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Can Enhancements to Patient EHRs Tailor PDMP Risk Indicators?

Pew research found that enhancements to patient EHRs, such as the ability to sort data, could help identify potential PDMP risk areas.

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Source: Thinkstock

By Elizabeth Snell

- Being able to sort data within patient EHRs, implementing maps that show distances between patients, prescribers, and pharmacies, and having graphical displays of patients’ controlled-substance prescription use could all potentially help in tailoring prescription drug monitoring programs (PDMPs), according to Pew Charitable Trusts.

Researchers conducted online focus groups of PDMP administrators to determine if there was support for enhanced PDMP profiles, what perceived barriers to implementation existed, and find recommendations to advance such work.

“Historically, health care providers have reported that time constraints make it difficult to adequately review the information in PDMP patient records, also known as profiles,” Pew explained. “To address this barrier, some states have made, or are planning to make, improvements to how patient profiles are presented to prescribers.”

“Instead of displaying controlled-substance prescriptions in a list, enhanced PDMP profiles summarize or graphically display a patient’s controlled-substance use,” researchers continued. “These profiles can aid providers in making better prescribing decisions and identifying patients at risk for substance use disorder (SUD) or overdose.”

There can often be significant differences between states in how PDMP data is interpreted and applied to clinical decision-making, the research team noted. By approximately one year ago, nearly half of the US had developed enhanced PDMP patient profiles that provide summary information, risk assessments, or data visualizations.

READ MORE: Federal Opioid Commission Seeks PDMP Health Data Exchange

Twenty-one administrators from 18 states participated in the Pew focus groups, with many stating support for potential enhancements to PDMP profiles. However, there were still some key concerns identified.

The cost to implement such changes could be very high and that there may be reduced state control over profile features and risk indicators, the researchers found.

“Another disadvantage discussed was a reduced ability to monitor for the appropriateness and extent of PDMP use (e.g., compliance with mandatory PDMP use laws) in instances where the PDMP is accessed by a prescriber in a hospital or clinic with numerous providers,” the research team wrote. “In situations where PDMP data are integrated with EHRs, PDMP staff must rely on hospital systems to identify and authenticate end users.”

Some health systems and clinicians may also lack access to EHRs that can deliver the enhanced profiles.

Additionally, logistical and legislative issues could hinder the process of implementing enhanced profiles. For example, vendor contract negotiations may be lengthy and the time need to upgrade software to handle such a change can also be great.

READ MORE: Yale to Integrate State Prescription Drug Data into Epic EHR

One administrator in the focus group noted that an enhanced profile may be outside of the scope of state laws.

“Some of the information displayed, such as risk factors and score[s], can be [considered an] interpretation of PDMP data,” the focus group participant said. “That process is currently not authorized in our law and anything not specifically authorized is assumed to be prohibited.”

However, PDMP administrators suggested the following ways to overcome implementation issues:

  • Involve key stakeholders in the profile enhancement process, both before implementation and as part of a continuous improvement process
  • Report outcomes to key stakeholders to demonstrate the value of the PDMP
  • Seek grants or other funding to implement enhanced profiles.

“Moving forward, states should collaborate with all stakeholders in an interdisciplinary way to determine optimal risk indicators and thresholds that are reported to prescribers,” researchers concluded. “Enhancements should be evaluated to determine whether they influence prescribing behavior in a beneficial way.”

Earlier this year, the College of Healthcare Information Management Executives (CHIME) also stressed the need for improving EHR integration with PDMPs to help curb the opioid epidemic.

READ MORE: New York PDMP Achieves Healthcare Interoperability with 25 States

“Today, oftentimes the information offered to a clinician in a PDMP is presented in a disjointed manner, requiring the prescriber to take additional steps to review past scripts from other healthcare providers,” CHIME wrote in its letter. “This creates a fragmented picture for clinicians and results in data that is not integrated seamlessly within an EHR.”

Having a fragmented presentation of information from PDMPs also creates an interoperability barrier, CHIME added.

“According to the CDC, ‘Clinicians do not consistently use practices intended to decrease the risk for misuse, such as PDMPs, urine drug testing, and opioid treatment agreements,’” the letter explained. “This is likely due in part to challenges related to registering for PDMP access and logging into the PDMP (which can interrupt normal clinical workflow if data are not integrated into electronic health record systems).”

Overall, CHIME maintained that EHR technology needs to improve to better support opioid and substance abuse treatment. Federal agencies must simplify the process for how clinicians refer to PDMPs to facilitate seamless data access.

“Unless the barriers at the local level can be overcome, prescribers will continue to have an incomplete picture of a patient,” CHIME said. “These obstacles amount to a serious patient safety issue and until corrected will plague prescribers’ ability to treat patients holistically.”

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