0
0
1
9
56
MedTech Media
1
1
64
14.0
Normal
0
false
false
false
EN-US
JA
X-NONE
DefSemiHidden="true" DefQFormat="false" DefPriority="99"
LatentStyleCount="276">
UnhideWhenUsed="false" QFormat="true" Name="Normal" />
UnhideWhenUsed="false" QFormat="true" Name="heading 1" />
UnhideWhenUsed="false" QFormat="true" Name="Title" />
UnhideWhenUsed="false" QFormat="true" Name="Subtitle" />
UnhideWhenUsed="false" QFormat="true" Name="Strong" />
UnhideWhenUsed="false" QFormat="true" Name="Emphasis" />
UnhideWhenUsed="false" Name="Table Grid" />
UnhideWhenUsed="false" QFormat="true" Name="No Spacing" />
UnhideWhenUsed="false" Name="Light Shading" />
UnhideWhenUsed="false" Name="Light List" />
UnhideWhenUsed="false" Name="Light Grid" />
UnhideWhenUsed="false" Name="Medium Shading 1" />
UnhideWhenUsed="false" Name="Medium Shading 2" />
UnhideWhenUsed="false" Name="Medium List 1" />
UnhideWhenUsed="false" Name="Medium List 2" />
UnhideWhenUsed="false" Name="Medium Grid 1" />
UnhideWhenUsed="false" Name="Medium Grid 2" />
UnhideWhenUsed="false" Name="Medium Grid 3" />
UnhideWhenUsed="false" Name="Dark List" />
UnhideWhenUsed="false" Name="Colorful Shading" />
UnhideWhenUsed="false" Name="Colorful List" />
UnhideWhenUsed="false" Name="Colorful Grid" />
UnhideWhenUsed="false" Name="Light Shading Accent 1" />
UnhideWhenUsed="false" Name="Light List Accent 1" />
UnhideWhenUsed="false" Name="Light Grid Accent 1" />
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 1" />
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 1" />
UnhideWhenUsed="false" Name="Medium List 1 Accent 1" />
UnhideWhenUsed="false" QFormat="true" Name="List Paragraph" />
UnhideWhenUsed="false" QFormat="true" Name="Quote" />
UnhideWhenUsed="false" QFormat="true" Name="Intense Quote" />
UnhideWhenUsed="false" Name="Medium List 2 Accent 1" />
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 1" />
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 1" />
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 1" />
UnhideWhenUsed="false" Name="Dark List Accent 1" />
UnhideWhenUsed="false" Name="Colorful Shading Accent 1" />
UnhideWhenUsed="false" Name="Colorful List Accent 1" />
UnhideWhenUsed="false" Name="Colorful Grid Accent 1" />
UnhideWhenUsed="false" Name="Light Shading Accent 2" />
UnhideWhenUsed="false" Name="Light List Accent 2" />
UnhideWhenUsed="false" Name="Light Grid Accent 2" />
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 2" />
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 2" />
UnhideWhenUsed="false" Name="Medium List 1 Accent 2" />
UnhideWhenUsed="false" Name="Medium List 2 Accent 2" />
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 2" />
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 2" />
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 2" />
UnhideWhenUsed="false" Name="Dark List Accent 2" />
UnhideWhenUsed="false" Name="Colorful Shading Accent 2" />
UnhideWhenUsed="false" Name="Colorful List Accent 2" />
UnhideWhenUsed="false" Name="Colorful Grid Accent 2" />
UnhideWhenUsed="false" Name="Light Shading Accent 3" />
UnhideWhenUsed="false" Name="Light List Accent 3" />
UnhideWhenUsed="false" Name="Light Grid Accent 3" />
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 3" />
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 3" />
UnhideWhenUsed="false" Name="Medium List 1 Accent 3" />
UnhideWhenUsed="false" Name="Medium List 2 Accent 3" />
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 3" />
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 3" />
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 3" />
UnhideWhenUsed="false" Name="Dark List Accent 3" />
UnhideWhenUsed="false" Name="Colorful Shading Accent 3" />
UnhideWhenUsed="false" Name="Colorful List Accent 3" />
UnhideWhenUsed="false" Name="Colorful Grid Accent 3" />
UnhideWhenUsed="false" Name="Light Shading Accent 4" />
UnhideWhenUsed="false" Name="Light List Accent 4" />
UnhideWhenUsed="false" Name="Light Grid Accent 4" />
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 4" />
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 4" />
UnhideWhenUsed="false" Name="Medium List 1 Accent 4" />
UnhideWhenUsed="false" Name="Medium List 2 Accent 4" />
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 4" />
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 4" />
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 4" />
UnhideWhenUsed="false" Name="Dark List Accent 4" />
UnhideWhenUsed="false" Name="Colorful Shading Accent 4" />
UnhideWhenUsed="false" Name="Colorful List Accent 4" />
UnhideWhenUsed="false" Name="Colorful Grid Accent 4" />
UnhideWhenUsed="false" Name="Light Shading Accent 5" />
UnhideWhenUsed="false" Name="Light List Accent 5" />
UnhideWhenUsed="false" Name="Light Grid Accent 5" />
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 5" />
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 5" />
UnhideWhenUsed="false" Name="Medium List 1 Accent 5" />
UnhideWhenUsed="false" Name="Medium List 2 Accent 5" />
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 5" />
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 5" />
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 5" />
UnhideWhenUsed="false" Name="Dark List Accent 5" />
UnhideWhenUsed="false" Name="Colorful Shading Accent 5" />
UnhideWhenUsed="false" Name="Colorful List Accent 5" />
UnhideWhenUsed="false" Name="Colorful Grid Accent 5" />
UnhideWhenUsed="false" Name="Light Shading Accent 6" />
UnhideWhenUsed="false" Name="Light List Accent 6" />
UnhideWhenUsed="false" Name="Light Grid Accent 6" />
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 6" />
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 6" />
UnhideWhenUsed="false" Name="Medium List 1 Accent 6" />
UnhideWhenUsed="false" Name="Medium List 2 Accent 6" />
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 6" />
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 6" />
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 6" />
UnhideWhenUsed="false" Name="Dark List Accent 6" />
UnhideWhenUsed="false" Name="Colorful Shading Accent 6" />
UnhideWhenUsed="false" Name="Colorful List Accent 6" />
UnhideWhenUsed="false" Name="Colorful Grid Accent 6" />
UnhideWhenUsed="false" QFormat="true" Name="Subtle Emphasis" />
UnhideWhenUsed="false" QFormat="true" Name="Intense Emphasis" />
UnhideWhenUsed="false" QFormat="true" Name="Subtle Reference" />
UnhideWhenUsed="false" QFormat="true" Name="Intense Reference" />
UnhideWhenUsed="false" QFormat="true" Name="Book Title" />
Prescription drug monitoring programs show promise, limitations
The prescription drug abuse epidemic throughout the United States may be a difficult pill to swallow, but states have pledged to combat the issues and are utilizing health information technology to help them do it. Prescription drug monitoring programs (PMPs) are one tool utilized by states to curb issues of overprescribing, doctor shopping and drug abuse.
Essentially statewide electronic databases, PMPs collect and track patient prescription data submitted by pharmacies and other healthcare practitioners. An authorized user, such as a physician, can access the data and identify whether the patient may be potentially misusing certain controlled substances, which also allows the physician to better treat the patient.
PMPs are nothing new - the first one established in California in 1939. Now 49 states currently authorize these programs, with Missouri being the odd one out. Much has changed since the inception of the statewide programs, however, and information technology has assumed a more crucial role.
"Over the last few years, there have been a number of attempts to try to maximize the use of the PMP particularly as a public health tool in order to try to address some of the prescription drug abuse problems the states are facing right now," said Sherry Green, chief executive officer of the National Alliance for Model State Drug Laws (NAMSDL), an organization funded by Congress. The alliance assists states with legislative and quality issues pertaining to prescription drug abuse and addiction.
One of the ways to maximize these PMPs, Green explained, is by modernizing the health IT capabilities. Some of these updates include integrating the PMPs with the state's own electronic health record (EHR) system, ultimately simplifying the physician or prescribers' access to data.
In Nebraska, for example, physicians can go right into the EHR, do a patient search, and a complete list of the patient's prescriptions will be listed, as the PMP is completely encompassed within the EHR technology.
Other technological tweaking to PMPs include adding interstate sharing capabilities, Green continued, "So if I am a doctor in one state and have a patient in another state, I could actually access prescription data for that patient in that other state." This technology also helps reduce the number of individuals who cross state lines to obtain a prescription from a state with a less restrictive PMP.
Limitations
But are these programs effective? Current data remains ambiguous, and experts say limitations still exist that thwart PMPs from being entirely effective.
In Maine, for example, physician and pharmacist participation in the state's PMP is completely voluntary, which severely limits the benefits the program could potentially precipitate, said Guy Cousins, director of the state's Office of Substance Abuse.
The program, begun in 2003, "was intended to be used as an intervention tool, an educational tool to really have conversations with clients who may be attempting to get scheduled medications from a number of different sources," said Cousins. But when the majority of physicians and pharmacists don't participate in the program, the benefits can be difficult to discern.
Cousins said he thinks more providers will come onboard when a real-time PMP is implemented, an upgrade that is slated for later this year. Currently, state physicians can download updated data once per week, which still leaves room for patient drug shopping.
Oklahoma's real-time system
Oklahoma is the only state in the country to have its entire PMP program report in real-time, an upgrade that was implemented early this year - this in response to the state's inordinately high rate of drug abuse, as in 2011, Oklahoma topped the list for prescription painkiller abuse.
State officials say it's too early to see statistical results, but Mark Woodward, spokesman for the Oklahoma Bureau of Narcotics and Dangerous Drugs said, anecdotally, the results are there. He cited an emergency room physician who said the real-time prescription reporting, "absolutely has changed the way we do medicine."
"[PMPs] can cut down and have cut down on prescription fraud for patients who go to multiple doctors in an attempt to feed their own addiction," Woodward said, "Because of having a real-time system, they're not able to simply go to one ER and complain of back pain, get a drug, and then go across the street within an hour, see another doctor in a different ER."
It only takes 60-90 seconds to run the report and access a patient's comprehensive prescription history, said Woodward, so it doesn't backlog the system. "Running that report gives the doctor concrete evidence that [a patient] is going to multiple doctors to feed an addiction, and they can treat him differently."
"Years ago, they used to report every 30 days," said Green, "then it was every two weeks. Now the average is every seven days."
Following in Oklahoma's footsteps, Indiana and Ohio state officials announced in June they would begin pilot programs aimed at spurring real-time PMPs. The programs are managed by the Office of the National Coordinator for Health Information Technology (ONC) and will receive funding from the Substance Abuse and Mental Health Services Administration (SAMHSA).
Officials hope that from these new real-time PMPs, studies can finally examine statistical benefits these programs may have on overprescribing, doctor shopping and drug abuse. The University of North Carolina at Chapel Hill has recently received a grant form the Robert Wood Johnson Foundation to look at the effectiveness of the PMPs.
Green concluded, "A PMP, in its best form, is an information tool, and what it's doing is providing [physicians] with more information about the prescription history of their patient so they can make more informed decisions."
