- State Medicaid programs should improve EHR integration of prescription drug monitoring program (PDMP) data to reduce provider burden and allow healthcare organizations to easily track patient information related to opioid use, stated CMS Acting Director Tim Hill in a June 11 letter to state Medicaid directors.
The letter provided guidance to states about which funding authorities are able to support health IT, EHR technology, and health data exchange for the purposes of reducing opioid misuse. This letter is one of several CMS resources recently issued to accelerate progress on addressing the opioid crisis.
According to CMS, states can receive enhanced federal funding to build a PDMP or enhance PDMP functionality per 42 CFR — a federal rule governing patient health data use for substance abuse disorder treatment under the EHR Incentive Programs.
PDMPs that are declared specialized registries ready to accept data for the purposes of meaningful use requirements are eligible for this enhanced federal funding and may claim 90 percent HITECH match for costs related to the design, development, implementation, and connection of PDMPs.
“However, Medicaid Management Information System (MMIS) matching funds may be a more appropriate source of federal funding for costs related to developing a PDMP in some cases, and states should not claim 90 percent HITECH match for costs that could otherwise be matched with MMIS matching funds,” clarified Hill.
Hill encouraged states to use this funding to enhance PDMPs, boost interstate health data exchange, and improve EHR integration of PDMP data.
“This integration removes the requirement for providers to log in to a separate system, manage a separate log in, and disrupt their workflow to query the PDMP,” Hill said. “Single sign-on interoperability between EHR and PDMP such that PDMP results are displayed when the EHR indicates a controlled substance is prescribed could be supported, as an example.”
In addition to reducing provider burden, integrating PDMP data into EHRs may also improve the overall effectiveness of PDMPs. Hill cited a 2016 study from the New England Journal of Medicine (NEJM) that found PDMP use alone is not as effective as a PDMP deployed along with well-designed clinical workflows.
“States have the opportunity to design programs where the state-supported PDMP practices are developed in conjunction with business process modeling to help minimize provider burden related to implementing new workflows, and to further make investments in systems with appropriate linkages to provider delegates such as case managers or social workers,” wrote Hill.
Integrating PDMPs with health information exchanges (HIEs) could further improve clinical decision-making, Hill wrote. By connecting to an HIE, states can further integrate PDMP data with pharmacy data, shared care plans, drug utilization review programs, EMS data, medication assisted therapy data, advanced directives, and other EHR data.
States can also leverage federal funding opportunities for PDMP development through the Managed Registry business process in Medicaid Information Technology Architecture (MITA.) MITA allows states to support specialized registries that receive an individual’s health outcomes information, prepare information, prepare updates for a specific registry, and supply information in response to inquiries.
“In the context of MITA, the registry must consolidate related records from multiple sources (e.g., intrastate, interstate, or federal agencies) into one comprehensive data store, which may or may not reside within the state’s Medicaid information system,” Hill stated.
In addition to EHR integration of PDMPs, Hill also offered guidance related to advanced data analytics and public health data, technologies for coordinating care and increasing access to care, and enhanced statewide interoperability.
“CMS hopes states will use this information to improve the technological capacity of state Medicaid agencies, providers, and partners to address the opioid crisis and improve the health outcomes for Medicaid beneficiaries,” said Hill.