Report offers guidance for state drug monitoring programs

State prescription drug monitoring programs (PDMPs) can help reduce prescription drug abuse but there is room for improvement, according to a report prepared by MITRE for the Office of the National Coordinator for Health IT (ONC), in partnership with the Substance Abuse and Mental Health Services Administration.

State PDMPs collect prescription data on medications that the federal government classifies as controlled substances and other non-controlled substance drugs. PDMPs are not federally operated but are statewide electronic databases that collect, monitor and analyze electronically transmitted prescribing and dispensing data submitted by pharmacies and dispensing physicians.

PDMP information can be useful to improve decision-making when prescribing and dispensing scheduled prescription drugs, but not all states benefit equally from these programs, according to the report. Although these data are made available to authorized healthcare professionals in the majority of states, access is generally optional.

These state programs were created for law enforcement, legal and regulatory compliance, and, more recently, patient care and safety. This led to great variability in the design, process and functions among PDMP systems. As of July 31, there are 43 operational programs, yet technology and policy issues and inconsistencies impact their effectiveness. Consequently, organizations such as the National Alliance for Model State Drug Laws and the Alliance of States with Prescription Monitoring Programs are pushing to make laws and technological processes for PDMPs consistent across the states.

States, PDMP groups and vendors “bear some of the greatest responsibility for enhancing access to PDMPs for use by prescribers and dispensers,” according to the report, which listed the top seven recommendations that are “central to enhancing access to PDMPs”:

• Streamline the registration process. PDMP registration should improve with automatic or mandatory registration.
• Expand the pool of authorized healthcare professionals permitted to access PDMP data. Authorized users should have the ability to delegate their access to other healthcare professionals under their supervision.
• Create a common application programming interface (API) for PDMP system-level access. PDMPs need technology to allow other systems to query and retrieve data to supplement the standalone web portals that exist today for user-level access.
• Integrate access to the PDMP data into the clinical workflow. PDMP information should be integrated in EHR and pharmacy systems to varying degrees of sophistication depending on resources and expertise available.
• Define a standard set of data that should be available in PDMP reports. Every report should contain a standard set of PDMP information.
• Adopt the National Information Exchange Model Prescription Monitoring Program specification.
• Implement an agreement framework and model agreements. Standard business agreements with third-party intermediaries should be widely used to facilitate PDMP data sharing.

"These seven recommendations serve as a starting point for PDMPs and related stakeholders," the report stated, and "they can be implemented to different degrees with great success. While some are more immediate and others require a greater degree of community organization, they are all critical to increasing PDMP usage and moving toward greater integration with other health IT."

The complete report is available on the ONC's website.