Enhancing Access to Prescription Drug Monitoring Programs Through Health Information Technology National Rx Drug Abuse Summit 4-10-12

1. Enhancing Access to Prescription
Drug Monitoring Programs through
Health Information Technology
Kate Tipping, J.D.
Office of the National Coordinator for Health
Information Technology
Jinhee J. Lee, Pharm.D.
Substance Abuse and Mental Health Services
Administration

2. Disclosure Statement
The presenters for this continuing
education activity report no relevant
financial relationships.

3. True or False:
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.

4. 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

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

6. 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."

7. Of the 36,500 drug poisoning deaths
in 2008, what percentage involved
opioid analgesics?
A. 10%
B. 20%
C. 30%
D. 40%

8. 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

9. The Problem
The CDC* has declared that the U.S. is in the midst of an
epidemic of prescription painkiller overdose deaths. Deaths
from these drugs now outnumber deaths from heroin and
cocaine combined.
*Centers
for
Disease
Control
and
Preven2on

10. 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)

11. 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.

12. 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

13. 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

14. ONC’s Strategic Plan
Goals:
• 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

15. 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.

16. 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

18. 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

19. 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)

20. 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.

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

22. 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.

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

24. 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.

25. Work Groups
Number/Name Purpose
1: Data Content and To determine the data content and vocabulary necessary to support
Vocabulary data exchange between Prescription Drug Monitoring Programs
(PDMP) and recipients.
2: Information Usability To determine how PDMP information will be presented in the user
and 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 data
Architecture 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 of
for Intermediaries intermediaries (e.g., Switches, HIEs) to route transmissions between
PDMPs and data recipients.

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

27. 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

28. 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

29. Sample Use Case: Provider

30. Sample Use Case: Emergency
Department

31. Sample Use Case: Pharmacist
31

32. Project Structure and Objectives
Pag
e 32

33. 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

34. Contact Information
ONC:
• Kate Tipping – Kate.Tipping@hhs.gov
SAMHSA:
• Jinhee Lee – Jinhee.Lee@samhsa.hhs.gov
MITRE:
• Jeffrey Hammer – jmhammer@mitre.org

35. Questions?