PRESENTATION TO THE STANDARDS AND INTEROPERABILITY FRAMEWORK

WORKGROUPMAY 21 , 2014

3 PM

Prescription Drug Monitoring Programs and the PMIX Architecture

What is a Prescription Drug Monitoring Program?

A prescription drug monitoring program (PDMP) is a state program that collects controlled substance prescription records from dispensers and then

provides prescription histories and other compiled and/or analyzed data to authorized end-users for use

in clinical care, law enforcement, regulation of professional practice, research and evaluation.

PDMP Models

States with internally developed solutions * Data storage – 16 Report generation – 15 Data collection – 8 Web hosting - 8

States with third party solutions (Six different vendors)* Data collection – 41 Web hosting – 38 Report generation – 34 Data storage – 33

Staffing - Average staff size 2.96** 13 PDMPs have 1 employee 16 PDMPs have 2 employees 7 PDMPs have 3 employees 5 PDMPs have 5 or more employees

Mandated participation vs voluntary participation

* - responses are from a March 2014 survey of PDMPs by the PDMP Training and Technical Assistance Center at Brandies University. 47 PDMPs responded to this portion of the survey. **41 PDMPs responded

Status of Prescription Drug Monitoring Programs (PDMPs)

AK

AL

AR

CACO

ID

IL INIA

MN

MO

MT

NE 1

NV

ND

OH

OK

OR

TN

UT

WA

AZ

SD

NM

VA

WYMI

GA

KS

HI

TX

ME

MS

WINY

PA

LA

KYNC

SC

FL

VT

WV

Operational PDMPs

Enacted PDMP legislation, but program not yet operational

Legislation Pending

NHMA

RICT

NJ

DE

MDDC 2

1 The operation of Nebraska’s PMP is currently being facilitated through the state’s Health Information Initiative. Participation by patients, physicians, and other health care providers is voluntary. 2 The Mayor of D.C. has approved the legislation but it is pending a 30-day review process by Congress.

© 2014 The National Alliance for Model State Drug Laws (NAMSDL)..

Prescription Information Collected by PDMPs

Patient identification: Name & Address DOB & Gender Pt Identifier

Prescriber InformationDispensing Pharmacy InformationDrug Information, e.g.

NDC # = name, type, strength, manufacturer Quantity & date dispensed Source of payment (some states)

Data Collected from Pharmacies

PDMPs Collect Dispensed Controlled Substances Rx: 30 collect Schedules II – V 18 collect Schedules II – IV 1 collects Schedule II & III 1 collects Schedules II only Some Collect Non-Controlled Medications 8 collect tramadol (Ultram®) 1 each – Butorphanol, butalbitol w/acetamenophen

Some states collect “Drugs of Concern” e.g. Tramadol

Reporting Frequency varies – POS, 24 hours, 7-30 days

PDMP Data

Data is Provided to: Doctors and other prescribers Pharmacists Health Professional Licensing Boards Law Enforcement Medical Examiners Medicaid State Agencies Other:

Drug Courts Worker’s Compensation Third Party Payers Certified Drug Counselors

These vary depending on

individual state

regulations regarding

data sharing.

Impact of Prescription Monitoring in Virginia

1Jan-30Jun 12 1 Jul-31 Dec 12 1Jan-30jun 13 1 Jul - 31 Dec 13

5&5 3607 3876 3242 2904

250

750

1250

1750

2250

2750

3250

3750

4250

Number of Individuals Using Both 5 Prescribers and 5 Pharmacies CII-IV Prescriptions

Source: Virginia’s Prescription Monitoring Program

Impact of Prescription Monitoring in Virginia

1Jan-30Jun 12 1 Jul-31 Dec 12 1Jan-30jun 13 1 Jul - 31 Dec 13

10&10 146 139 112 85

15&15 19 15 16 14

10

30

50

70

90

110

130

150

Number of Individuals Using Both 10 Prescribers and 10 Pharmacies and 15 Prescribers and 15 Pharmacies CII-IV Prescriptions

Source: Virginia’s Prescription Monitoring Program

Impact of Prescription Monitoring in Kentucky

4Q 2012 1Q 2013 2Q 2013 3Q 2013 4Q 2013 1Q 2014

224467

209552 208801 205291198122

193626

Alprazolam(# of prescriptions

filled)

4Q 2012 1Q 2013 2Q 2013 3Q 2013 4Q 2013 1Q 2014

742612

707836722395 720106

691844684116

Hydrocodone(# of prescriptions

filled)

4Q 2012 1Q 2013 2Q 2013 3Q 2013 4Q 2013 1Q 2014

244385

209729 213385 214980 212894 210603

Oxycodone(# of prescriptions

filled)

PDMP Use is Mandatory in KY

• HB1 made use mandatory as of 7/20/2012

• Mandated use of the PDMP (KASPER) by Prescribers for Schedule II or Schedule III with hydrocodone

Data provided by Kentucky All Schedule Prescription Electronic Reporting system

Impact of Prescription Monitoring in Kentucky

4Q 2012 1Q 2013 2Q 2013 3Q 2013 4Q 2013 1Q 2014

39813799

4079 4012 4043 4077

Oxymorphone(# of prescriptions

filled)

4Q 2012 1Q 2013 2Q 2013 3Q 2013 4Q 2013 1Q 2014

1856817560

1697216486

15310 14963

Methadone(# of prescriptions

filled)

4Q 2012 1Q 2013 2Q 2013 3Q 2013 4Q 2013 1Q 2014

93318 95796

107466 110133 113459 113713

Buprenorphine(# of prescriptions

filled)

Prescribers must:• Query KASPER before initially

prescribing

• Query once every 3 mos. for ongoing treatment

• Query before issuing new prescriptions or refills

Data provided by Kentucky All Schedule Prescription Electronic Reporting system

Prescription Monitoring Information Exchange (PMIX)

As electronic monitoring of prescription drugs advanced, the need to share data between PDMPs grew.

The states realized that a standard for the exchange was needed.

The initiative that established PMIX grew out of the Bureau of Justice Assistance/IJIS Institute PMP Committee.

The Four Pillars of the PMIX Architecture

End to End SecurityStandards Based Exchange (GRA)Common Exchange Data and Metadata

(NIEM)Hub Connections (Hub to Hub)

PMIX Architecture

A information exchange standard designed by PDMP Administrators and based on: National Information Exchange Model (NIEM) data &

metadata Global Reference Architecture (GRA) Profile Open Standards

Contains: Information Exchange Package Documentation (IEPD) State to State Service Specification Hub to Hub Service Specification Execution Context Document

PMIX Architecture

Specifically designed for: Flexibility in its use

Hub to Hub State to State Direct Connections by various third parties

PMP to PMP security and privacy using Public Key Infrastructure (PKI)

Cost Effective Use (no fees for using PMIX) Compliance with Grant Requirements

Supported by NABP and BJA/IJIS

Choice and Flexibility

Hub

State RoutingService (SRS) SRS

PotentialIn-statePartners

PMPSystem

PMPSystem

PMPSystem

PMPSystem

Hub

PMPSystem

PMPSystem

Ohio Automated Rx Reporting System (OARRS)

HIT to PDMP Data Sharing utilizing the PMIX Architecture

Coming Soon!

HIT to OARRS Connectivity

Utilized Web Service (PMIX Architecture)A web-based application intended for

software consumptionTypical credential is digital certificateThe connecting software/customer

organization authenticates – not the end user

PMIX Work Group

Representatives from AL, CA, FL, KY, ME, NM, OH, OK, VA, WA, Bureau of Justice Assistance and the PDMP Training and Technical Assistance Center.

Recommend, review and approve enhancements to PMIX

Summary of PDMP Data Sharing

Resources limited in many PDMPsState Regulations guide sharingData available to share varies from state to

statePMIX standard built on the common elements

between states

Expanded Data Sharing

Have a strong desire to data sharing with HIE, HIT and other parties

Broad consensus that ease of access for providers will increase timely access and utilization of data

Questions

For More Information

Chad Garner, Director, Ohio Automated Rx Reporting System (OARRS) – cgarner@ohiopmp.gov

Ralph Orr, Director, Virginia Prescription Monitoring Program – ralph.orr@dhp.virginia.gov

Don Vogt, PMP Program Manager, Oklahoma Bureau of Narcotics Prescription Monitoring Program – dvogt@obn.state.ok.us

Jean Hall, Integration Project Manager, Kentucky All Schedule Prescription Electronic Reporting – jean.hall@ky.gov