Evolving the PDMP to Create A Powerful Medication Reconciliation - PowerPoint PPT Presentation

Evolving the PDMP to Create A Powerful Medication Reconciliation Tool & PDMP Panel Discussion

Introductions -Marilee Benson, President of Zen Healthcare IT - Kevin Borcher , Pharm.D, PDMP Program Director, NeHII - Paula Weldon , Operations Manager, Reliance eHealth Collaborative - Keith Parker , Chief Information Officer, Health Current

Nebraska PDMP Initiative

PDMP • A prescription drug monitoring program (PDMP) is an electronic database that tracks controlled substance prescriptions in a state. PDMPs can provide health authorities timely information about prescribing and patient behaviors that contribute to the epidemic and facilitate a nimble and targeted response. 1 • Tool to allow healthcare professionals to make better informed decisions relating to the treatment and safety of the patient 1 CDC. https://www.cdc.gov/drugoverdose/pdmp/states.html

ASAP and NCPDP and HL7, Oh My Ø ASAP Ø American Society for Automation in Pharmacy Ø Standard format for PDMP data submission Ø NCPDP Ø National Council for Prescription Drug Programs Ø ANSI-accredited standards Ø e-Prescribing, pharmacy claims adjudication Ø HL7 Ø ANSI-accredited standards Ø Exchange, integration, sharing, retrieval of electronic health information

Data Availability Ø ASAP format Ø Patient • Name • Address • Date of Birth • Gender (optional) • Phone Number (optional) • ** No unique MRN or unique identifier Ø Pharmacy • Name • Address • Phone Number • NPI/DEA

Data Availability Ø Prescriber • Name • NPI/DEA Ø Prescription • Rx# • Date written • Date filled • Date sold (optional) • NDC • Qty • Days supply

PDMP Workflow Process PDMP PDMP PDMP

Nebraska PDMP Highlights Ø Operated by NE Department of Health and Human Services Ø In collaboration with Nebraska Health Information Initiative Ø Optum platform for user maintenance and access Ø PDMP Vendor – DrFirst Ø Dispensers (e.g., pharmacies) must report daily

Nebraska PDMP History Ø 2011 NeHII integrated the PDMP into the HIE • First HIE to accomplish this • Surescripts data feed • 60-80+ % complete • Missing Medicaid, much self-pay

Nebraska PDMP Legislation Ø 2016 – Legislation to enhance PDMP • Mandatory collection of controlled substances January 1, 2017 • No opt out • Prescribers and pharmacists may access at no cost • Pharmacists may authorize designees • Report ALL dispensed prescriptions by January 1, 2018 Ø 2017 – Prescribers may authorize designees • Mandatory training Ø 2018 – Exclude non-human non-controlled substances

Nebraska PDMP Reported Data July 2017 – July 2018

User Queries July 2017 – July 2018 # Unique Queries per Month 4 0,00 0 34,444 3 5,00 0 31,328 29,528 3 0,00 0 24,939 2 5,00 0 20,315 2 0,00 0 15,431 1 5,00 0 12,461 9,844 9,008 9,088 1 0,00 0 8,160 7,741 7,169 5 ,000 - J ul-1 7 Aug -17 Sep -17 Oc t-1 7 Nov -17 Dec -17 J an-1 8 Fe b-18 M ar-18 Apr-1 8 M ay -1 8 J un-1 8 J ul-1 8

Who Can Access? NeHII HIE users PDMP users PDMP Pathway HIE Pathway Prescribers (MD, PA, APRN, DDS) Any HIE participant Dispensers (RP) Designees (RN, Pharm tech)

Patient PDMP Queries – Access through PDMP portal

MME Alert

Multiple Provider Episode Detail

Overlapping Opioid/Benzodiazepine Alert Detail

Reporting all dispensed prescriptions Ø Required reporting as of January 1, 2018 Ø Comprehensive medication history • 10 x more data than traditional PDMP’s that include controlled substances only Ø Patient safety tool Ø Allows clinicians to make better informed decisions Ø Identify medications from multiple prescribers and pharmacies Ø Identify potential drug interactions, allergies Ø Provides a valuable resource in the event of natural disasters, system power interruptions Ø Tool for medication reconciliation

Current Methods to Obtain Medication History Ø Only as accurate as the history obtained Ø Time-consuming Ø Distractions Ø Patient Ø Family/caregiver Ø Patient/family to bring in all medication bottles Ø Call pharmacies Ø Review EHR

Medication Reconciliation Medication reconciliation is the process of creating the most accurate list possible of all medications a patient is taking — including drug name, dosage, frequency, and route — and comparing that list against the physician’s admission, transfer, and/or discharge orders, with the goal of providing correct medications to the patient at all transition points within the hospital Institute for Healthcare Improvement

Importance of Medication Reconciliation • Medicare hospital readmissions (2003-2004) 1 • 19.6% within 30 days • 34.0% within 90 days • Longer rehospitalization length of stay • Estimated cost of Medicare unplanned rehospitalizations in 2004 - $17.4 billion • Readmissions • 18.3-24.8% for HF, AMI, Pneumonia 2 • 13.1-17.8% 3 • 23% suffered adverse event post-discharge 4 • 12% considered avoidable • 72% adverse drug events • $$$ • Medicare Reimbursement/HRRP • 1. Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2,597 hospitals penalized in FY 2017 5 2009;360(14):1418-1428. • 2. Dharmarajan K, Hsieh AF, Lin Z, Bueno H, Ross JS, Horwitz LI, Barreto-Filho JA, Kim N, Bernheim SM, Suter LG, Drye $528 million EE, Krumholz HM. Diagnoses and Timing of 30-Day Readmissions After Hospitalization for Heart Failure, Acute Myocardial • Infarction, or Pneumonia. JAMA. 2013;309(4):355-363. 0.73% average penalty 3. Zuckerman RB, Sheingold SH et al. NEJM 2016; 374:1543-1551 • 4 . F o r s te r A J , C la r k H D , M e n a r d A e t a l. A d v e r s e e v e n ts a m o n g m e d ic a tio n p a tie n ts a fte r d is c h a r g e fr o m h o s p ita l. C a n M e d 3% max penalty A s s o c J . 2 0 0 4 ; 1 7 0 ( 3 ) :3 4 5 - 3 4 9 . 5. Kaiser Health News, 8/2/2016

Importance of Medication Reconciliation Ø TJC 2005 National Patient Safety Goal #8 • “accurately and completely reconcile medications across the continuum of care.“ Ø National Patient Safety Goal #3 (July, 2011) • 03.06.01Obtain information on the medications the patient is currently taking when he or she is admitted to the hospital or is seen in an outpatient setting. This information is documented in a list or other format that is useful to those who manage medications. (Effective 1/1/15)

Importance of Medication Reconciliation Ø Adverse Drug Events Ø Strategies for effective medication reconciliation 1 Coordinated communication that includes • standardized medication lists, medication administration programs (MAP), interventions, and referrals; A foundation of automation and technology to • close the communication gap between health care professionals 1 Hume K, Tomsik E. Enhancing Patient Education and Medication Reconciliation Strategies to Reduce Readmission Rates. Hospital Pharmacy . 2014;49(2):112-114. doi:10.1310/hpj4902-112.

Opportunities for PDMPs Ø Easy access Interoperability • Workflow integration • Directly access through health • information exchange, electronic health record or pharmacy software Single Sign-On • Interstate data sharing •

Opportunities for PDMPs Ø MPI/Patient identifier Ø Specialized registry Ø Medication reconciliation Ø Data analytics Ø Quality improvement initiatives Opioid use • Chronic Disease •

Making it Work Ø Support Professional associations • Medical, Pharmacy, Hospital • State government • Health department • PDMP administrators • Legislators • Attorney general • Governor • Ø Federal/state legislation

Oregon PDMP Initiative

Reliance PDMP Connection Problem statement • We heard from providers that its outside of their workflow, its to cumbersome, its too slow • We wanted to provide a solution that allowed access through the HIE during their normal community health record query • In 2015 received an interoperability grant from the ONC through the Oregon Health Authority • Part of the funding was to pay for the connection between PDMP and Reliance HIE • Reliance contract with Appriss directly for this connection • Changing vendors on our side caused delay in implementation

Oregon PDMP Legislation PDMP program created to improve lives of Oregonians 2009 First state PDMP program to focus on public health aspects of data HB 4124 passes allowing PDMP data access via Health IT systems 2016 Gives providers information at point of care HB 3440 passes allows interstate sharing and mandatory registration 2017 Allows Medical and Pharmacy Director PDMP Access 2018 HB 4143 passes mandates all opioid prescribers to register for the PDMP

Oregon PDMP Governance

Oregon PDMP Goals • Increase use of PDMP data at the point of care • Improved access and prescriber efficiency • Minimized changes to current workflow • Optimized prescribing practices