Using Health Information Exchange to Improve Use of Prescription Monitoring Data

Abstract

ObjectiveDemonstrate that use of the Washington State health informationexchange (HIE) to facilitate access to prescription monitoringprogram (PMP) data enhances the effectiveness of a PMP. Theincreased accessibility will lead to improved patient care by givingproviders more complete and recent data on patients’ controlledsubstance prescriptions.IntroductionWashington State experienced a five-fold increase in deaths fromunintentional drug overdoses between 1998 and 2014. The PMPcollects data on controlled substances prescribed to patients andmakes the data available to healthcare providers, giving providersanother tool for patient care and safety. Optimal impact for theprogram depends on providers regularly accessing the information toreview patients’ dispensing history. We have found through providersurveys and work with stakeholders that the best way to increase useis to make data seamlessly accessible through electronic health recordsystems (EHRs). This approach does not require a separate login tothe PMP portal. This linkage works through the Health InformationExchange (HIE) to make PMP data available to providers via EHRs.The HIE facilitates electronic communication of patient informationamong organizations including hospitals and providers. In additionto the PMP, another resource to address the prescription drug abuseproblem is the Emergency Department Information Exchange(EDIE), a web-based technology that specifically connects emergencydepartments statewide to track patients who visit multiple EDs.We also developed a connection between EDIE and PMP datathrough the HIE.MethodsIncreased provider utilization of the PMP will be achieved byusing the HIE to create more seamless access to PMP data throughproviders’ EHRs and through the EDIE system. This will be done bycompleting the build out of a transaction using NCPCP 10.6, pilotingthe connection with healthcare systems and EHR vendors, and bycontinuing to promote and encourage the PMP to remain an MUoption through recent rule changes being proposed by CMS/ONC.The pilot with Epic was conducted in 2015 from April to October.Epic has released an update, available to Washington customers, thatincludes the connection between EHR and PMP. PMP data is alsoconnected to EDIE. That connection is now live in 80 of 93 acute carehospital emergency departments.ResultsTo date the transaction is in production with 80 emergencydepartments and achieving positive results. In 2015 the PMP receivedmore than 2 million queries from the EDIE system via the HIE,compared to 900,000 queries via the online PMP portal in the yearbefore the link through the HIE was available. We have also finisheda pilot with a major EHR vendor and are working to on-board theircustomers. We are also working directly with healthcare systems, andas of September 2016 there are 3 healthcare facilities in testing thatare expected to go live by the end of the year. Over 90 registrationsfor meaningful use of the PMP have been received, representing morethan 1000 clinics. Improved access to PMP data benefits providers byallowing them to check the history of transactions linked to their DEAnumbers, which can alert them to fraudulent prescriptions.ConclusionsIntegration of PMP data with other information systems will greatlyenhance the accessibility and impact of the data. Making a connectionto EDIE alone more than doubled the number of queries we receivedfrom providers in 2015. We anticipate even more inquiries onceadditional care settings are connected. We hope from this to see acontinued decline in unintentional poisonings due to prescriptiondrugs.