Not just for opioids: Why PDMPs should cover all medications

Rather than use prescription drug monitoring programs (PDMPs) only to track opioid prescriptions, two physicians writing in the American Journal of Managed Care suggested the concept be expanded to collect and report information on all prescriptions.

PDMPs are currently in place in 49 states (Missouri being the lone exception), and more states are now requiring physicians to check them before prescribing potentially addictive opioid painkillers. Elisabeth Askin, MD, of the University of California, San Francisco, and David Margolius, MD, of Cleveland’s Case Western Reserve University, argue the same databases, if expanded, could have benefits beyond reducing opioid addiction and doctor shopping.

“In the outpatient setting, it is exceedingly difficult to know what medications our patients have been prescribed and are taking. Each encounter with a specialist, hospital or pharmacy can generate a change to a patient’s list of medications, and in most systems, this information is not communicated back to the primary care practice’s electronic health record (EHR)—the exception being opiate prescriptions,” Askin and Margolius wrote. “We propose that policy-makers act to expand these programs to all medications, thus improving the likelihood that any provider prescribing a new medication would know what medicines their patient is already taking.”

Calling this idea statewide medication reconciliation programs (SMRPs), the authors argued it could solve numerous problems around prescriptions. For example, Askin and Margolius wrote it would allow better patient-physician interaction on medication adherence, especially with high-risk prescriptions which require frequent dosage changes.

SMRPs may also solve issues between specialists inside and outside a primary care provider’s health system.

“Providers may be unclear on who is in charge of a medication—for example, the cardiologist or the primary care provider—leading to inconsistent dose changes,” Askin and Margolius wrote. “Finally, EHRs of different health systems rarely interact, meaning that any patient seen at more than one health system will have at least two separate medication lists, which, at best, will have a time lag to mutually update, and, at worst, discrepancies leading to preventable adverse drug events. Therein lies the key to why interventions have not worked: Medication reconciliation within a single system misses the point.”

The authors described their ideal SMRP: a single source “master list” used by all health systems, prescribers and providers in a state which updates in real-time, including when patients fill their prescriptions. They also said they wanted patients to have easy access to their own information and make it both interoperable with EHRs and easy to use.

It would be a daunting task, Askin and Margolius admit, and one which all organizations may balk at due to the coordination and costs required.

And that’s before considering the privacy concerns.

“First, any EHR is vulnerable to cyber-attack, and an SMRP connected to many individual health systems would need appropriate encryption and security to avoid data breaches. Second, our current culture of patient privacy allows for data sharing within a health system, but not beyond; the sharing of information in an SMRP would need to hew to privacy laws. It is important to note, however, that data privacy is not a concern that is exclusive to healthcare, nor is the current system without problems,” Askin and Margolius wrote.

In conclusion, the authors argued that despite those hurdles, such a system is possible and could simplify the process for learning what medications patients have been prescribed and are actually taking.