Everyone in healthcare, the Trump administration, the public, and even our bipartisan Congress all agree we have a serious problem with regards to the abuse of prescription drugs.
The CDC reports that overdose deaths increased by 28% between 2015 and 2016, while prescription rates remained level for insured patients according to a Mayo Clinic report.
However, converting agreement into action is the hard part, and some of the proposed changes—while interesting—ignore fundamental aspects of human nature on the part of physicians and pharmacists.
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We now have proof that state-specific PDMPs can help. These programs provide clinicians access to a patient’s historical use of prescription drugs and controlled substances, and help to identify overuse and the potential for further abuse. State-specific PDMPs have helped prevent patients from obtaining drugs fraudulently and have kept those drugs from being prescribed and dispensed. They also help patients with valid medical needs gain access to the drugs that they need.
However, we also know that, in many cases, state-specific PDMPs have not been put to use. Now, if we know that PDMPs work, why wouldn’t pharmacists and physicians use them?
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The answer is simple: It all comes down to ease of use. To access an individual state’s PDMP database, the clinician—whether a pharmacist or prescribing doctor—must leave their pharmacy or physician management system and navigate to the PDMP website. In other words, they have to interrupt and abandon their normal workflow.
With the time pressures people face, this just isn’t going to happen.
We have also created additional friction with state-specific PDMPs. These programs make it less likely for medical professionals to crosscheck. Sure, individual states can grant access to doctors and pharmacists from other states, but it’s a time-consuming process that reinforces the disruption of normal workflow and requires not just one or two extra steps but almost a dozen.
Although some proponents and vendors claim the opportunity exists to use a gateway between individual state programs, it doesn’t get to the core problem of having to dial out and conduct outside interaction. Unless we integrate into existing systems, we will not solve the issue.
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We now have the technological and electronic means to create a national solution that can be embedded into systems within the normal workflow. The National Council for Prescription Drug Programs (NCPDP) provides standards for communication of pharmacy claims and electronic prescriptions between pharmacies, physicians and third parties. These communications occur millions of times every day. The standards are critical to electronic communication related to prescriptions. With relatively minor changes, these standards and networks could be used to develop a national PDMP solution.
Using NCPDP standards, access to this information could be made available within the workflow of the pharmacy and physician computer systems whatever the area. At FDB, we advocated this same position nearly four years ago, when we published our Issue Brief on Prescription Drug Abuse in America. I encourage you to read more about our perspective.
It is understandable that states are protective of their own PDMPs. A lot of money and time went into development, and with the state-specific model, they believe they can be more innovative and have more control.
Security and privacy continue to be concerns. There is the common question: can we protect the privacy of the individuals in a nationwide system? There is no perfect answer to this. You cannot go a day without seeing a breach in healthcare systems. People are rightly concerned, but the benefits of a nationwide PDMP outweigh the risks.
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There is still a lot of work to do, but there is no time like the present. Issues related to state-specific laws and regulations, privacy concerns, state permissions for access and development of a national data repository need to be addressed. All of these issues can be resolved. The infrastructure and standards are ready, the technology is ready; now we need to solve the political and states’ rights issues.
We need to acknowledge that the state-specific process, now in place, needs to be replaced with a national solution. We have a nationwide prescription drug abuse epidemic that jeopardizes patient safety.
This is not a technology issue, it is a matter of having the will to do it.
Tom Bizzaro is vice president of health policy and industry relations for FDB, where he is responsible for proactively monitoring all healthcare policy issues and proposals emanating from both the federal and state governments as well as participating in health policy initiatives related to the use of electronic drug information.