Data: Garbage In, Garbage Out
There are also data and usability hurdles for the state PDMPs to overcome. One is that often, the data on filled prescriptions for a patient is incomplete because of the lag in entering it at pharmacies:
“When pharmacists dispense controlled substances to patients, they have to enter the prescription into the state PDMP. However, pharmacies submit this data to state PDMPs at varying intervals—ranging from monthly to daily or even in “real-time,” i.e., under five minutes. If there is a long interval between dispensing and submission into the state PDMP, providers and other PDMP users will not have information on patients’ most recent prescriptions.” – A CDC web page, “What States Need to Know about PDMPs.”
There are other data problems with the PDMP data and databases:
In some states, these systems show the physician a clunky,1990s-computer-era laundry list of a patient’s prescriptions. In addition, in most caregiver settings, they’re not integrated with the electronic health record (EHR), so the prescriber has to exit the patient’s health record, log into the PDMP system, do the search, log out, and log back into the EHR, according to an article in Healthcare IT News, a magazine published by the professional association of hospital and health systems IT executives.
They have other modernizing to do. State PDMPs show in-state data only. So there’s an interface system called PDM InterConnect. Most states already use it to allow a physician to check the database of neighboring states.
Integrating PDMP With EHR Systems
However, there are other, potentially very costly problems along with integrating PDMPs into the HER workflow. For example:
- integrating data from one PDMP to another
- differing definitions of what constitutes an alert threshold
- how and when is PDMP presented to the prescriber
According to work done by the Pew Charitable Trust (“Improvements to Prescription Drug Monitoring Programs Can Inform Prescribing,” 5/22/18, some states expressed worries that integrating PDMP systems could result in a loss of state control over profile features and risk indicators.
For example, the Pew discussions with users revealed that some states are leery of a modern, graphical-user-interface summary of a patient’s opioid use, on grounds that summary data doesn’t always tell a true picture, and a physician might rely on the summary and not dig down deeper into the data.
Given physicians’ busy schedules, it’s probably true that many won’t dig beyond a main summary screen. So the data in the summary has to be the right data. Problem: that concept of the right data likely differs from one state bureaucracy to the next—especially given the fact that some state PDMPs are run by law enforcement while others are run by health officials, with differing priorities.
