- Less than half of Michigan physicians can access the state prescription drug monitoring program (PDMP) through their EHR systems a year after the state spent $2.8 million upgrading the PDMP to support EHR integration.
Michigan state officials invested millions to help prescribers access patient EHRs and complete medication histories to more easily identify patients who may be visiting multiple physicians to gain several prescriptions to painkillers.
However, a year after the investment most providers still struggle to access the PDMP — called Michigan Automated Prescription System (MAPS) — directly through their EHR systems.
Deputy Director of Michigan Licensing and Regulatory Affairs (LARA) Kim Gaedeke told Crain’s about 42 percent of Michigan’s 50,102 prescribers and dispensers have EHR-integrated access to MAPS.
According to Gaedeke, fewer health systems and physician practices have applied to integrate with MAPS than expected. LARA estimated about 80 percent of providers would integrate with the state PDMP by August 2019.
However, large health systems including Detroit Medical Center and McLaren Health Care Corps have not yet linked up with the system.
“We thought we would get a lot of people calling the office,” Gaedeke told Crain’s. “That didn’t happen.”
Part of the problem stemmed from the difficulties of integrating hospitals and small physician groups into the state PDMP.
“We discovered our process was so simple, but health systems have a process, too,” said Gaedeke. “We have to respect each other’s processes. Health systems have to go through their own legal process.”
While participation remains low, Gaedeke said most health systems plan to integrate with MAPS in accordance with state law.
“There is a minority group of practitioners who are not following the laws, but feedback from the new system has been nothing but positive,” she maintained.
Health systems that have so far integrated with MAPS include Beaumont Health, Munson Health Care, Michigan Medicine, Holland Hospital, Lakeland Health, and Henry Ford Health System.
Ascension Health, Trinity Health, Spectrum Health, Sparrow Health, Hurley Medical Center, and Covenant HealthCare are currently in the process of enabling EHR integration of the state PDMP.
By enabling EHR integration with the PDMP, users will have one-click access to patient prescription information.
Michigan family physician Chris Bush told Crain’s he has heard some fellow doctors who cannot connect with the PDMP say they have limited opioid prescriptions to three days for acute or chronic pain because of the state requirement that physicians query MAPS for more than a three-day supply.
“We have been using MAPS for years and I have only seen one person break the rules,” Bush said. “Many people have chronic pain. They worked in the steel mills or automotive. I have them come in once a month.”
Some physicians take issue with the stringent three-day limit on opioid prescribing for groups who have not connected to the state PDMP.
“The law requires a MAPS query for more than a three-day supply, but there are a lot of issues with that,” said Michigan State Medical Society President Betty Chu, MD. “Some patients only need three days, but some need more.”
Some physicians who do not integrate with MAPS deal with significant administrative burden when trying to access prescription data. Without one-click access, the process of viewing patient prescription information can be a time-consuming, multi-step process.
For MAPS users at Henry Ford Health System, physicians automatically query the PDMP when they order prescriptions within the health system’s Epic EHR.
According to Chu, Henry Ford queries MAPS about 2,000 times per day.
Without a MAPS integration, these queries would be significantly more time consuming for health system staff.
“If integrated, MAPS automatically pulls up the query from the EMR,” said Chu.
While Henry Ford Health System’s Epic EHR is integrated with the state PDMP, solo practitioner and family physician Loretta Leja, MD, told Crain’s Allscripts has been slow to integrate with MAPS.
“Allscripts is trying to get integrated by the end of the year, but it is causing doctors problems and taking time away from patients,” said Leja.
Health systems, hospitals, and physician groups who have not integrated with the state PDMP using state funding have until August 2019 to connect. After August 2019, state funding will not pay for the EHR integration process.