The state of Michigan has stepped up its efforts to fight opioid drug abuse and over-dispensing, using improved prescription drug monitoring technology and more stringent enforcement. Along with reducing opiate use, the state also wants to improve patient care for those suffering from substance use disorders, officials said.
“We are attempting to prevent over-prescribing and over-dispensing in two ways,” Kim Gaedeke, the state’s acting deputy director of Licensing and Regulatory Affairs, told Health Care IT News. “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 over-prescribing 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 over-prescribing or those who are doctor-shopping.
“Additionally, we are able to use individual and statewide prescription and dispensing data to determine over-prescribing and over-dispensing by health professionals,” she said. “The state uses this data to follow up with disciplinary actions against health professionals who are over-prescribing or over-dispensing.”
Michigan also wants to use the system’s ability to determine individuals’ susceptibility to substance use disorder, and when, necessary, provide help to 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.”
The technology can be integrated into a physician’s electronic health record system or a pharmacist’s dispensation system. The direct integration of the systems allows for the physician or pharmacist to stay in the software.
If the same patient is also in the state’s PDMP, called MAPS for Michigan Automated Prescription System, the patient’s data 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 to 5 controlled substances that have been prescribed and dispensed to the patient,” Gaedeke said.
“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 state residents receiving an opioid prescription and decrease in the rate of doctor shopping by patients, she said. 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.”
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, Gaedeke said.
Late last year, a new state law took effect, requiring providers to check the state’s prescription database before they prescribe painkillers and powerful medications.
The legislation also limits the number of opioids prescribed to patients for acute pain and establish a “bonafide physician-patient relationship before prescribing controlled substances.” And, the law specifies specific penalties for providers who fail to meet these requirements.