As everyone involved in U.S. healthcare knows, the United States is mired in a broad and intense crisis around opioid abuse and addiction. Much of the action taking place has involved state governments, but the actions of state governments have been extremely diverse, and often, for providers, confusing and overly complex—especially for the leaders of patient care organizations with patient care presence in more than one state.
With regard to all of that, last month, leaders at the Coral Springs, Fla.-based Point-of-Care Partners consulting firm released a broad report looking at what actions state governments have been taking in order to address the opioid crisis. Under the title, “Fighting the Opioid Epidemic at the State- and Rx-Level Report,” the new report examines the diversity of efforts and actions, in considerable detail.
As explained on the consulting firm’s website, “The 33-page report includes details of state responses to opioid prescribing organized around three main trends: 1) prescribing, 2) curbing fraud and abuse, and 3) preventing and treating addiction.” And, it “explains overarching trends across the states on opioid prescribing and provides the latest summary details on a state-by-state basis,” based on original research and data collection by Point of Care Partners researchers in 2017.
There are many implications of all this activity, for healthcare IT leaders. One of the report’s co-authors, Connie Sinclair, R.Ph., the director of POCP’s Regulatory Resource Center, spoke recently with Healthcare Informatics Editor-in-Chief Mark Hagland, about the implications for CIOs, CMIOs, clinical informaticists, and other healthcare IT leaders in patient care organizations. Below are excerpts from that interview.
Overall, what were your team’s high-level findings, as detailed in the report?
There are lots of avenues of attack for this opioid crisis—the federal level, the state level, the provider level, the idea of law enforcement, of getting more people into treatment—but what we’re saying in the report is that if you want to reduce the number of addicts, which really is the long-term goal, you have to impact this at the point of prescribing—it’s at the moment when that prescriber is writing that prescription. And states have a lot to say about this—treating addicts, dealing with the fallout of all of that, is very expensive for the states, especially as Medicaid payers. Their Medicaid populations are very heavily hit by this crisis. And states have a lot to gain from solving this. And of course, there are task force recommendations, and activity is taking place on the part of the FDA [Food and Drug Administration], DEA [Drug Enforcement Administration], and other agencies. But states have been at this for a long while, really dealing with this since 2012; so they’ve been passing lots of new laws and adopting new rules, to curb this.
Meanwhile, at POCP, our Regulatory Center has been tracking all these rules and regulations, including anything that ties into e-prescribing or EHR [electronic health record] regulations. Hundreds of elements are involved—from whether e-prescribing is allowed, whether it’s mandated, and if so, for which schedules; and hundreds of data elements are involved. How do you prevent generic substitution of drugs? And so on. And our work has exploded over the past few years. I have a team of pharmacists who are also informaticists—I’ve been an e-prescribing product manager many times—I’ve spent more than 30 years in HIT.
I’ve been a product manager, a product marketing person, and a business analyst, before I became a consultant. So that’s the lens we’re looking at all this through: what’s the impact of all of this on healthcare systems, and healthcare information systems? So the whole report is relevant to that; but we’re really zeroing in on the regulations and laws that impact that prescriber at the moment of prescribing. It might be a limit on quantity. Is it a first-time patient who’s never had an opioid before, just broke their arm and needs a few pills? Or is it a cancer patient? And states are doing things like quantity limits. But they’re all doing all different things, and in different ways.
And in many cases, that means curbs on how much quantity of any opioid can be prescribed, correct?
Yes, that’s right, it means quantity limitations, and also the mandated use of state prescription drug monitoring programs, or PDMPs. The state-run databases of controlled substances, etc. There are many new requirements—over 30 states now require the prescriber to look at the PDMP before writing the prescription. And then the pharmacist dispensers may have that requirement as well. And then things like mandating electronic prescriptions to prevent fraud and abuse—we have several states in process. That is to prevent paper prescriptions from being manipulated.
About how many states have done that?
It’s about nine right now, but there are several that are debating that in legislatures right now. And of course, some have already implemented, and others have future deadlines.
And the other piece of the PDMP is the profiles. And it might be just for opiates, or for anti-anxiety drugs like Xanax, and opiates, or for all Schedule 2 drugs. But the other challenge with those profiles is that these state-run databases are accessed via portals. So for a physician to stop in the middle of a prescription and have to log into a new portal, that takes an average of four-and-a-half minutes. Every patient has a profile of controlled substances that they’ve had prescriptions filled for, from all pharmacies. That is available to prescribers, but typically, by exiting their EHR and logging into a specific state site.