Each time they deal with opioid painkillers, US doctors and pharmacists must interact with a database called a prescription drug monitoring program, PDMP for short. These frequent connections are needed to prevent the misuse and overdose of dangerous substances. But if not organized properly, they significantly increase the burden on the medical staff.
The best possible solution is to enable PDMP access from within an internal IT system. In this case, each interaction takes just a few seconds instead of an average of three to five minutes per patient report.
If your EHR or pharmacy management system is not integrated with the PDMP database, probably, your IT department should make that happen as quickly as possible.
What is PDMP and how does it work
A prescription drug monitoring program appeared as a means to combat the opioid epidemic way back in 1939 in California. Since then, it has evolved from a paper-based registry to a network of electronic databases that keep a record of the dispensing of controlled dangerous substances (CDSs).
The stakeholders involved in PDMP activities are pharmacies, state insurance programs, healthcare license boards, state health departments, law enforcement agencies, and healthcare providers. Currently, the program embraces 49 of 50 states with the exception being Missouri.
Organizations engaged in PDMP initiatives.
Prescription Drug Monitoring Program regulations
By January 2022, every state must have a PDMP database to comply with the SUPPORT Act, a federal law where SUPPORT is an abbreviation for Substances Use-Disorder Prevention that Promotes Opioid Recovery and Treatment.
The act also makes mandatory Electronic Prescribing of Controlled Substances (EPCS) which means that doctors must prescribe opioids in the digital form only.
Besides the SUPPORT Act, all states have their local rules to regulate dispensing of dangerous drugs. That’s why PDMPs across the country significantly differ from each other in:
the list of CDSs to be tracked;
registration requirements;
limitations on who can access PDMP data (prescribers, pharmacists, their delegates, researchers, medical, pharmacy, and dental directors);
situations when prescribers and dispensers must query PDMP;
the length of PDMP data storage; and
the way PDMP data can be queried and retrieved.
It’s worth noting that PDMP data is not subject to HIPAA (the Health Insurance Portability and Accountability Act), the federal law that controls sharing of private health information. However, prescribers and dispensers are allowed to use it for direct patient care only.
PDMP database interactions with other systems
Checking a state PDMP supports decision-making and helps practitioners detect doctor shoppers or those who visit multiple clinicians to get opioids. In most cases, this is how querying the PDMP system looks.
1. An authorized prescriber logs into a PDMP portal to enter the patient’s demographic information and the name of a drug.
2. The PDMP database returns the CDS history of the patient in an HTML (web page view) or a PDF format.
3. If approved, an electronic order is submitted to a pharmacy via an e-prescribing module.
4. In some situations — say, if a patient requests an early refill or has opioid prescriptions from more than one doctor — a pharmacist also must query the PDMP before dispensing.
5. Once the drug is dispensed, a pharmacist sends an update to the PDMP database within 24 to 72 hours (depending on the state.)
6. The PDMP adds this information into the patient’s history.
The drawback of the above-mentioned sequence of steps is that experts waste precious time switching between an EHR / pharmacy management system and PDMP portal. The more advanced approach is to integrate PDMP directly into the clinical workflow.
Interactions in the PDMP-integrated environment.
While the process will be more or less the same, in this case it takes less time and brings better outcomes for all parties since
a user logs in only once;
a doctor doesn’t need to enter the patient’s first name, last name, and data of birth;
practitioners check PDMP more often — not only when “a visitor looks like a junkie”;
a physician sees PDMP data through a lens of the entire health history presented in the patient record, improving decision-making;
prescription history gets directly into the clinical or pharmacy workflow; and
the PDMP database is automatically updated once the medication in question is dispensed.
About one-third of US hospitals have already enabled one-click access to PDMP data from their internal tools. Sooner or later, other healthcare providers should also consider PDMP integration. Let’s look at key steps of this process in more detail.
Step one: Assign an integration project leader
The length and complexity of PDMP implementation largely depend on your location and software vendor. Considering that it can take up to several months, you need someone to control the project from beginning to end. The natural choice is the director of your IT department. Yet, another person with leadership skills and technical background can be also a good fit for this role.
The integration leader will be the primary contact for all outside participants of the project — state PDMPs, their tech partners, IT system vendors, and third-party developers should you require their services.
Step two: Submit documents
To initiate the process, the integration leader must submit all required documents via the state health authority website. The package varies across the country, but typically it includes at least two items.
A PDMP integration request form.
You can find and fill out this form on the state PDMP webpage. Here, you need to specify
a primary contact, meaning the person leading the integration project in your organization;
your software vendor; and
the number of prescribers (doctors, nurses, pharmacists, etc.) requesting access.
Within a couple of days after completing the form, the integration leader will receive a confirmation email and an agreement to be signed.
An End User License Agreement (EULA)
This agreement is made between your organization and a PDMP provider that maintains an application programming interface (API) through which your system will be connected to the state PDMP database.
Sometimes, a state health department develops and manages a PDMP database on its own. But the more typical approach is to choose a tech partner to take care of integrations. Currently, the majority of states work with Appriss Health that connects 43 PDMP databases and over 500 healthcare technology platforms via its PMP Gateway API.
NIC and its health platform RxGov in Maine and Maryland; and
OneHealthPort, the statewide Health Information Exchange (HIE), in Washington.
In any case, you need to sign the agreement and send it back. After that, the API provider will create production credentials for your healthcare organization which can take up to five business days.
These credentials will be sent to your integration project leader or to your system vendor if it is already pre-linked with the API in question.
Step three: Connect with your EHR or pharmacy management system provider
Once you submit documents, it makes sense to communicate with your software vendor and let them know about your plans. Chances are your health system has pre-built connections with Appriss and other PDMP APIs. If so, you will work directly with the vendor on your integration schedule and the gateway provider won’t interfere with this process.
Below, we’ll provide a brief overview of PDMP-ready providers and additional services they offer. If you partner with any of these vendors, skip step four and move directly to step five.
PDMP integration capabilities of different EHR vendors.
Epic EHR
Covering almost 30 percent of EHR market share, Epic positions itself as “vendor neutral,” meaning they're ready to link with any API.
PDMP access is organized with a single sign-on (SSO) authentication method. Once physicians log into the EHR, they can click a link in the workflow to send their and patient credentials to the PDMP database. This reduces the process of confirming CDS prescriptions from thirteen to three steps. Another Epic’s option to connect with PDMP is via an NCDPD (National Council of Prescription Drug Program) interface.
The system reminds a prescriber to check the PDMP when dealing with controlled substances. Yet, such a query is possible at any moment of any encounter, not only when opioids are involved.
Cerner EHR
The second biggest EHR vendor with 26 percent of the market share, Cerner was the first one to integrate with Appriss. It also supports two non-Appriss APIs (OneHealthPort in Washington and LogiCoy in Illinois) and partners with DrFirst to reach out to other databases.
PDMP access in Cerner is executed during an EPCS session (when a controlled substance is being prescribed), with the workflow customizable according to the role, venue, or specialty. The vendor complements the integration with its Opioid Toolkit that helps prescribers identify risks of use disorders.
MEDITECH EHR
MEDITECH is recognized as the best EHR for acute care hospitals and homecare. It allows for on-demand, one-tap access to the PDMP via an integrated link. Instead of working with multiple API providers, MEDITECH partners with DrFirst, healthcare SaaS (software-as-a-service) provider which leverages connections to Appriss and non-Appriss PDMP data sources.
Additionally, MEDITECH offers its branded Opioid Stewardship Toolkit that includes an embedded opioid risk tool, templates for tracking opioid use and outcomes, and other features.
Allscripts EHR
The top EHR vendor for hospitals of 101-250 beds, Allscripts has developed connections with PDMP aggregators like Appriss and standalone PDMP databases. Where it’s allowed, the provider makes CDS histories accessible for authorized users at any time, not only on demand and for opioid prescribing.
DrFirst e-prescribing
DrFirst provides a suite of apps for e-prescribing, pharmacy management, clinical messaging, and so on. It acts as the state PDMP in Nebraska, and has connections with Appriss, LogiCoy, and state-specific APIs in California and Maryland. So, if your healthcare organization already uses DrFirst software, in most cases, the integration process will be simplified.
Besides pre-built links to the majority of PDMP databases, DrFirst delivers analytical solutions to alert doctors and pharmacists to potential abuse.
NextGen Enterprise EHR
NextGen EHR and practice management platform supports Appriss-connected databases. After integration, the system automatically retrieves patients’ medical histories prior to prescribing of controlled substances. The feature is available for any users with proper credentials.
Step four: Ask for support from your state PDMP provider and outside experts
Suppose, your vendor doesn’t offer pre-built links or integration services. In this case, the gateway provider will give you API documentation, testing materials, and technical support to facilitate development work. However, you may need help from external experts to address the challenges of system integration.
The complexity grows if your state database doesn’t partner with any PDMP aggregator, offering a direct connection. In such cases, API specifications and content formats often deviate from standard schemas. Their integration takes more effort and comes pricier.
Step five: Configure your PDMP workflow
Before launching an integration, you have to decide on how exactly interactions with PDMP will happen and customize the workflow accordingly if such an opportunity is available in a given state and with a given system.
Access and general workflow settings
PDMP availability and general workflow can be configured according to
a role, for example, a prescriber, a dispenser or a nurse who access PDMP on their behalf;
specialty, i.e., general pathology, anesthesiology, dentistry, etc.; and
location, for instance, taking into account state-specific restrictions.
More often than not, access to PDMP is organized via a single-sign on (SSO) authentication method which enables a user to securely log into multiple systems and applications using just one set of credentials.
PDMP data querying terms and timing
In some settings, PDMP queries are available only in the case of Electronic Prescribing of Controlled Substances (EPCS). Others allow for requesting such data at any time of any encounter, so that physicians can be notified about potential problems even during regular visits. Yet, options are sometimes limited by state law.
Besides that, queries can be manual or automated. A manual scenario might be clicking a link in the patient record. In the automated process, a request is triggered by a certain event: for example, once an appointment is scheduled or after a doctor enters a drug information. Query automation is highly desirable to remind experts to check PDMP and save them time.
Step six: Consider additional features and analytics
Very few states allow for long-term storage and processing of PDMP data, which limits your abilities to apply analytics. Yet, in most cases you still can add such features as
check reminders,
alerts notifying practitioners on potential drug-seeking and drug-abuse behaviors,
risk scores calculated from health histories to support decision making, and
This functionality is sometimes offered by EHR systems. It is also available via third-party solutions like NarxCare, an analytical module by Appriss Health pre-integrated with PMP Gateway.
Another popular tool to analyze PDMP data is PastRx. It generates proactive alerts to highlight risk factors — cash payments, similar prescriptions from other hospitals, and high levels of CDS usage, to name a few. It also visualizes behavior patterns across patients and compares results within or across specialties.
PastRx analytics dashboard shows trends in patient behavior within and across specialties.
You can also opt for custom development to turn PDMP data into comprehensible charts and graphs and see the bigger picture.
Once the integration and additional features are ready for production, your system vendor will schedule the deployment date.
Step seven: Educate your staff
PDMP integration makes things easier for prescribers and dispensers since they no longer have to jump from one system to another. What is more, in some settings, many manual steps are automated.
Yet, users need instruction on how the innovation works and what improvements it promises. Create comprehensive, step-by-step tutorials and short training videos so that your staff can take full advantage of the integration. For example, prescribers at Lakeside Physicians point of care report time savings of one hour per day if seeing five to seven patients. Maybe, you can do even better than that.
