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Improved Clinician Decision Support with Data-rich PDMP?

The opioid-abuse epidemic, both from illicit opioids (e.g., heroin) as well as prescription narcotics (e.g., Vicodin, Oxycodone), in the US is well documented. In addition to addiction treatment programs, a software tool has also been designed to help combat this epidemic – the Prescription Drug Monitoring Program (PDMP).

What is the PDMP?

At a high level, the Prescription Drug Monitoring Program is a web-accessible database listing patients, their physician(s), and their prescribed drugs. The PDMP is a nationwide program that is operated at the state level. Some states have formed agreements to share prescription drug information, while Missouri remains the only state without a program, though efforts are underway to establish one.

A key aim of the program is to reduce opioid-related mortality. Specifically, the PDMP aims to assist physicians detect patients who see multiple doctors for narcotics prescriptions to feed their addiction or to sell on the black market (which is called opioid diversion).  Pharmacies and dispensaries can also access the PDMP and, along with physicians, have to report when they write or fill narcotic prescriptions.

Does it Work?

Many states that have implemented the program have seen reductions in opioid abuse complications. PDMP-related successes in New York and Tennessee, for examples, are listed here. Still, there are those who suggest the system has not achieved the level of utilization needed to meet its full potential. This is certainly true in Maryland which passed a law in April 2016 to become one of 16 states to require physicians to check the PDMP when prescribing a narcotic.

What is the PMDP Problem?

Low utilization rates can likely be attributed to many factors, only one of which is that many physicians consider the system difficult to use. Of greater concern is that the PDMP may not provide information to practitioners in a manner they can quickly and easily use when treating patients.

However, turning data into actionably decision-support information is what IT is all about. This may be an opportunity for Health IT to positively benefit healthcare.

An IT-based Approach May Help

If in addition to listing of a patient’s prescription drug history, the PDMP could provide insights into which patients are at high-risk for opioid-dependency or related complications, such as depression, it may be more valuable and therefore gain greater adoption.

Additional population-based statistics and analytics is likely required to make this determination, along with algorithms to process these various data points. All this sounds like a pilot is necessary. A targeted pilot to validate if a PDMP augmented with population and real-time analytics will lead to greater utilization and if that will in turn lead to a reduction in opioid diversion, abuse, and related mortality and morbidity.

At HSR, we are working on designing such a pilot and believe that if successful, it will go a long way in validating and demonstrating how an IT-based system can serve as or augment an existing clinician decision support tool at the point of care. These findings could then potentially be leveraged throughout the healthcare industry.

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