Pharmacist Tom Kelly has seen firsthand the difficulty that chronic pain-patients can have earning the trust of pharmacists and physicians. The serious problem of abuse that hangs over the medications required by patients with legitimate needs puts all parties in a very difficult situation. In this interview with ComputerTalk Senior Editor Will Lockwood, Kelly describes his new solution to this persistent problem.

CT: Tom, tell us about your background.

Kelly: I graduated from Temple University, and I've been a practicing pharmacist for the last 31 years. My wife, Samantha, is also a pharmacist. She's a graduate of Philadelphia College of Pharmacy. We own or are partners in four retail pharmacies in southern New Jersey.

CT: Your newest venture is designed to create an environment of trust around the prescribing and dispensing of medications for chronic-pain patients, right? Tell us about it.

Kelly: The Patient Physician Trust Partnership [PPTP] is a tool I developed to help increase transparency and trust among patients, physicians, and pharmacists. This trust is sorely lacking, especially when it comes to narcotic opioid analgesics. The genesis of the program came roughly three years ago when a physician friend of mine was being challenged by caring for chronic-pain patients. He found himself becoming very involved in nonclinical issues surrounding their care. He was dealing with early refills, lost medications, and changing dates, quantities, and strengths on prescriptions. These are all possible signs of abuse or diversion, but they are also all common problems faced by legitimate patients. It got to the point where this doctor was having a difficult time engaging this patient population without wondering which patients were truly legitimate and which weren't. He would bring this up routinely with me. He's not unique. There are many prescribers who are unwilling to take on new patients with chronic pain or other needs for controlled medications because of very real concerns about diversion and abuse.

CT: The issues around pain medication are clearly very serious. How do you build trust?

Kelly: One idea we talked about was creating a registry for patients. The problem we saw with this solution was that, for all intents and purposes, it places a scarlet letter on the patients and is not really enhancing patient care. So a little while later, I woke up in the middle of the night with the thought that it might be best for a patient to self-enroll in a program. The patient would take ownership of the responsibility to be transparent. This would help change the current model where all the responsibility for determining a patient's legitimacy falls squarely on the shoulders of the prescriber, a burden that makes it more difficult for practitioners to write for these products.

The idea behind PPTP is similar to someone filling out a credit application for a bank, where they verify their financial information. In this case, they verify the details surrounding their pain medication use.

CT: How exactly does the process work?

Kelly: We've developed a tool where patients go online and do a very robust identity verification test. They can only do it once and can't create aliases, because it's the same verification test that the majority of the biggest banks use to verify the identity of their customers.

Once the patients have verified identity, they have the ability to select prescribers - physicians or nurse practitioners, for example - and pharmacies they want to participate in the transparency program with them. Patients might select a general practitioner or primary-care physician, if that doctor is writing prescriptions for pain medications. They might also select a secondary practitioner - for example, a psychiatrist - and perhaps a dentist. Then they will select one - and only one - pharmacy for dispensing controlled substances. When the patient makes those choices, all that information is forwarded to each of the prescribers the patient has selected. If the patient removes or adds a prescriber or changes pharmacy, all prescribers on the list are notified of the change. This creates an enhanced level of transparency.

CT: How do you get patients involved?

Kelly: In my view, this can happen in the pharmacy. There are many scenarios in which a pharmacist may have concerns about the legitimacy of a patient's needs for controlled substances. Unfortunately, there's an immense amount of diversion and abuse, and the last thing a pharmacist wants to do is dispense a medication that may cause harm. But these very real concerns have a serious impact on legitimate patients. For example, if a chronic-pain patient moves to a new area, it may be very difficult to find a prescriber who is willing to take him into his practice or a pharmacy to dispense the medications. If the patient is participating in a transparency program, I believe that's going to increase the likelihood of receiving meaningful care.

CT: And there's an opportunity here for pharmacists to help legitimate patients have their needs for care met.

Kelly: Yes. If a pharmacist is presented with a patient who confides that he's having a hard time finding a prescriber practice that will accept him, through no fault of his own, the pharmacist can educate him about the benefits of a transparency program like PPTP and the confidence it's going to provide for both a prescriber practice and for the pharmacy dispensing the medications.

CT: Will a pharmacy be able to access the profile the patient creates in order to verify the dispensing needs? What are the nuts and bolts of how this works, from the pharmacy's perspective?

Kelly: For retail pharmacists to be able to verify a patient's PPTP enrollment status and also find out what prescriber practices are caring for the patient, they simply transmit a standard NCPDP billing claim to PPTP's BIN, which is 014922. This is done right through the pharmacy management system. We send a response with full information about registered physicians and the patient's enrollment status, as well as any details on the pharmacy a patient has enrolled with, if it's not the one requesting. The response transaction then becomes a part of the patient's profile in the pharmacy management system, creating a record of the steps taken to establish the legitimacy of the patient.

CT: This sounds like a chance for pharmacists to build relationships with both patients and prescribers.

Kelly: Many maintenance medications are going mail order, leaving the brick-and-mortar stores to compete for acute care prescriptions. Chronic pain is one of the few remaining categories that have little intrusion by mail services, and the gross margin for this class is inherently higher than most all other categories. It only makes sense that pharmacies interested in driving higher margin market share while satisfying due diligence will want to embrace a transparency program.

The beauty of the program is that it is available at no charge to healthcare providers - except standard fees from claim switches. And it involves only the triad of care - the patient, prescriber, and pharmacist. Today there are many programs that force wedges between patients and care. We wanted to make sure that only the stakeholders drive the program. The tool was designed to provide due diligence while using automated platforms currently embraced by healthcare professionals for ease of use. We rarely see programs that are win-win-win, and PPTP hits that mark.