AT THE HEIGHT OF THE PRESCRIPTION DRUG ABUSE EPIDEMIC, NABP (National Association of Boards of Pharmacy) was approached by several states to develop a solution that would make it possible to share vital information from prescription monitoring programs (PMPs) across state lines.
As a culmination of this request and months of shared effort, NABP PMP InterConnect was launched in 2011, allowing participating state PMPs throughout the United States to share PMP information. This service enhances existing PMPs and allows physicians, pharmacists, and other authorized users to better identify patients whose prescription history may indicate issues with prescription drug misuse and diversion, particularly in cases where patients are crossing state lines. Despite the COVID-19 pandemic, PMP InterConnect is now stepping into its second decade of serving the states (at no cost to them) in a position of strength. Now a comprehensive, fully integrated option for reviewing patient prescription history, PMP InterConnect is expected to soon reach the significant milestone of more than 1 million users.
Combating A Historic Epidemic
In 2011, the healthcare community was starting to recognize the full scope of the opioid epidemic and the role that prescription drug abuse and diversion were playing. The Centers for Disease Control and Prevention (CDC) data showed that more than seven Americans per 100,000 were dying of opioid overdoses, and more than half of those overdoses (4.9 per 100,000) involved commonly prescribed opioids. An estimated 21,088 people died of opioid overdoses in 2010 alone.
Eager to find ways to fight the rapidly increasing number of overdose deaths, many states developed PMPs and passed laws that required prescribers and pharmacists to use PMPs to watch for patients who might be in danger of developing an opioid use disorder or diverting opioids. As PMP technology was developed, expectations increased. However, a significant blind spot was identified when it became clear that some of these activities were happening across state lines.
“We weren’t able to share information,” explains Mark J. Hardy, Pharm.D., R.Ph., executive director of the North Dakota State Board of Pharmacy. “That was the problem we were looking to solve. It was the height of the prescription drug abuse epidemic, and a lot of individuals we identified were moving between states. Data wasn’t flowing between practitioners in those states, and it became clear that something like PMP InterConnect was needed.”
NABP and its technology provider, Appriss, developed and deployed the necessary technology and infrastructure for PMP InterConnect in just seven months. At launch, PMPs in Ohio and Indiana had started to share data, and Connecticut, Kansas, North Dakota, South Carolina, Virginia, and West Virginia were in the process of implementing the technology. In total, 15 states had already agreed to take the steps necessary to participate in the program.
To help govern the system and ensure responsible use and rollout of the technology, a PMP InterConnect steering committee was created, composed exclusively of representatives of the PMPs that were participating in the system. During the early meetings of the committee, the group engaged in many discussions about security, methods for auditing access to PMP data, and ways to integrate PMP InterConnect into clinical workflows of healthcare providers. As a result of these discussions, a software solution known as PMP Gateway was developed to allow PMP InterConnect integration into electronic health records (EHRs), making it possible to view PMP data without having to manually access a separate website.
“PMP InterConnect and Gateway facilitate integration — integrating the PMP into the clinical workflows through [EHR] systems and pharmacy management systems,” says Steven W. Schierholt, executive director of the State of Ohio Board of Pharmacy. “That has been huge — honestly, a game changer. Ohio was the first state in the country to provide that feature to its hospitals, doctors, and pharmacies free of charge. It has driven our use exponentially, and it was probably the biggest step in turning our PMP into an indispensable healthcare tool here in Ohio.”
“In 2016, Indiana started integrating PMP data directly into [electronic medical records],” says Kara Slusser, director of the Indiana Scheduled Prescription Electronic Collection and Tracking Program, Indiana’s PMP. “In 2017, we launched a statewide integration project with the added benefit of allowing practitioners to access multistate data using PMP InterConnect. This was all made possible because of NABP’s work and the PMP InterConnect system. Over the last decade, NABP has worked diligently to develop connections with nearly all 50 states. Without that ability to view patient data from multiple states, our integration efforts would not have been as successful as they are today.”
Pandemic Surge Shows Vigilance Is Still Needed
In the decade since PMP InterConnect was introduced, PMPs have become a vital tool in helping to reduce prescription drug misuse. Although the opioid crisis continues to be an important priority for NABP and its member boards of pharmacy, overdoses related to prescription opioids have declined significantly. Similarly, dangerous pain clinics run by unscrupulous prescribers and problematic patient behaviors such as “doctor shopping” (visiting multiple prescribers to seek the same or similar controlled substances) have also declined. “I don’t think it’s a coincidence that a decrease in these metrics occurred after PMP InterConnect started to see widespread use,” Hardy comments when discussing the impact PMPs have had on the pandemic in North Dakota. “It fostered sharing between jurisdictions, addressed major problems we had 10 years ago, and made PMPs into a high-level tool. It’s been built on a lot of successes.”
“Once sharing through PMP InterConnect began we saw significant decreases in the number of people crossing state lines to obtain controlled substances as part of illegal activity,” adds Joe Fontenot, R.Ph., assistant executive director of the Louisiana Board of Pharmacy. “To my knowledge, there was no mechanism in place to share information across state lines before PMP InterConnect.”
“Our instances of doctor shopping have fallen 93% since 2011,” says Schierholt. “That is directly attributable to our PMP, PMP InterConnect, PMP Gateway, and the prescriber community. Today, healthcare providers are all working diligently to be a part of the solution, and interconnectivity is a huge part of that.”
Although efforts to combat the opioid crisis have seen great strides since 2011, the COVID-19 pandemic and emergency measures taken to slow the spread of the disease may have complicated the situation. The CDC and other authorities report that the opioid crisis in recent years has been driven by the proliferation of illegally manufactured fentanyl being sold through various methods. In addition, the CDC has reported significant increases in overdose deaths over the last two years, and evidence suggests that this resurgence can be attributed, at least in part, to the pandemic. In summary, increased isolation and greater economic stresses may have led to a resurgence of opioid overdoses. As the pandemic-related isolation has eased over the last year, vigilance regarding prescription opioids continues to be important.
Healthcare Providers Benefit
As of fall 2021, 52 states and jurisdictions are participating in PMP InterConnect. Of the nearly 1 million users of PMP Inter- Connect, approximately 900,000 are physicians and prescribers, and 100,000 are pharmacists. In fact, in the last five years, the volume of information requests sent through the system has increased more than 7,000%. According to Appriss, PMP InterConnect regularly delivers information to one out of every three prescribers in the United States, and over 132,000 facilities have integrated PMP Gateway into their workflows.
Another important metric for PMP InterConnect is the amount of time it saves providers, particularly when fully integrated into EHR systems and healthcare system workflows. Appriss estimates that PMP InterConnect saves providers between two and five minutes per patient encounter. Because the system now processes over 1 billion annual patient encounters per year, PMP InterConnect is saving PMP users a minimum of 33 million hours each year.
Schierholt believes that PMP Gateway integration has been an important part of improving participation in his state’s PMP. “Seven years ago, I heard that our PMP was slow and cumbersome,” Schierholt says “Now, it is seamless. With a click of a button, providers can get a prescription history from Ohio or any other participating state. Integration is a game changer, and we would encourage any state to work toward it. It is also helping prescribers get time back — time once used to log into a system, enter data, and make queries can be used to have more meaningful conversations with patients.”
Enhancements to PMP InterConnect continue to be developed and implemented, with several new technical improvements underway. These developments will continue to make it easier for users to monitor the system, get reports and other vital information when they need it, and enable stronger, secure connections between PMPs. CT
Danna E. Droz, J.D., R.Ph., is the prescription monitoring program liaison at the National Association of Boards of Pharmacy. She can be reached at firstname.lastname@example.org.