Prescription opioid overdoses killed nearly 15,000 Americans in 2016 and nearly 15,000 more in 2017, part of a growing crisis that has driven the United States into the longest sustained decline in life expectancy since World War I.
To help curb the epidemic, President Trump on Oct. 24 signed into law the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act). The new law expands the mandate of the Centers for Disease Control and Prevention (CDC) to provide grants to states to improve their prescription drug monitoring programs (PDMPs), with an emphasis on electronic health records integration and interstate data sharing. These are two longstanding pain points for PDMPs across the country.
Prior to the SUPPORT funding, the Centers for Medicare and Medicaid Services (CMS) reminded states in June 2018 of a 90/10 federal funding match program, where the federal government through CMS will, in some instances, pay 90 percent of the costs to enhance or replace an existing PDMP system. The SUPPORT Act broadened this CMS mandate in an unprecedented way, authorizing it to provide 100 percent federal funding support to states for technology investments that ease the impact of the opioid crisis among Medicaid beneficiaries. This authority includes funding for PDMPs.
The President’s Commission on Combating Drug Addiction and the Opioid Crisis, the CDC, the American Medical Association and other experts cite PDMPs as one of the most promising tools to help detect and prevent opioid abuse. While states can leverage other tactics to address the crisis as well, a comprehensive PDMP program is foundational to giving states a full set of data on controlled substance prescriptions being written and dispensed.
The Promise of PDMPs
According to the Congressional Research Service, all 50 states and the District of Columbia had core platform PDMPs as of February 2018. However, many states use simplistic PDMPs built several years ago to meet basic reporting requirements. These existing legacy systems typically have been “black boxes,” meaning it is difficult and costly to enable the free flow of information among the state, front-line clinicians and other parties such as law enforcement and public health officials. Offering the data transparency, reporting and other functionality required to deliver government and health-care providers with actionable, predictive information has been difficult or cost-prohibitive for many states.
For state government, law enforcement, public health officials and health-care providers to all play an integral role in fighting the epidemic, states must enhance their systems to find suspicious patient prescribing, as well as collect public health information and enhance data sharing. The SUPPORT Act and CMS funding are designed to help state-based PDMPs make it easier and less expensive to integrate with health-care providers’ electronic health records software and engage in information sharing with hospitals, physician offices and across state lines. They also support the use of national standards for data exchange that already are common across the health-care industry, instead of proprietary methods.
Technology’s Role in Combating the Epidemic
Technology has improved the landscape for PDMPs. It has become a key factor in helping solve the opioid epidemic, first and foremost because it connects the dots.
A visit to a doctor’s office is a critical moment when the physician has the most direct influence on how the patient manages his or her care after leaving the exam room. Making the patient’s complete health history, including prescription opioid data, available in that moment through the provider’s electronic health records software — as a modern, comprehensive PDMP can do — allows the physician to check for over-prescribing patterns and “doctor shopping” for multiple prescriptions, as well as to advise on addiction treatment options, if necessary.
Technology will play a critical role for states that want to pursue federal funding for PDMP enhancements. These states should look for a system that:
Focuses on providing standards-based tools that are easy to access and integrates seamlessly with hospital and physician electronic medical records workflows.
Provides complete, end-to-end data transparency among health-care officials, pharmacies, policymakers and law enforcement.
Includes a patient-matching algorithm that enables information coming from multiple sources to be connected to the individual patient. For example, when addicted patients “doctor shop,” they may attempt to use aliases, maiden names, past addresses, etc., to obtain additional prescriptions. Patient-matching algorithms identify these multiple records as belonging to a single patient.
Integrates predictive analytics, which allow health-care providers to predict the most likely patient outcome or next step based on a relevant data set.
Includes robust data visualization tools. This will help public health officials, researchers, law enforcement and all stakeholders to access anonymized data to identify local, community trends.
The Long-Term PDMP Outlook
PDMPs historically have operated on behalf of state agencies to fulfill compliance requirements by collecting information and providing reports. Currently, the focus is on getting actionable data into the hands of health-care providers for better patient outcomes.
Going forward, PDMP data will be just one facet of states’ integrated population health strategies. For states to effectively manage the cost of providing health care to their citizens, while at the same time improving the quality of care, they will need better and more sophisticated tools for understanding which patients are high-risk or have the most complex needs. Programs and interventions will need to be more tailored and patient-centered.
The prescription opioid epidemic is one factor pushing us in that direction. As states consider how they will take advantage of federal funding programs to enhance their PDMPs, they should begin thinking about how new technology can go far beyond regulatory compliance and use data to inform everyone who has a stake in combating this national crisis.