Response to the GAO Report on the Operation of PDMPs

The SUPPORT Act required the Government Accountability Office (GAO) to issue a report that examines the operations of PDMPs. The GAO report reflects interviews with only 31 physicians in 10 states, representatives from three national pharmacy associations, 4 pharmacists, and PDMP officials from 9 states. GAO notes that the information and findings in the report should not be generalized to all physicians, pharmacists, health care providers, or state PDMPs.

The interviews reflected in the report present some good insights. However, the report falls short of painting the full picture about the utility of PDMPs and the ongoing innovation to improve the identification of potential opioid misuse and abuse, and increased patient safety. As the vendor for 43 of the nation’s 54 PDMPs, Appriss Health shares the goal of policymakers and prescribers to integrate access to PDMP data directly into electronic health records (EHRs). Today, one-third of all U.S. prescribers are using Appriss Health’s PMP Gateway integration as part of their EHR system, which enables them to seamlessly access PDMP data.

PMP Gateway facilitates the integration of PDMP information into clinical workflow for almost 90 million monthly patient encounters. More than 800,000 clinicians rely on Appriss Health to deliver PDMP data at any given moment through 130 plus integrated EHRs. Seventy-five percent of the nation’s largest healthcare systems use our solutions, as well as more than 32,000 pharmacies. Appriss is at the frontlines of this work and is innovating every day to solve for challenges faced by prescribers and pharmacists.

Every day our team is working with states and health systems to make this integration a reality for more prescribers. This work is executed on a site-by-site basis and today we have established our Gateway integration in more than 104,000 healthcare facilities throughout the United States.

Prescribers without Gateway, or another effective form of integration, are appropriately demanding easier use and access to PDMP information. They need this information incorporated in their clinical workflow while they are with the patient so they can easily evaluate the best course of action for optimal care. The data shows that in some states, after Gateway EHR integration, prescriber engagement with PDMP data has increased 10-fold. Each of these clinical interactions provide valuable insights from near-real time data housed in 51 PDMPs around the nation.

Given the limited prescriber input, the GAO report fails to fully highlight the value of alerts and risk scoring as a resource for reducing drug misuse and dangerous prescribing. Prescribers face a difficult task in tracking and understanding when a patient may demonstrate unsafe use practices.

Appriss Health created NarxCare to help prescribers more easily understand which patients may be at risk for opioid misuse or abuse. NarxCare uses artificial intelligence and machine learning to leverage prescription data and other available information. Today, more than 675,000 physicians are receiving risk scores from our application with the goal of improving patient safety. This solution enables prescribers to more efficiently use multiple data resources to inform patient care.

For example, NarxCare provides at-a-glance knowledge of the number of active medications prescribed to a patient categorized by narcotics, stimulants, and sedatives. Physicians can easily identify changes to prescription history. This is clinically valuable because it allows care coordination among physicians to avoid over prescribing. The medical team can also identify the patient’s acute, episodic, and chronic treatment history, while differentiating between transactional care or longitudinal treatment.

And finally, NarxCare identifies patients who may benefit from more frequent monitoring, dose tapering, and/or a Naloxone prescription to reduce risk of opioid related harm. Physicians have told us they value this decision-support assistance and have saved lives as a result. The continued adoption of standardized measures and analytics will improve patient access to treatment, patient education and engagement, and care coordination.

The report briefly mentions that the Department of Justice (DOJ) and the Centers for Disease Control and Prevention (CDC) have required states, as a condition of grant funding, to maintain an active connection to the Bureau of Justice Administration’s (BJA) preferred PDMP data-sharing hub, RxCheck. In fact, CDC and BJA require states to also maintain a connection to PMP InterConnect, to which 51 PDMPs are currently connected and through which the vast majority of all data sharing occurs today, ensuring that states have options. Many PDMPs have invested considerable resources in building infrastructure and data-sharing capabilities around PMP InterConnect and have achieved amazing results. It is vital that these options and preferences, as well as the existing EHR integrations of one-third of all U.S. prescribers, are protected.

This snapshot report can serve to demonstrate how both the public and private sector can work together. Together we can better utilize resources to accelerate efforts to improve public health. Appriss has worked with federal agencies and states for over 25 years bringing high-value projects involving data sharing through a vast interoperability network and delivering real, rapid benefits to our nation.

 

Rob Cohen

Author

Rob Cohen

Rob Cohen, president of Appriss Health, brings over 13 years of healthcare experience to Appriss with a career spanning leadership positions at McKinsey and Company, Anthem, and Healthways.

Mr. Cohen holds a BBA, summa cum laude, from the University of Texas at Austin, a master of computer and information technology from the Moore School of Engineering at the University of Pennsylvania, and an MBA with honors from the Wharton School at the University of Pennsylvania.

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