Cooperative Agreements for Electronic Health Record (EHR) and Prescription Drug Monitoring Program (PDMP) Data Integration

The Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Treatment (CSAT) is accepting applications for fiscal year (FY) 2013 Cooperative Agreements for Electronic Health Record (EHR) and Prescription Drug Monitoring Program (PDMP) Data Integration. The purpose of this program is to reduce prescription drug misuse and abuse by providing healthcare providers with access to PDMP data to make sound clinical decisions without disturbing their regular clinical workflow. Providing resources to states to enable hospital emergency department EHRs, primary care facility EHRs, and retail store pharmacy dispensing systems to link electronically to PDMPs will facilitate increased utilization. In order to foster the ability of states to reduce the nature, scope, and extent of prescription drug abuse, SAMHSA expects these grantees to: 1) improve the quality of prescription drug information available to healthcare providers by integrating PDMP data into existing technologies, e.g., EHRs, Health Information Exchanges (HIEs); and 2) support real-time access to prescription drug information by integrating PDMP data into existing clinical workflows. Grant funds will assist states in addressing prescription drug misuse and abuse strategies by integrating their PDMP data into EHRs and other Health Information Technology (HIT) systems. These grant funds cannot be used to enhance or expand PDMPs and can only be used for the purposes of integrating PDMP data into health information systems. BackgroundThe United States is in the midst of an unprecedented drug overdose epidemic. Drug overdose death rates have increased dramatically in the last twenty years – increasing five-fold since 1980. By 2009, drug overdose deaths outnumbered deaths due to motor vehicle crashes for the first time in the United States (U.S.). Since at least 1999, prescription drugs, especially opioid analgesics, have been increasingly involved in drug overdose deaths. Opioid analgesics were involved in 30 percent of drug overdose deaths where a drug was specified in 1999, compared to nearly 60 percent in 2010. Between 1999 and 2010, more than 125,000 people in the U.S. died from an overdose involving an opioid analgesic – far exceeding deaths from any other drug or drug class, licit or illicit, during this time period. In fact, opioid-related overdose deaths now outnumber overdose deaths involving all illicit drugs combined. In addition to overdose deaths, nonmedical use of prescription drugs, use without a prescription or use for the feeling or experience the drug caused, and the consequences associated with it are significant. In 2011, more than 14.5 million people 12 years and older reported nonmedical use of psychotherapeutic prescription drugs (pain relievers, sedatives, tranquilizers, and stimulants) in the past year, with 11 million reporting nonmedical use of pain relievers. Rates of emergency department (ED) visits associated with pharmaceutical misuse or abuse increased 114 percent between 2004 and 2011 while rates for illicit drugs remained stable. By 2011, more than 1.4 million ED visits annually were related to the misuse or abuse of pharmaceuticals – with over 420,000 involving opioid analgesics and over 425,000 involving benzodiazepines. Substance abuse treatment admissions for opioid analgesic abuse have also increased significantly over the last decade. While recent SAMHSA surveys suggest that the actual abuse of prescription drugs has been trending lower over the last few years, prescription drug abuse remains a significant public health problem. The consequences of abuse, morbidity and mortality, maternal exposure, treatment admissions, and emergency department encounters continue to increase. In addition, there have been steady increases in the number of individuals initiating heroin abuse each year, with 81 percent of those heroin initiates indicating prior non-medical use of prescription pain relievers. In light of these issues, the Obama Administration issued the 2011 Prescription Drug Abuse Prevention Plan which includes four major areas to reduce prescription drug abuse, one of the areas involving the expansion of PDMPs. Moreover, one of the action items for the 2012 National Drug Control Strategy includes the promotion of “links among state systems and to EHRs.”PDMPs support states’ efforts to reduce abuse of controlled prescription drugs by collecting, monitoring, and analyzing electronically transmitted prescribing and dispensing data submitted by pharmacies and dispensing practitioners. PDMPs support public health and enforcement efforts and are managed under the auspices of a state, district, commonwealth, or territory of the United States. PDMPs have been shown to affect practitioner opioid dosing and prescribing patterns. A 2012 study found that PDMPs mitigated opioid abuse and misuse trends. Without a PDMP in place, intentional opioid exposures reported to Poison Control Centers increased, on average, 1.9 percent per quarter, whereas intentional opioid exposures increased 0.2 percent (P = 0.036) per quarter in states with a PDMP in place. Another study showed that after Wyoming’s PDMP implemented an unsolicited reporting initiative that did not require significant resources, it saw reductions in the number of people meeting criteria for filling multiple controlled substance prescriptions from different prescribers or in different pharmacies over a short period (sometimes referred to as doctor shopping) and increases in providers utilizing the PDMP. Unsolicited reporting (also known as proactive reporting) is a product of a PDMP where the prescription information is analyzed by PDMP staff and questionable activities are then reported to appropriate personnel based on thresholds established by the PDMP. In addition, a study in Ohio found that use of Ohio’s PDMP data helped guide clinicians to prescribe more appropriate doses of opioids for patients. Currently, 49 states have authorization to establish and operate a PDMP and 45 are operational. Since the inception of the Department of Justice (DOJ) Harold Roger’s Prescription Drug Monitoring Program grant program in FY 2002, 47 states and one U.S. territory have received support through this grant program. The PDMP programs receive technical assistance support through the Alliance of States with Prescription Drug Monitoring Programs, a membership organization, and the PDMP Center of Excellence and PDMP Training and Technical Assistance Center at Brandeis University which are both supported by the Bureau of Justice Assistance, U.S. DOJ. Many stakeholders have pointed to the need to expand utilization of PDMPs and promote the appropriate sharing of information among states through system interoperability.While PDMPs on their own are useful tools for clinical decision making, they are still underutilized. One of the reasons is that the current processes do not support clinical workflows. The current healthcare landscape is changing so that there is an increase in the adoption of HIT. As of 2010, it is estimated that over 50 percent of providers in the United States adopted and currently use EHR systems. HIT systems like these can be used to improve the workflow of accessing PDMP information. The EHR and PDMP Data Integration grant program aims to help reduce prescription drug misuse and abuse by providing prescribers and dispensers with important prescription drug information to make sound clinical decisions. Likewise, it seeks to enable the capacity for the exchange and analysis of EHR data to assess quality of care and improve patient outcomes. Access to PDMP data is governed by state law. In general, practitioners and pharmacists are allowed access to the data to inform their prescribing practice. Opportunities to increase practitioner and pharmacist utilization of PDMP data include making the appropriate data more accessible by integrating the PDMP into existing systems like EHRs and pharmacy dispensing systems, with appropriate privacy protections.Integration will allow healthcare providers to access the PDMP data without disturbing their regular workflow and will allow the information to be accessed in as timely a manner as possible. For example, some prescribers have commented that creating a “single login” for their EHR systems and the state PDMP system would make them more likely to access PDMP data. Moreover, PDMP integration encourages utilization by increasing the production and distribution of unsolicited reports and alerts to prescribers and dispensers of prescription data. The EHR and PDMP Data Integration grant program aligns with two of SAMHSA’s Strategic Initiatives, Prevention and Health Information Technology. More information on SAMHSA’s Strategic Initiatives is available at the SAMHSA website: http://www.samhsa.gov/About/strategy.aspx. It also parallels the Administration’s plan to prevent prescription drug abuse released in April 2011. In addition, this grant initiative relates to the Centers for Medicare and Medicaid Services’ EHR Incentive Program for Stage 2 and/or Stage 3 of Meaningful Use. The EHR and PDMP Data Integration cooperative agreements are authorized under Section 509 of the Public Health Service Act, as amended. This announcement addresses Healthy People 2020 Substance Abuse Topic Area HP 2020-SA.