PHARMACIST STEVE

https://www.medpagetoday.com/publichealthpolicy/opioids/71434

WASHINGTON — Interoperability, predictive analytics, e-prescribing: these were some of the terms buzzing around the dais at a hearing of the Senate Health, Education, Labor and Pensions Committee on Tuesday.

The focus of the hearing was to solicit expert input on the role of technology and data in addressing the opioid crisis. The committee is currently drafting legislation related to the epidemic, which it plans to mark-up as soon as late March.

Specifically, Chairman Lamar Alexander (R-Tenn.) asked the experts how the federal government can use the data it collects to identify and stop the overprescribing of opioids.

Sen. Patty Murray (D-Wash.), the committee’s top Democrat, also spoke of the challenge of interoperability with prescription drug monitoring programs, noting that “the prescription a patient receives in one state may not show up in the system of another state. Two doctors in different states may not see they are writing prescriptions for the same patient.”

The concern is that providers may miss meaningful data that could alert providers to signs of a substance use disorder, she added.

Snezana Mahon, PharmD, vice president of clinical product development for pharmacy benefit manager Express Scripts in St. Louis, offered several recommendations to the committee.

First, pass the “Every Prescription Conveyed Securely Act,” which would mandate e-prescribing for opioids for all Medicare enrollees, she said.

“Encouraging e-prescribing of controlled substances would restrict pharmacy shopping [and] enable better prescription tracking, as well as reducing fraud waste and abuse,” Mahon explained.

Second, limit prescription for a first-time opioid user to 7 days (with exceptions for cancer, hospice, and palliative care) in keeping with the “Opioid Addiction Prevention Act,” she said.

Mahon also urged Congress not to mandate coverage for abuse-deterrent opioids saying that it was a “flawed approach” because some providers and patients mistakenly believe such products are less addictive.

Sherry Green, CEO of Sherry L. Green & Associates and co-founder of the National Alliance for Model State Drug Laws in Santa Fe, New Mexico, urged the committee to establish a federally funded hub that would break down the data silos and have consistent standards.

Green told MedPage Today after the hearing that there needs to be standards in each state for three key elements: what data is recorded, who can access it, and for what purpose.

In addition, she recommended that all states should integrate Prescription Drug Monitoring Programs (PDMP) into electronic health record (EHR) systems.

“We’ve got to get this information integrated seamlessly into these [health information exchanges] and [EHR] to get this information to professionals during their clinical work flow, so that they have it when they’re trying to make a decision,” she said.

In his testimony, Sanket Shah, a clinical assistant professor of health informatics at the University of Illinois at Chicago, focused on the impact of predictive analytics to leverage data, and identify warning signs of potential opioid dependency.

He cited a recent study that found “each refill and week of opioid prescription is associated with a large increase in opioid misuse among opioid naive patients. The data from this study suggest that duration of the prescription rather than dosage is more strongly associated with ultimate misuse in the early postsurgical period.”

Shah also stressed that “To truly have predictive analytics we need more data sources.”

He explained in a follow-up email to MedPage Today that self-reported data from people on opioids, after they’re discharged, such as the Current Opioid Misuse Measure, is one type of data that he’d like to see leveraged as it might be more accurate than information patients share in a doctor’s presence. Such data could be used to improve risk assessment tools, and better predict factors leading to relapse for those in recovery, he said.

Shah specifically recommended passage of the Prescription Drug Monitoring Act of 2017, which mandates that any state that receives funding from the federal government for a PDMP must share their data with other states. The bill also includes language around helping fund a data-sharing hub.

He noted in his testimony that the federal government has both “the means and the infrastructure” to develop an “integrated data environment” that could use factors such as social determinants of health, family and medical history and access to complete episodes of care to help health informaticists improve their predictive capabilities.

Alexander balked at the idea of the federal government overseeing a federal hub, and being responsible for data-sharing on a large scale. He pointed to Healthcare.gov and Meaningful Use as examples of government-failed experiments in this same realm.

“Why not instead establish the standards that states can use and why not leave room for Amazon, Google, Delta … Why not let the private sectors come in and offer a way to fill in whatever gap remains after we gradually improve the state PDMP?”

Alexander also asked whether e-prescribing should be tested more gradually, rather than mandated because “the technology is still evolving.”

“Because we have an epidemic, I don’t think we have time to wait. What we can do is carefully figure out what are some of those areas that we could leave some exceptions and give them extended dates of when they should be ready” for e-prescribing, “but certainly the rest of the physician practices that do have the ability to do e-prescribing. We should move on them now,” Mahon said.

As for the idea of a federal hub, Green stressed that the federal government would not need to run the hub.

After the hearing, she suggested to MedPage Today that one program in particular, the National All Schedules Prescription Electronic Reporting program within the Department of Health and Human Services (which has been authorized but not funded), could potentially put out a grant for running such a hub.

Maintaining the right standards would be critical as the data is valuable itself and could become a commercial commodity, if the government isn’t careful.

But “this an area where there truly needs to be a public-private partnership,” she said.

What this group of people are doing.. intentionally, unintentionally or out of ignorance… first of all … faked/forged sets of ID’s are readily available and without giving the healthcare professional the means of validating those ID’s that are presented. A dedicated/organized addict/diverter could cycle thru 1-2-3 office visits a day – 5 days a week… meaning that they could potentially get a 30 days supply of controlled meds 22-66 times a month and NEVER SHOW UP ON ANY PMP DATABASE PRINTOUT… and may never get caught.

They are also ignoring that most/all pts dealing the subjective diseases – including the mental health disease of addiction – are part of a protected class of the Americans with Disability Act and/or Civil Rights Act.

What they are attempting to do is prevent anyone with a undiagnosed disease of addictive personality from encountering “their trigger”, but their trigger may be Caffeine, Nicotine, Alcohol or some substance they got from a friend or off the street… and once they encounter a trigger could cascade into a whole range of experimenting with other substances legal and illegal… They may get to this point without ever having a legal opiate prescription filled for them. Yet, all those millions of chronic pain pts are going to be expected to live in a torturous level of pain to attempt to protect those with mental health issues from falling in that “hole of addiction” that the odds are that they will eventually fall into sooner or later.

To the best of knowledge there has never been any clinical study that documents/proves that abstinence, jail, prison has every been the most appropriate treatment for mental health issues nor a means of controlling/curing mental health issues

Filed under: General Problems