MA Prescription Monitoring Program Prescriber Electronic Alert Notifications

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1 MA Prescription Monitoring Program Prescriber Electronic Alert Notifications Bureau of Health Care Safety and Quality Len Young, Epidemiologist February 20, 2014 Slide 1

2 MA PRESCRIPTION MONITORING PROGRAM (PMP) BACKGROUND Purpose of the MA PMP: To help promote safe prescribing and dispensing To help prevent drug diversion and abuse. MA PMP collects data on Schedule II-V prescriptions dispensed in MA pharmacies and from out-of-state pharmacies delivering to MA. Over 12 million Schedule II-V prescription records were reported to MA PMP in CY Slide 2

3 Why Threshold Reports Can Make a Difference Threshold Percent Difference by Doctor Shopping Threshold (2009 and 2012) CY 2009 CY 2012 % Difference Rate Rate per 100,000 per 100,000 population population >= 2 Presc & 2 Pharm 15,144 14, >= 4 Presc & 4 Pharm 1,687 1, >= 6 Presc & 6 Pharm >= 8 Presc & 8 Pharm >= 10 Presc & 10 Pharm Rate: Number of unique individuals who meet the specified threshold criteria per 100,000 population Numerator: Includes individuals who meet the specified doctor/pharmacy threshold obtaining Schedule II (C-II) opioid drugs during the calendar year. Denominator: Individuals who have received at least one Schedule II opioid drug during the specified calendar year. Slide 3

4 Massachusetts Prescription Monitoring Program Prescriber Electronic Alert Initiative Slide 4

5 Efficiencies Prescription Monitoring of Electronic Program MA Online PMP Unsolicited Reports Identify questionable activity for providers without need for prescriber to actively log in and lookup patient. [Note: alert notifications occur after a potential problem has been identified and are not preventative interventions; they should not take the place of looking up patient s controlled drug prescription histories.] A patient who meets criteria automatically generates an alert notifying the prescriber. The alert contains no personal identifying information only a record ID that the prescriber uses to look up the patient. MA PMP prevents multiple alerts on a patient to already notified providers to prevent alert fatigue Slide 5

6 Electronic Alert From: Massachusetts Department of Public Health (DPH), Prescription Monitoring Program (MA PMP) Notification: Patient obtaining multiple Schedule II-V prescriptions from multiple providers (Patient) Record ID: To: Prescriber The MA PMP is informing you that one of your patients appears to be receiving multiple Schedule II V prescriptions from multiple pharmacies and multiple prescribers. You can view the patient prescription history that triggered this message by doing the following: * Go to - * Click "Log in to the Virtual Gateway" * Enter your Virtual Gateway username and password (If you forgot your login credentials call VG Help line at ) * Once at the MA Online PMP page click Single Patient Lookup and enter the Record ID number listed above. You are not obligated to take any action in response to this message. It is designed to be an additional tool for you in providing optimal patient care, including effective treatment in addition to assessment of the possibility of drug abuse or diversion. Please note the Record ID search displays the patient prescription history as it appeared at the time this message was created. The most current prescription history can be retrieved by entering the patient s name and birth date on Single Patient Look-up page and omitting the Record ID. The MA PMP requests for you complete a survey regarding this notification by visiting A follow-up survey will be sent to you in two months. The surveys are essential MA PMP evaluation tools. Visit for further information on the MA Online PMP and other informational materials, such as The Prescriber Guide to Interpreting Prescription Monitoring Data. You may reply directly to this message with comments or questions. NOTICE: This communication contains confidential information from the Massachusetts Department of Public Health. This information is intended only for the use by the recipient listed above. If you are not the intended recipient or the employee or agent of the intended recipient responsible for the delivery of this information, you are hereby notified that the disclosure, copying, use or distribution of this information is strictly prohibited. If you have received this communication in error, please notify the Department immediately by replying to this . Slide 6

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9 Prescription Monitoring Program MA Online PMP Electronic Alert Results (December 2013 Alerts) Electronic alerts were activated in December MA PMP applied a questionable activity threshold in collaboration with the PMP Medical Review Group (MRG) comprised of pharmacists and prescribers. Using this threshold, an electronic alert would have been sent to 4,268 prescribers if all prescribers were enrolled in the MA Online PMP. Forty-five percent (1,920) of the 4,268 prescribers are enrolled in the MA Online PMP and actually received an alert .* 1 MA PMP initiated the alerts for the first time in July, 2013; these initial alerts revealed a couple of errors in the system. These were corrected and after testing the alerts were reinstated in December, *This includes a small number of s that were undeliverable due to changes in s or otherwise incorrect addresses in the system. Slide 9

10 MA PMP Electronic Alert Notifications Electronic Alert Results Summary Table (First 3 Months) Descriptive Statistics for Alert Notifications (Dec, 2013 and Jan and Feb, 2014) Trigger Date Patients Identified Providers Identified* Notifications Sent % Sent / Identified (Enrolled %) Dec_ ,268 1,920 45% Jan_ ,396 1,116 47% Feb_ , % * Note that the number of providers identified were not all sent alert notifications because they are not all enrolled in the MA Online PMP. In order to receive an alert notification the provider must have an active MA Online PMP account. Slide 10

11 Key Observations/Findings After the initial alerts were sent out in December 2013 we observed the following: An increase or spike in the number of end-user patient searches following the alert notifications A notable increase in the number of first time users of the Online PMP (21% of the prescribers who received an alert notification logged into the system for the first time on the first day the alert was sent). Nearly 80 percent of the patients identified in the December alerts were searched by at least one prescriber enrolled in the MA Online PMP system from Dec 3-5. Slide 11

12 Prescription Monitoring Program MA Online PMP Some Items for Discussion How should undeliverable s (i.e. changes/errors in addresses) be handled when activating electronic alerts? Frequency of sending electronic alerts (what do other states do?) What resources should be provided to assist providers in interpreting patient unsolicited reports. Other considerations/experiences initiating electronic alerts by other states. Slide 12

13 Prescription Monitoring Program Acknowledgement Portions of this project were supported by grants awarded by the U.S. Bureau of Justice Assistance. Points of view or opinions in this presentation are those of the author and do not represent the official position or policies of the United States Department of Justice. Contact Information Len Young MA Department of Public Health, Drug Control Program Phone: Slide 13

14 PDMP TTAC Webinar Use and Impact of Threshold Reports February 20, 2014 Lisa Adams, Program Administrator Nevada Prescription Monitoring Program

15 Unsolicited Reports Average Number of Prescribers & Dispensers Prescribers Dispensers

16 Initial Impact of Unsolicited Reports in Nevada Average Doses 10,000 9,351 9,000 8,000 7,000 6,000 5,000 4,000 3,000 2,000 1,000 4,714 Average Prescriptions

17 What is an unsolicited report? How is it created?

18 Unsolicited Reports Sent January 2013 Pre Report (8/1/12 1/31/13) Post Report (8/1/13 1/31/14) % Decline Prescriptions Doses 1, Prescribers Dispensers The information above relates to 40 patients. Forty-nine unsolicited reports were sent in January Nine patients had no prescriptions filled during the post report period.

19 Contact Information: Lisa Adams, Program Administrator Nevada Prescription Monitoring Program 431 West Plumb Lane Reno, NV (775)

20

21 Wyoming Population is roughly 550,000 residents 3,436 Active Controlled Substance Registrants 182 Active pharmacies, resident retail and Institutional

22 Section 4. Unsolicited Patient Profiles The board may generate patient profiles based on information showing use of controlled substances, which is in excess of established parameters. Profiles generated will be mailed to each pharmacy and practitioner where the patient was seen. A letter of explanation will accompany each profile

23 Use of Parameters Yes, first part of each month a query is generated for the previous month I usually wait until all the data is in from all pharmacies, but we are at 100% reporting each month Letters are sent to each practitioner and each pharmacy

24 Use of Parameters, cont Can send to Law Enforcement and Regulatory Agencies Wyoming Board of Pharmacy does have a set of parameters, but I also sent out unsolicited reports based on some numbers and types of drugs

25 Use of Parameters, cont The numbers that I look at are: Qty total for the month If I see an escalation of qty s Types, usually the same drugs, then I look for the Un-holy trinity of controlled substances

26

27 Luke Skywalker, MD Death Star Urgent Care 123 Home Street, Outer Space, WY Dear Practitioner, The Board of Pharmacy s WORx Program monitors the controlled substance prescriptions dispensed in Wyoming for potential abuse problems. Attached you will find a patient s controlled substance drug utilization profile report for the previous month. You are listed as one of the practitioners who prescribed controlled substances for this patient. If you feel you need additional information, please fax us a patient profile request. We are providing the attached profile to you confidentially for informational and assessment purposes. It is our experience that practitioners often are unaware that a patient is receiving controlled substance prescriptions from other practitioners. We are requesting that you review your records to determine whether this person is your patient and whether you wrote or authorized the prescriptions shown on the attached profile. If you find that any of the prescriptions shown on the profile were not, in fact, authorized by you, please contact our office immediately. If, on the other hand, you find that the prescriptions were authorized by you, please consider whether and how you should discuss your concerns with your patient, as you deem appropriate. You may also want to keep this profile in the patient file or chart. We are aware that some patients have special needs and conditions such as severe or intractable pain that require large quantities of controlled substances. On the other hand, many times patients who may be addicted to or abusing controlled substances use various mechanisms that involve the good names of practitioners such as you to obtain excess drugs. By providing the attached profile, we are not judging the propriety of the patient s conduct. Rather it is our belief that well informed practitioners can use their professional expertise to assist patients who may be abusing controlled substances, and we are hopeful that providing you with this information will lead to optimum care for your patient. Thank You,

28 Pharmacist in Charge Use The Force Pharmacy # Home Street Outer Space, WY Dear Pharmacy Manager, The Board of Pharmacy s Prescription Drug Monitoring Program monitors the controlled substance prescriptions filled in Wyoming for potential abuse problems. Attached you will find a patient s controlled substance drug utilization profile report. Every pharmacy and every practitioner listed on the profile receives a copy. You are listed as one of the pharmacies that dispensed controlled substances for this patient. We are providing the attached profile to you confidentially for informational purposes. Do not share this information with any other pharmacy, including any pharmacies within your organization. Please understand that it is not the Board s intent to determine how you dispense controlled substance prescriptions. We are aware that some patients have special needs and conditions such as severe or intractable pain that require large quantities of controlled substances. On the other hand, the Board is aware that many times patients who may be addicted to or abusing controlled substances use various mechanisms to obtain excess drugs. By providing the attached profile, we are not judging the property of the patient s or your conduct. Rather it is our belief that well informed pharmacists can and will use their professional expertise to assist patients who may be abusing controlled substances, and we are hopeful that providing you with this information will lead to optimum care for your patient. Thank You,

29 Number of Unsolicited Profiles Since Number of Unsolicited Profiles

30 Contact Information David N. Wills, MBA Wyoming State Board of Pharmacy 1712 Carey Avenue, Suite Mary K. Walker, R.Ph Executive Director Wyoming State Board of Pharmacy

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