How Michigan kicked its PDMP up a notch to clamp down on doctors overprescribing opioids
Michigan, like much of the rest of this country, is in the midst of an opioid crisis. The number of opioid prescriptions, individuals in substance use disorder programs and, worst of all, opioid-related drug overdose deaths have all increased from 2011 to 2015 in the state.
Michigan has turned to health IT to try to accomplish two goals: prevent overprescribing and over-dispensing by health professionals, and improve patient care for individuals suffering from substance use disorders.
“We are attempting to prevent overprescribing and over-dispensing in two ways,” said Kim Gaedeke, acting deputy director of the Department of Licensing and Regulatory Affairs for the State of Michigan. “First, equipping Michigan physicians and dispensers with real-time patient data to be viewed prior to prescribing and dispensing schedule 2-5 controlled substances and dissuading overprescribing through disciplinary and enforcement actions.”
Michigan health officials selected specialized vendor Appriss Health for its substance use disorder system NarxCare. The vendor works with 46 states that are sharing PDMP data across state borders to inform physicians and pharmacists at the point of care of a patient’s Rx history to avoid overprescribing or those who are doctor shopping.
NarxCare provides participating physicians and dispensers with an abundant amount of patient history and data to help determine the degree to which the patient is at risk for substance use disorder, Gaedeke added. This helps inform a health professional’s clinical diagnosis.
"In the past, it would take health professionals on average 5-10 minutes to pull up a patient report. The state has experienced a return on its investment with an annual savings of roughly $1 million in staff costs."
Kim Gaedeke, State of Michigan
“Additionally, we are able to use individual and statewide prescription and dispensing data to determine overprescribing and over-dispensing by health professionals,” she said. “The state uses this data to follow up with disciplinary actions against health professionals who are overprescribing or over-dispensing.”
The second way Michigan is attempting to prevent overprescribing and over-dispensing is through the system’s ability to determine the degree to which a patient is susceptible to substance use disorder and, if necessary, provide ways to help that patient.
“The additional resources can be presented within the health professional’s clinical workflow,” Gaedeke said. “This assures that the patient immediately receives appropriate assistance during a visit. This technology has helped transform the traditional model of a Prescription Drug Monitoring Program to a more robust clinical, care management, analytical and prevention tool.”
The NarxCare technology fits into the clinical workflow by being integrated into a physician’s electronic health record system or a pharmacist’s dispensation system. This direct integration of the systems allows for the physician or pharmacist to stay in the software, and if the same patient is also in the state’s PDMP, called MAPS for Michigan Automated Prescription System, the patient’s data in MAPS automatically appears in the health professional’s EHR or pharmacy dispensation system without requiring the practitioner to log in and out of two separate interfaces.
“Once the provider clicks to view on the NarxCare report, the practitioner can see the full data set of the patient such as risk scores, Medical Morphine Equivalent, and history of schedule 2-5 controlled substances that have been prescribed and dispensed to the patient,” Gaedeke explained. “In addition, it includes any red flags such as whether the patient has gone to multiple doctors or pharmacies in a short period of time to obtain the same prescriptions, indicating possible substance use disorder or drug diversion.”
Based on an interactive visualization of usage patterns to help identify potential risk factors, the physician or dispenser can determine the appropriate course of action for treatment, she said.
Since implementing the Appriss Health technology in April 2017, Michigan has documented a decrease in the number of Michigan residents receiving an opioid prescription and decrease in the rate of doctor shopping by patients, she said.
She added the state expects a drop in the total number of controlled substance prescriptions filled in Michigan from 2016 to 2017 once the data is tabulated and finalized.
“Additionally, the improvement in technology has increased the number of health professionals using the new MAPS/NarxCare platform,” she explained. “The increase in the number of users further contributes to aggregated data that is collected and analyzed to better inform clinical diagnoses by individual health professionals and potential enforcement actions by our department.”
The state’s Department of Licensing and Regulatory Affairs, where MAPS is housed, has also experienced overall efficiencies with the new system compared to the old system by instantly providing data in real time along with system reports in less than half a second for its users, she added.
“In the past, it would take health professionals on average 5-10 minutes to pull up a patient report,” she said. “The state has experienced a return on its investment with an annual savings of roughly $1 million in staff costs. Prior to replacing the state-maintained system, the state went from 13.5 FTEs to now 4.25 FTEs.”
And ultimately, Gaedeke said, with the innovations and efficiencies created with the new MAPS/NarxCare platform, the Department of Licensing and Regulatory Affairs has been able to better identify licensed health professionals who are overprescribing, over-dispensing and diverting drugs, which has allowed for improved regulatory actions and in many cases more swift action taken by the department and its licensing boards.
“Technology plays a vital role in our fight against the opioid epidemic and substance use disorders in Michigan overall,” she said. “Technology allows health professionals to go beyond their individual instincts or preconceived notions by providing them with access to comprehensive real-time data with a single click in their existing electronic health records.”