
MA.
• Over
12
million
Schedule
II-­‐V
prescrip7on
records
were
reported
to
MA
PMP
in
CY
2012.

51. MA
PMP
PROGRAM
ENHANCEMENTS
• New
Pa<ent
Iden<fiers:
Prior
to
January
2009,
MA
PMP
only
collected
customer
iden7fiers
(e.g.,
drivers
license
numbers).
Aper
regula7on
change
the
MA
PMP
began
collec7ng
pa7ent
iden7fiers
(i.e.,
names
and
addresses).
• Expanded
Schedules:
Originally
the
MA
PMP
only
collected
data
on
Schedule
II
prescrip7ons.
In
January
2011,
MA
PMP
expanded
monitoring
requirements
to
include
Schedule
III-­‐V
prescrip7ons.
• Unsolicited
Reports:
In
February
2010,
MA
PMP
began
providing
unsolicited
(paper)
reports
to
prescribers,
iden7fied
as
prescribing
to
individuals
mee7ng
or
exceeding
a
pre-­‐determined
threshold
for
suspected
ques7onable
ac7vity
(i.e.,
poten7al
doctor/pharmacy
shopping).
• MA
Online
PMP:
In
December
2010,
the
MA
Online
PMP
became
opera7onal.

52. DEFINING
THE
PROBLEM
• Individuals
who
are
dependent
on,
maybe
becoming
dependent
on
or
who
are
diver7ng
prescrip7on
opioids
may
visit
many
different
providers
(prescribers
and
pharmacies)
in
order
to
obtain
mul7ple,
open
overlapping,
and
dangerous
quan77es
of
prescrip7ons
of
the
same
or
similar
opioid
drugs.
• Prescribers
may
inadvertently
serve
these
individuals
because
of
lack
of
informa7on
about
their
prescrip7on
histories.

53. EsXmated
Number
of
Individuals
per
100,0001
Showing
QuesXonable
AcXvity2
by
Fiscal
Year
in
MA
7,411
(0.85%)
Individuals
121,238
(5.8%)
Prescrip7ons
1
Popula7on
includes
all
individuals
(iden7fied
by
customer
ID)
who
received
at
least
one
Schedule
II
opioid
prescrip7on
in
a
fiscal
year.
2
Ques7onable
ac7vity
is
defined
as
having
received
Schedule
II
opioid
prescrip7ons
from
a
minimum
of
4
providers
and
4
pharmacies
during
the
reported
fiscal
year.

54. ADDRESSING
THE
PROBLEM
1. Focus
on
individuals
receiving
the
prescrip=on
controlled
substances
 Sending
unsolicited
reports
to
prescribers
 Referring
“highly
suspicious”
individuals
to
law
enforcement
2. Focus
on
the
health
care
providers
who
are
prescribing
the
controlled
drugs
 Target
for
ini7al
outreach
(i.e.,
educa7on
and
invita7on
to
enroll
in
the
MA
Online
PMP)
prescribers
who
have
a
large
number
of
pa7ents
exhibi7ng
ques7onable
ac7vity.
 Con7nue
to
reach
out
and
aIempt
to
follow-­‐up
with
those
prescribers
who
do
not
enroll
in
the
MA
Online
PMP
and
con7nue
to
prescribe
to
large
numbers
of
pa7ents
with
ques7onable
ac7vity.

55. FOCUSING
ON
INDIVIDUALS
Unsolicited
Report
Analysis
• MA
PMP
evaluated
the
impact
of
unsolicited
reports
on
the
prescrip7on
controlled
substance
use
of
individuals
who
met
specified
thresholds
of
ques7onable
ac7vity
for
whom
such
reports
were
sent.
• A
non-­‐interven7on
comparison
group
was
included
to
provide
more
accurate
measures
of
the
impact
of
unsolicited
reports.

56. Preliminary
Findings
cases:
n
=
84,
controls:
n
=
84
†
Sta<s<cally
significant
at
p
<
0.05

57. FOCUSING
ON
INDIVIDUALS
Electronic
Alerts
• Unsolicited
report
analysis
provides
empirical
evidence
that
aler7ng
prescribers
can
reduce
doctor/pharmacy
shopping
ac7vity
over
7me.
• MA
Online
PMP
system
allows
for
electronic
alerts
to
be
sent
out
to
prescribers
and
dispensers
based
on
established
thresholds
(e.g.,
min
#
prescrip7ons,
prescribers,
pharmacies,
within
a
specified
7me
frame).
• MA
PMP
has
conducted
some
pilot
tests
of
these
electronic
alerts
and
is
in
the
process
of
establishing
appropriate
thresholds
for
full
implementa7on.

58. FOCUSING
ON
PROVIDERS
MA
PMP
IniXaXve
• Iden7fy
prescribers
who
have
significant
numbers
of
pa7ents
with
ques7onable
ac7vity
(i.e.,
doctor/pharmacy
shopping)
based
on
pre-­‐
specified
criteria
(described
in
methodology).
• From
the
list
of
prescribers
iden7fied
above
determine
who
are
not
already
enrolled
in
the
MA
Online
PMP.
• Send
an
“outreach”
leIer
to
those
prescribers
with
significant
numbers
of
pa7ents
with
ques7onable
ac7vity
who
have
not
enrolled
in
the
MA
Online
PMP
encouraging
poten7ally
“at
risk”
prescribers
to
enroll
in
the
MA
Online
PMP.
• This
ini7a7ve
resulted
in
150
leIers
sent
to
non-­‐enrolled
prescribers
in
CY
2012
and
approximately
40
percent
of
these
prescribers
are
currently
enrolled
in
the
MA
Online
PMP.

59. PRELIMINARY
ANALYSIS
• A
small
pilot
analysis
was
conducted
to
evaluate
possible
impacts
of
prescriber
enrollment
to
the
MA
Online
PMP
• Time
Period:
July
1
through
December
31
(2010
and
2011)
• The
top
50
prescribers
(i.e,
prescribers
with
the
highest
number
of
individuals
who
met
the
doctor/pharmacy
shopper
threshold)
were
used
for
a
preliminary
analysis:
– Those
prescribers
who
enrolled
in
the
MA
Online
PMP
(n=12)
had
a
26
percent
decline
in
individuals
who
met
the
ques7onable
ac7vity
criteria
from
2010
to
2011.
– Those
prescribers
who
were
not
enrolled
in
the
MA
Online
PMP
(n=38)
had
a
7.5
percent
decline
in
individuals
who
met
the
ques7onable
ac7vity
criteria
at
the
7me
of
this
evalua7on.

60. EXPANDED
PRESCRIBER
ANALYSIS
Methodology
• Based
on
the
posi7ve
findings
of
the
pilot
evalua7on,
a
larger
analysis
was
undertaken.
• Time
Period:
Data
queried
from
CY
2009-­‐2012
• For
purposes
of
this
ini7a7ve,
ques7onable
ac7vity
is
defined
as
an
individual
who
receives
Schedule
II-­‐V
opioid
prescrip7ons
from
4
or
more
different
providers
and
fills
such
prescrip7ons
at
4
or
more
different
pharmacies
during
the
calendar
year.
• Prescribers
with
reported
hospital
DEA
numbers
were
excluded
from
this
evalua7on.
• In
order
to
be
included
in
the
analysis
a
prescriber
must
have
had
10
or
more
individuals
who
met
the
ques7onable
ac7vity
criteria
during
at
least
1
of
the
4
calendar
years
evaluated
and
a
minimum
of
at
least
two
non-­‐zero
data
points
during
the
4
calendar
years.

61. EXPANDED
ANALYSIS
Results
*Online
Users
-­‐
prescriber
must
have
conducted
a
minimum
of
one
pa7ent
search
since
being
enrolled
in
the
MA
Online
PMP.

62. EXPANDED
ANALYSIS
Results
• Online
Users
>
1
year:
The
“high
doctor/pharmacy
shopper”
prescribers
enrolled
in
the
MA
Online
PMP
for
at
least
one
year
(n=20)
had
a
50
percent
decline
in
the
number
of
doctor/
pharmacy
shopper
pa7ents
(Avg
#
=
103.3
pa7ents
[2009-­‐2010]
versus
51.7
pa7ents
[2011-­‐2012]).
• Not-­‐Enrolled
Prescribers:
The
“high
doctor/pharmacy
shopper”
prescribers
not
enrolled
in
the
MA
Online
PMP
(n=70)
had
a
31
percent
decline
in
doctor/pharmacy
shopper
pa7ents
during
the
same
7me
period
(Avg
#
=73.7
pa7ents
[2009-­‐2010]
versus
53.4
pa7ents
[2011-­‐2012]).

63. EXPANDED
ANALYSIS
Results
1
Ques7onable
ac7vity
is
defined
as
having
received
Schedule
II
opioid
prescrip7ons
from
a
minimum
of
4
providers
and
4
pharmacies
during
the
calendar
year.
2
The
"average"
percentage
of
all
pa7ents
prescribed
a
Schedule
II-­‐V
controlled
drug
who
meet
the
ques7onable
ac7vity
threshold
within
each
prescriber
category
analyzed.

64. EXPANDED
ANALYSIS
Results
• Among
the
3
groups
of
prescribers
analyzed:
 Online
“High”
Users
>
1
Year:
Those
prescribers
who
have
been
enrolled
in
the
MA
Online
for
over
1
year
PMP
(n=25)
and
are
among
the
top
25
enrolled
prescribers
in
number
of
pa7ents
searched
(an
average
of
about
twice
as
many
searches
as
the
“Online
Users
>
1
year”
group)
had
a
71.9
percent
decrease
(13.9
to
3.9)
in
the
percentage
of
all
pa7ents
prescribed
a
Schedule
II-­‐V
controlled
drug
who
met
the
ques7onable
ac7vity
criteria
from
2009
to
2012.
 Online
Users
>
1
Year:
The
“high
doctor/pharmacy
shopper”
prescribers
enrolled
in
the
MA
Online
PMP
for
at
least
one
year
(n=20)
had
a
64.8
percent
decline
(from
CY
09-­‐10
to
11-­‐12)
in
the
number
of
doctor/
pharmacy
shopper
pa7ents.
 Not
Enrolled
Prescribers:
The
“high
doctor/pharmacy
shopper”
prescribers
not
enrolled
in
the
MA
Online
PMP
(n=70)
had
a
35.1
percent
decline
(from
CY
09-­‐10
to
11-­‐12)
in
the
number
of
doctor/
pharmacy
shopper
pa7ents.

65. CONCLUSIONS
• Prescribers
who
are
enrolled
and
use
the
MA
Online
PMP
have
exhibited
a
larger
decrease
in
the
number
and
propor7on
of
their
pa7ents
who
have
been
prescribed
controlled
drugs
and
who
meet
the
specified
doctor/pharmacy
criteria
compared
to
non-­‐
enrolled
prescribers.
• More
frequent
use
of
the
MA
Online
PMP
by
prescribers
results
in
greater
decreases
in
doctor/
pharmacy
shopper
ac7vity
among
their
pa7ents.

66. Prescription Monitoring Program
Acknowledgement
• Portions of this project were supported by grants
awarded by the U.S. Bureau of Justice Assistance.
Points of view or opinions in this presentation are
those of the author and do not represent the official
position or policies of the United States Department
of Justice.

67. CONTACT
INFORMATION
Len
Young
MA
Department
of
Public
Health
Drug
Control
Program
Phone:
617-­‐983-­‐6705
Email:
leonard.young@state.ma.us

68. PDMP
Powerful
Tool
for
MulXple
ModaliXes
April
2
–
4,
2013
Omni
Orlando
Resort
at
ChampionsGate

69. Learning
Objec7ves
Imbue
PDMP
colleagues
with
the
noXon
we
can
and
should
do
much
more.

70. Disclosure
Statement
This
presenter
reports
no
relevant
financial
interests.

71. “During
the
spring
and
summer
of
2001,
U.S.
intelligence
agencies
received
a
stream
of
warnings
that
al
Qaeda
planned,
as
one
report
put
it,
“something
very,
very,
very
big.”
The
Director
of
Central
Intelligence
said,
“ The
system
was
blinking
red.”
Execu=ve
Summary,
The
9/11
Commission
Report,
Page
6

72. The
FBI’s
approach
to
counterterrorism
inves7ga7ons
was,
“case-­‐specific,
decentralized,
and
geared
toward
prosecu7on.”
Execu=ve
Summary,
The
9/11
Commission
Report,
Page
13
“Each
agency’s
incen7ve
structure
opposes
sharing,
with
risks
(criminal,
civil,
and
internal
administra7ve
sanc7ons)
but
few
rewards
for
sharing
informa7on.”
The
9/11
Commission
Report,
Page
417

73. The
9/11
Commission’s
boIom-­‐line
recommenda7on
was
for
a…
Unity
of
Effort

74. One
fight,
one
team.

75. 2,390
Pearl
Harbor
Deaths
2,973
9/11Deaths
hIp://www.cbsnews.com/2100-­‐224_162-­‐2035427.html

76. >15,500
PrescripXon
Painkiller
Overdose
Deaths
CY
2009
hIp://www.cdc.gov/vitalsigns/MethadoneOverdoses/

77. Current
PDMP
Systems
PDMPs
serve
the
public
health
and
the
public
safety.

78. Current
PDMP
Systems
PDMPs,
generally,
serve
two
principal
clients:
 Health
Care
Prescribers
and
Dispensers
 Law
Enforcement
Police and Sheriff Agencies
Investigative Agencies (DEA, DOJ, Coroner, etc)
District Attorneys & DA Investigators
Regulatory Board Investigators (Medical, Osteopathic,
Pharmacy, Podiatry, Veterinary, Dental, etc.)

79. Current
PDMP
Systems
Generally,
relevant
provisions
of
laws
for
the
PDMPs
are:
 Health
Insurance
Portability
and
Accountability
Act
(HIPAA)
&
AIendant
Regula7ons
42
U.S.C.
§§
1320d
to
1320d-­‐8,
and
45
CFR
164,
et
seq.
 A
State
Confiden7ality
of
Medical
Informa7on
Act
 A
State
Informa7on
Prac7ces
Act
 State
PDMP
Legisla7on

80. Current
PDMP
Systems
 Pharmacists
are
required
to
report
dispensaXons
scheduled
controlled
substances
at
a
frequency
prescribed
by
statute.
 Use
of
the
PDMP
by
prescribers
and
dispensers
for
prescripXon
abuse
prevenXon/intervenXon
is
voluntarily
in
many
states.

82. Current
PDMP
Systems
Many
states
presently
limit
law
enforcement
PDMP
queries
to
a
single
name/date
of
birth
search
with
and
only
with
an
acXve
case
number.

83. LICENSE
ALERT
On
July
23,
2012,
the
Orange
County
Superior
Court
issued
a
PC23
Order
that
suspended
the
license
of
JOHN
DOE,
M.D.,
with
an
address
of
record
in
Laguna
Beach,
CA.
He
shall
cease
and
desist
from
the
prac7ce
of
medicine,
as
a
condi7on
of
bail,
or
own
recognizance
release,
during
the
pendency
of
the
criminal
ac7on
un7l
its
final
conclusion
and
sentence.

84. The
Privacy
and
Security
Rules
apply
only
to
covered
en<<es.
Individuals,
organizaXons,
and
agencies
that
meet
the
definiXon
of
a
covered
enXty
under
HIPAA
must
comply
with
the
Rules'
requirements
to
protect
the
privacy
and
security
of
health
informaXon
and
must
provide
individuals
with
certain
rights
with
respect
to
their
health
informaXon.
If
an
en<ty
is
not
a
covered
en<ty,
it
does
not
have
to
comply
with
the
Privacy
Rule
or
the
Security
Rule.
hNp://www.hhs.gov/ocr/privacy/hipaa/understanding/covereden==es/index.html

85. HIPAA
Privacy
and
Security
Rules
Covered
EnXXes
A
Health
Care
Provider
A
Health
Plan
A
Health
Care
Clearinghouse
This
includes
providers
This
includes:
such
as:
This
includes
en77es
Doctors
Health
insurance
that
process
Clinics
companies
nonstandard
health
Psychologists
informa7on
they
Den7sts
HMOs
receive
from
another
Chiropractors
en7ty
into
a
standard
Nursing
Homes
Company
health
plans
(i.e.,
standard
electronic
Pharmacies
format
or
data
content),
Government
programs
or
vice
versa.
...but
only
if
they
transmit
that
pay
for
health
care,
any
informa7on
in
an
such
as
Medicare,
electronic
form
in
connec7on
with
edicaid,
and
the
M
a
transac7on
for
which
military
and
veterans
HHS
has
adopted
a
standard.
health
care
programs
www.hhs.gov/ocr/privacy/hipaa/understanding/covereden==es/index.html

86. Entities not required to comply with HIPAA’s Privacy and
Security Rules include:
• Life Insurers
• Employers
• Workers Compensation Carriers
• Many Schools and School District
• Many State Agencies like Child Protective Services
• Many Law Enforcement Agencies
• Many Municipal Offices
http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html

87. Two
major
law
enforcement
operaXonal
objecXves:
1.
Discern
Crime
2.
InvesXgate
Crime

88. InformaXon-­‐led
policing
discerns
crime.
In their now famous 1982 article,
Broken Windows, social scientists
James Q. Wilson and George L.
Kelling stated:
“Just as physicians now recognize the
importance of fostering health rather than
simply treating illness, so the police – and
the rest of us – ought to recognize the
importance of maintaining, intact,
communities without broken windows.”
Atlan=c
Monthly,
March
1982

89. PDMP
data
value
for
law
enforcement:
 Inves7ga7ve
leads
to
evidence
(prescrip7ons)
 Indicia
for
inves7ga7ve
targe7ng
 Indicia
for
suspicious
death
inves7gators
 Raw
informa7on
for
inves7ga7ve
analy7cs

90. AnalyXc-­‐oriented
inquiry
capabiliXes
that
could
greatly
benefit
law
enforcement:
 Pa7ent,
Prescriber,
and
Pharmacy
Reports
by
Date
Range
Parameters
 Method
of
Payment
 Pa7ent
Distance
to
Prescriber
 Pa7ent
Distance
to
Pharmacy

91. AnalyXc-­‐oriented
inquiry
capabiliXes
that
could
greatly
benefit
law
enforcement
(conXnued):
 Top
Prescribers
by
Date
and
Region
 Top
Pa7ents
by
Date
and
Region
 Top
Pharmacies
by
Date
and
Region
 Overdose
Surveillance:
Histories
of
Decedents’
Prescribers;
Histories
of
the
Prescribers’
Top
Pa7ents

95. One
fight,
one
team.

96. New
England
Journal
of
Medicine
2012;
366:2341-­‐2343,
June
21,
2012,
DOI:
10.1056/NEJMp1204493
Jeanmarie
Perrone,
M.D.,
and
Lewis
S.
Nelson,
M.D.

97. Drs.
Perrone
and
Nelson
noted
barriers
to
today’s
PDMPs
include:

Time
and
access
issues.

Complicated
applica7on
and
notariza7on
procedures

Prescribers
will
have
to
be
educated
about
PDMPs
if
voluntary
compliance
is
to
be
improved
and
rou7ne
use
encouraged.

98. IntegraXon
/
InteroperaXon
PDMPs
need
to
integrate
and
interoperate
with
the
major
health
care
systems
in
their
regions.
PDMP
data
can
be
rendered
by
the
health
care
system
to
be
presented
with
the
EHR
when
the
prac77oner
walks
into
the
exam
room
to
see
the
pa7ent.

99. IntegraXon
/
InteroperaXon
Integra7on/Interopera7on
leverages
a
trust
arrangement
that
the
various
interopera7on
partners
vet
their
respec7ve
members.
Integra7on/Interopera7on
can
facilitate
peer-­‐to-­‐peer
collabora7on.
Integra7on/Interopera7on
can
facilitate
a
“watch”
flags
across
member
systems.

100. 3rd
Party
Payers
EsXmated
Savings
from
Enhanced
Opioid
Management
Controls
through
3rd
party
Payer
Access
to
the
Controlled
Substance
UXlizaXon
Review
and
EvaluaXon
System
(CURES)
California
Workers’
Compensa7on
Ins7tute
January,
2013
Alex
Swedlow
&
John
Ireland

101. 3rd
Party
Payers
The
study
states
that
access
to
a
PDMP
system,
“…coupled
with
enhanced
medical
cost
containment
strategies
including
medical
provider
networks
(MPN)
monitoring
and
u7liza7on
review
(UR)
–
could
significantly
reduce
the
average
number
of
prescrip7ons
and
the
average
dose
levels
of
workers’
compensa7on
claims
that
u7lize
opioids.”

102. 3rd
Party
Payers
The
CWCI
study
es7mates
the
cost
savings
to
AY
2011
California
workers’
compensa7on
claims
to
be
$57.2
million.
The
CWCI
study
states
a
California
workers’
compensa7on
system
investment
in
PDMP
would
realize
an
es7mated
$15.5:$1
return-­‐
on-­‐investment.

103. 3rd
Party
Payers
3rd
Party
Payer
PDMP
access
could:
Help
promote
adherence
with
accepted
chronic
pain
management
guidelines.
Provide
another
mutually
advantageous
check
point
against
poten7ally
dangerous
prescrip7ons.
Save
rate
payers
money.

104. Health
Care
Administrators
Health
care
system
administrators
rou7nely
monitor
professional
performance
for
quality
of
care
assurance,
protocol
adherence,
cost
control
and
liability
mi7ga7on.
Certainly
PDMP
access
would
allow
health
care
system
administrators
to
deal
with
outliers
at
the
system
level
before
a
great
public
health
and/or
public
safety
peril
takes
hold.

105. Mental
Health
Crisis
IntervenXonists
PDMP
data
can
well
serve
mental
health
clinicians
and
behavorial
professionals
who
must
determine
likely
causes
of
an
individual’s
mental
crisis
as
well
as
a
best
course
of
treatment.

106. One
fight,
one
team.
Thank
You!