Loss of Control
That “…loss of control…” phrase hints at a core political problem.
Every state has invested heavily in its own standards and its own computer system, created in its internal political and social climate. The federal government sat idly by, other than creating the two separate systems for DOD and VA patients. After going to the trouble of creating and implementing them, and in some instances integrating them with vendors’ electronic health records, and with their long histories of setting their own standards of medical care and licensing, and with some states preferring voluntary use, most states will understandably want to keep their own PDMPs.
Yet, in terms of a systems architecture, the best way to make the PDMP idea work nationally is a single, national system working from a single, probably cloud-based database, with one set of rules and standards, with all physicians using the PDMP within the electronic health record (or as a standalone if the caregiver lacks an EHR), and with all pharmacies reporting prescriptions filled on a timely basis.
There’s a battle looming over control.
Federal Legislation Seems to be Pointing and Nudging Toward One National System
The 2016 opioid crisis law signed by President Obama, S524, includes funding to help states create or upgrade their PDMPs and offers funding to integrate them into EHRs.
HR6, just passed by the House (but not yet acted upon by the Senate) goes beyond encouraging. Sections 5041-5042 would require physicians nationwide to check the PDMP before prescribing for a Medicaid patient. In practical effect, requiring the use of a PDMP for Medicaid means requiring it for every patient because a physician would likely be courting liability if the system were there and she/he don’t use it.
The House bill would “encourage” Medicaid providers to pay to have the PDMP system integrated into the clinical workflow. However, it’s uncertain whether Congress will fund the 2016 Obama plan to pay this expense.
The Senate hasn’t put HR6 or companion legislation on its floor calendar yet. Democrats are demanding that a bill come to the floor before the election; Majority Leader Mitch McConnell has it on the Senate Calendar (#485), but a recent Scientific American newsletter said he wants to wait until after the election. (The Senate Majority Leader’s media staff didn’t respond to a query by the deadline for this article.)
