Featuring posts written by the DoseSpot e-Prescribing Integration Team!

5 Shortcomings You Need to Know About Prescription Drug Monitoring Programs (PDMPs)

Posted: February 8th, 2017 | Author: | Filed under: Basics, Controlled Substances, Public Policy | Tags: , , , , , , , , , , , , , , , , , , , , , , , , , | No Comments »

PDMP Technology Under Construction

Prescription Drug Monitoring Programs (PDMPs) are state-run electronic databases that are used to track the prescribing and dispensing of controlled prescription drugs with the intent of helping to detect suspected abuse or diversion. These electronic databases provide important information regarding a patient’s controlled substance history that can be accessed by authorized individuals or agencies including law enforcement, medical examiners, addiction treatment programs, public and private payers, pharmacies, healthcare providers, and more.

All states except Missouri, the District of Columbia, and Guam have enacted PDMP legislation that mandate healthcare providers to record, consult and monitor prescribing data. Since the widespread implementation of PDMPs and corresponding legislations, there have been stories and statistics that seem to indicate success, however, there has also been feedback that indicates some major troubles with these databases and their use.

With PDMPs being utilized all over the country, should we expect a major turn-around in the prescription opioid crisis that is sweeping the nation? Are these databases in fact doing the job that they are intended to do? Or, are there major issues that are preventing their success? Let’s explore together.

The Benefits of PDMPs

PDMPs are considered to be the most promising state-level interventions to improve opioid prescribing, inform clinical practice, and protect patients at risk. They are intended to not only medically benefit patient care, but also to serve as a tool for law enforcement and other agencies concerned with opioid-related threats to the public health. This is because the information entered in to a PDMP can help prescribers and pharmacists identify patients at high-risk who would benefit from early interventions.

Further evaluations of PDMPs have demonstrated changes in prescribing behaviors, the use of multiple providers by patients, and decreased substance abuse treatment admissions. From a public health standpoint, PDMPs can be used by state health departments to better understand the current opioid addiction epidemic to better create new intervention methods.

[Read: The Link Between PDMPs and e-Prescribing]

As an example, in 2010, Florida established a PDMP and prevented health care providers from dispensing prescription opioid pain relievers directly from their office. That same year, there was a 50% decrease in oxycodone overdose deaths in the state. This change is thought to represent the first documented, substantial decline in drug overdose mortality in any state during the previous ten years.

Likewise, in 2012, prescribers in New York and Tennessee were required to check the state’s PDMP before prescribing opioids and the following year, New York saw a 75% drop in patients “doctor shopping” and Tennessee saw a 36% drop.

The Unfortunate Reality of PDMPs

Although PDMPs have significant potential to improve public health and patient outcomes, they do have the following shortcomings:

1. Under-Utilization

The inconsistent use, or under-utilization, of PDMPs is considered to be the biggest issue plaguing the database, as a PDMP is most useful when queried before prescribing and most maximized where usage is state mandated. A recent survey found that with physicians prescribing in a state without a PDMP mandate, only 22% were aware of their state’s PDMP, and only 53% had actually used it. These facts clearly indicate that state legislation is a critical success factor for the effectiveness of PDMPs to save patient lives.

2. Lack of Accessibility

Another issue with PDMPs is the ease of use and access, or lack thereof. States vary widely in which user categories are permitted to request and receive prescription history reports and under what conditions. Research suggests that usage may improve if states were to allow providers to appoint non-prescribing staff members to access the database on their behalf.

[Read: 3 States Laying Down the Law on Opioids]

Furthermore, not all PDMPs share information across state lines. This can lead to important information being missed and can allow at-risk patients to receive more prescriptions for controlled substances than intended. However, more states are realizing the importance of sharing data across state lines and have recently become a part of PMP InterConnect.

3. Varying Times of Information Entry

Another matter of concern with PDMPs is varying times of information entry. When a controlled substance is dispensed to a patient, the prescription and patient information is entered by the pharmacy to the state PDMP. However, this information is entered at varying intervals – hourly, daily, or even monthly. If there is a long interval between dispense and submission times into the state PDMP, users will not have the most up-to-date information on a patient’s most recent prescriptions, thereby eliminating the maximum benefit of a PDMP. Currently, Oklahoma is the only state that collects data in real time, whereas, most states allow up to a week or longer for data submission.

4. Patient Adoption

Many prescribers attribute their worry about a patient’s reaction when checking the PDMP as a major disadvantage. In a recent survey, providers reported a variety of issues that arose when they reviewed the PDMP:

  • 88% of patients reacted with anger or denial when questioned
  • 73% of clinicians said that those angered patients sometimes did not return
  • 22% of clinicians reported that the confronted patients had never asked for help with drug addiction or dependence problems

These clinicians also indicated that the unveiling of this information was not only upsetting to patients, and damaging to practitioner-patient relationships, but was also found to be inaccurate at times.

Additional concerns include added costs of more frequent office visits if prescribers become more cautious about writing prescriptions with refills, feelings of embarrassment when questioned about substance abuse, and patients turning to the illicit drug market if they are refused a controlled substance prescription.

Although the American Medical Association and American Society of Addiction Medicine stress the need to treat PDMP data just as well, if not better, than any other medical record, patients are becoming more vocal in their discomfort with PDMPs, claiming they make them feel that a medical consultation is no longer private.

5. Reluctant Prescribers

Like their patients, prescribers also show growing concern that they will be judged based on PDMP data. While most prescribers are assumed to support interventions to prevent fraudulent prescribing, high profile criminal prosecutions of prescribing large amounts of opioids can make prescribers reluctant to prescribe controlled substances in general for fear of legal retribution, also known as the “chilling effect”.

There is also greater perceived legal risk for prescribing or dispensing too much pain medication than for prescribing or dispensing too little pain medication. Because many practicing physicians have little if any formal training that would enable them to identify drug diversion, there is fear that PDMPs may wrongfully suspect and categorize some conscientious and caring physicians as fraudulent prescribers when they are actually prescribing in good faith, but lack training.

What Does This All Mean?

In this era of information technology, PDMPs are likely here to stay. While there are the aforementioned pitfalls of PDMPs, it is important to remember that there are still benefits to PDMPs in the public health sector, law enforcement, and of course, healthcare systems. What may be most helpful is to realize what changes could be made to make the PDMP process an ideal one.

From the standpoint of many prescribers, an ideal PDMP would:

  • Alert its users to signs of illegal drug use
  • Be easy to access
  • Provide real time updates
  • Be mandatory
  • Have interstates accessibility

Perhaps over time if these changes were to be made, we would see more consistent use of PDMPs, especially as a tool to help overcome the opioid epidemic. A clear standard of practice against which providers’ care would be judged could also further advance the utilization of PDMPs in each state. Lastly, adequate training on addiction and pain management, along with a careful review of who should access a PDMP, could also attribute to better utilization and help accelerate the acceptance of each states’ prescription drug monitoring programs.

Author: Lindsey W.

Sources: Centers for Disease Control and Prevention; Lynn Webster MD; PDMP AssistWolters Kluwer; Shatterproof; National Center for Biotechnology Information

About DoseSpot

DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit www.DoseSpot.com.


Opioid Turmoil: Addressing the Link between PDMPs and e-Prescribing

Posted: August 2nd, 2016 | Author: | Filed under: Basics, Controlled Substances, In the News | Tags: , , , , , , , , , , , , , , , , | No Comments »

Opioids, PDMPs, e-Prescribing, Electronic Prescribing

With a nationwide opioid epidemic upon us, states are starting to insist that prescribers conduct a bit of research before writing prescriptions for addictive medications like pain medications or benzodiazepines. States have therefore created statewide Prescription Drug Monitoring Programs (PDMPs) to monitor an individuals’ controlled substance dispense trends which are meant to assist a prescriber in making smarter treatment decisions. The goal here is to check a patient’s medication history to determine if the patient is doctor shopping or if they may have potential complications with medication(s) they are taking or have taken. Ultimately, PDMPs aid a prescriber in understanding the risks involved in prescribing these powerful medications for their patients.

“Databases known as Prescription Drug Monitoring Programs show doctors all controlled-substance prescriptions patients get and should be linked with the electronic health records (EHRs) that allow doctors to e-Prescribe.” USA Today

In most states, healthcare professionals who prescribe at least one controlled substance are encouraged, not required, to use PDMPs. The USA Today article addresses the fact that only five states promote the use of PDMPs and less than 20% of doctors use the databases when it isn’t required. On the other hand, e-Prescribing of controlled substances has proven to be an effective tool in combating this crisis, yet only three states have mandated the use of e-Prescribing, and one doesn’t enforce its own law.

Click here to learn more about e-Prescribing and how to stay ahead of this opioid crisis

All 50 States (and D.C) have now passed legislation allowing the e-Prescribing of both controlled and non-controlled substances, which is a drastic change from only a few years ago with federal regulations prohibiting the e-Prescribing of controlled substances.

Let’s take a look at the states that have mandated e-Prescribing:

New York: The first state to mandate and enforce its e-Prescribing laws as of March 2016, New York requires prescribers to check their state PDMP database and prescribers who continue to write paper prescriptions are subject to fines, jail time, or both. Since implementing, total numbers of opioid analgesics prescribed fell by 78%.

Minnesota: Technically the first state to deploy mandatory e-Prescribing, they currently do not enforce the use of such technology. The MN Department of Health recently reported that drug overdose deaths jumped 11% between 2014 and 2015 and more than half were related to prescription drugs, specifically opioid pain relievers, rather than illegal street drugs. Minnesota Health Commissioner Dr. Ed Ehlinger said, “The new data show the need for a broader approach to addressing the root causes of drug addiction and overdoses.” Stay tuned.

Maine: Experiencing one of the highest death rates in the country due to opioid overdose, Maine recently mandated e-Prescribing for schedule II controlled substances and will be put into effect come June 2017. Similar to New York, prescribers will face fines, jail time, or both if they choose to utilize paper prescription pads.

New Jersey is also on the horizon to mandate e-Prescribing in due time. As a collective nation, we can no longer sit back and overlook the link between opioid overprescribing and opioid overdose. E-Prescribing and PDMPs should work hand in hand; the benefits are exceedingly visible and with 3-9% of opioid abusers using forged written prescriptions, it’s a commonsense solution. Protect your company, protect your providers, but more importantly, protect your patients. They depend on it.

About DoseSpot

DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit http://www.DoseSpot.com.


Congress, Dentists, and the Opioid Crisis: Is Good, Good Enough?

Posted: July 13th, 2016 | Author: | Filed under: Basics, Controlled Substances, Dental, In the News, Public Policy, Security | Tags: , , , , , , , , , , , , , , | No Comments »

As the opioid epidemic continues and more policies have recently been implemented to curb this crisis, it seems that a crucial piece of the puzzle is missing: mandatory electronic prescribing. Like Devon Herrick mentions in his latest post, e-Prescribing is a commonsense solution for an issue that isn’t slowing down in the United States. Now is the time for Congress to step up and take advantage of solutions that are not only available, but approved and certified by the DEA. It’s clear that efforts to prevent and treat the opioid epidemic will fall short without additional investments and while states have implemented Prescription Drug Monitoring Programs (PDMPs), they’re not mandatory and the ability to further capture data will undoubtedly be a pivotal cornerstone while facing this epidemic and for several reasons. With electronic prescribing:

  1. A prescriber can track a patient’s medication history and make smarter treatment decisions, i.e. doctor shopping, recent prescriptions filled, and drug-to-drug and drug-to-allergy interactions.
  2. There is no more need for paper prescriptions, therefore no more interpreting messy handwriting, no more altered dispense quantities, and no more stolen prescription pads.
  3.  A significant decline will occur relative to the rate of fraud, resale and abuse of opioids because e-Prescribing secures all information exchanges from diversion.

Electronic prescribing has been utilized by doctors for a few years now, but the e-Prescribing of controlled substances is last to hop on the bandwagon. Until recently, federal regulations prohibited e-prescribing of controlled substances due to perceived risks, however electronic prescribing diminishes these elements of risk.

Click here to learn more about e-Prescribing and start saving time and money today!

Since New York mandated that all prescriptions must be sent electronically, dentists in particular, have seen a vast change in the number of opioid prescriptions: “In a study of dentists, within a few months after iSTOP was implemented in New York, opioid prescriptions fell by about half, from 31 percent of dental visits before iSTOP to 14 percent in the following three months. The quantity of pills per prescription also fell. The total numbers of opioid analgesics prescribed fell by three-quarters (78 percent).”

Whether it’s mandated or not, the numbers don’t lie – electronic prescribing proves to be the smarter and safer force as we battle opioid addiction. Congress, take note.

Sources: National Center for Policy Analysis; PLOS; National Safety Council; NPR; Congress

About DoseSpot DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit http://www.DoseSpot.com.