K-TRACS KANSAS TRACKING AND REPORTING OF CONTROLLED SUBSTANCES

K-TRACS KANSAS TRACKING AND REPORTING OF CONTROLLED SUBSTANCES K-TRACS History and Integration Initiatives Marty Singleton Assistant Director Kansas State Board of Pharmacy 800 SW Jackson, Ste. 1414 Topeka, KS 66612 Ph: 785.296.4056 Fax: 785.296.8420 marty.singleton@pharmacy.ks.gov

Creating K-TRACS SB 491-2008 Legislative Session -Enacted prescription monitoring program (PMP)-38th state to enact legislation Provided no funding for the program Obtained Federal grant funding in late 2009 Fully Operational in 2011 (Rx data back to 7/1/10) Original software vendor was HID Switched to software vendor Appriss on 7/1/2013 (grant funding ending)

K-TRACS Basics Dispensers required to report to K-TRACS daily as of January 1, 2013 Dispensing information on Schedule II-IV drugs as well as drugs of concern Includes drug, dosage, frequency, number, days supply Includes identifying information about prescriber and dispenser Includes identifying information about patient Emergency dispensing for a 48 hour supply of the prescription or less does not have to be reported Medications dispensed to inpatients do not have to be reported Medications dispensed in hospice DO have to be reported

Drugs of Concern 68-21-7. Drugs of concern. (a) Each of the following shall be classified as a drug of concern: (1) Any product containing all three of these drugs: butalbital, acetaminophen, and caffeine; (2) carisoprodol; and (3) tramadol. (4) Board just voted to add Promethazine with Codeine (b) The stakeholders of the program shall be notified by the board if a drug is to be considered by the board for classification as a drug of concern. (c) Any individual who wants to have a drug added to the program for monitoring may submit a written request to the board.

Who is Currently Reporting? KSA 65-1682 Dispenser means a practitioner or pharmacist who delivers a scheduled substance or drug of concern to an ultimate user, but does not include: (1) A licensed hospital pharmacy that distributes such substances for the purpose of inpatient hospital care; (2) a medical care facility as defined in K.S.A. 65-425, and amendments thereto, practitioner or other authorized person who administers such a substance; (3) a registered wholesale distributor of such substances; (4) a veterinarian licensed by the Kansas board of veterinary examiners who dispenses or prescribes a scheduled substance or drug of concern; or (5) a practitioner who has been exempted from the reporting requirements of this act in rules and regulations promulgated by the board.

Data Reporter Highlights DISPENSING PHYSICIANS- Required to Report (hard to track compliance) Reports required weekly from April 2011 to Jan 2013 Beginning Jan 1, 2013 Pharmacies Required to Report within 24 hours of Dispensing a Controlled Substance or Drug of Concern System contains retroactive data back to July 1, 2010 Most Kansas pharmacies in compliance Majority of pharmacies not in compliance located out of state

Data Delivery Methods Acceptable methods of data submission to K-TRACS: Secure FTP over SSH (shared service provider) Encrypted File with Open PGP Via FTP SSL Web Site Physical Media (Tape, Diskette, CD, DVD) Universal Claim Form (UCF) Submission Paper Submission Online UCF Submission

Who Can Request PMP Data Board is authorized to provide PMP data to Prescribers and Dispensers for the purpose of providing medical or pharmaceutical care to their patients Individuals for their own information Individuals from administrative oversight agencies Law enforcement officials-with grand jury or inquisition subpoena, for a case they are currently investigating, regarding a given suspect KDHE regarding Medicaid recipients PMP staff and Board staff De-identified data can be given for statistical, research, or educational purposes Allowed to share interstate data

Threshold Letters In addition to solicited reports through the K-TRACS portal, letters are sent to prescribers and dispensers when threshold have been reached or exceeded by a patient during a given quarter. Current threshold is 5/5/90. We encourage prescribers to review Patient PMP Report to confirm whether or not they wrote the prescriptions shown on the reports If the report is accurate, prescribers and dispensers are advised to discuss their concerns with the patient. If records on a report appear to be inaccurate, prescribers are asked to contact the dispensing pharmacy to correct the record in error. One goal of these reports is to help identify patients who may need substance abuse treatment. Clinicians are asked to assist such patients in finding substance abuse programs in their area.

K-TRACS KANSAS TRACKING AND REPORTING OF CONTROLLED SUBSTANCES Threshold Data Threshold data (5/5/90) for 2013 and 1Q14: 1Q13: 78 - HID 2Q13: 13 - HID 3Q13: 308 - Appriss 4Q13: 276 Appriss (10.4% decrease) 1Q14: 223* Appriss (19.2% decrease) * Top diverter saw 27 prescribers and 20 dispensers (new record!). Has been in the top 20 for three straight quarters.

K-TRACS KANSAS TRACKING AND REPORTING OF CONTROLLED SUBSTANCES 350 Patients Meeting 5/5/90 Threshold 300 250 200 150 Patients 100 50 0 1Q13 2Q13 3Q13 4Q13 1Q14

K-TRACS KANSAS TRACKING AND REPORTING OF CONTROLLED SUBSTANCES PMP Stats K-TRACS contains 22.1M Rx records as of 5/5/14 (KS pop: 2.89M) Web requests: 1/1/14 4/29/14 = 97,015 (24.3K/month average) Feb report was 17.5K/month average (28% increase). Web + PMPi: 1/1/14 4/29/14 = 191,962 (48K/month average) Feb report was 36.6K/month average (24% increase) For 2014 YTD PMP is averaging about 1600 patient queries per day including PMPi. When all integration partners are in production in 2015 with EHR integration, we are estimating at least 12000 patient queries per day including PMPi.

K-TRACS Technology Third party data repository vendor is Appriss. Utilizes proprietary system developed in house called AWARxE. Optimized for interoperability, performance and scalability Ideal for integration into EMRs where transactions increase significantly (Access through PMPi) System uses Ruby language with JavaScript on the front end and some Java on the back end. Data is stored in dual server locations instantly. Offsite tape backup daily and all data is encrypted.

K-TRACS Data Repository Features Data submitted by dispensers is processed immediately (requires no batching ) ASAP 3.0, 4.1, or 4.2 accepted (can accept all at once) Data is available for patient queries immediately Software constantly matching patients for consolidation Uses multi factor algorithm that utilizes fuzzy logic for name and DOB. Version 2 will use name analytics (up to 13 factors). Data errors immediately reported back to dispensers Dispensers can make error corrections online Multi state AWARxE dispensers (Pharmacy chains) can report to one location

Kansas PMP Grant Kansas PMP Receives SAMHSA Grant (Substance Abuse and Mental Health Services Administration) $450K used to make PMP more accessible in three targeted areas: Integrate PMP into EMRs with an HIE (LACIE & KHIN) Integrate PMP into Pharmacy workflow Integrate PMP into Hospital Emergency Room EMRs

Kansas PMP Initiatives LACIE (Lewis And Clark Information Exchange) Cerner finishing software development work. Starting first hospital pilot by mid May. Children s Mercy Hospital in Kansas City. Will begin with 10 ER Physicians/APRNs. Working with key staff to establish credentialing process

LACIE Process & Workflow 1b. LACIE Loads in EMR 2b. K-TRACS Pop-Up Window displays 1a. EMR queries LACIE 2a. K-TRACS link is clicked & LACIE calls K-TRACS

LACIE User s View K-TRACS PDMP REPORT LACIE Screen Shot; representative of what providers will see; click of hyperlink will launch the pop-up window 18

Screen Shot of K-TRACS Report Loading 19

Kansas PMP Initiatives KHIN (Kansas Health Information Network) MOU has been signed with KHIN. Cannot allow storage of PMP data. Technology / method is available going through VCH. All involved have reviewed the plan and agree it will work. Test message was successful. IT has developed a proposal and cost estimate to present to VCH leadership for approval to use VCH IT resources. SAMHSA grant funds are available to fund development. Development would begin in July, with a pilot in 4Q14.

Kansas PMP Initiatives

Kansas PMP Initiatives KHIN User Sample Screen Shot

Kansas PMP Initiatives Pharmacy Partner Integration SAMHSA grant funds are available to help fund development. Have draft MOU in review process with legal and Pharmacy Board. Ohio and South Carolina are two other states working with this partner. Goal is to have PMP available in Pharmacy software at DUR. Goal is to make software generic to be used by any pharmacy software. Information is delivered in standard format to pharmacy porch. Then formatted to specific pharmacy software for displaying in work flow.

Kansas PMP Initiatives Pharmacy Partner

Kansas PMP Initiatives Pharmacy Partner

Kansas PMP Initiatives Via Christi Hospitals Emergency room partner for PMP EMR integration VCH has single sign on 3Q13 pilot with one ER 4Q13 production with multiple ERs 1Q14 continuing to ramp up more ERs and clinics Grant funds passed on for development work Grant funds now paying for PMPi access

Kansas PMP Initiatives

123456 1234567891 0 987654 9876543210 9 234567 2345678910 1 200000 2000000001 0 800000 8000000000 1 K-TRACS Mouse, Mickey 16 0 Ott, M Jacob J Michael Patton Duck, Daffy B1 0 3 / 2 Stangl, Donna E Sweet Robert Pig, Porky 1A 0 6 / 5 Meinecke, Curt Leghorn, 05 0 Botros, Foghorn Maged Bunny, Bugs 22 0 Chang, Number of Number Howard of scripts physicians dispensed dispensing Andrew M Barcla Henwood, John Val J Brown Jr 456789 45678910111 Fudd, Elmer 20 0 Rogers, Mark Larry R Hund Indicates no scripts within last 100 days Indicates warning: scripts dispensed within last 100 days (less than 5) Indicates threshold exceeded: 5 or more scripts dispensed within last 100 days

Wichita Hospitals Integration When the physician clicks on the cell with the PDMP score the detail data from the PDMP query is rendered and displayed. Queries are performed automatically when patients are admitted to the Emergency Department 29

Physicians click the KTRACS button to request a PDMP query be performed for this patient

PDMP score is displayed with a color coded Red / Yellow / Green button. Clicking the button opens the full report

All methods open the detailed report showing PDMP data retrieved from KTRACS

The Future of K-TRACS K-TRACS migrating from MIME (Multipurpose Internet Mail Extensions) Most PMPs currently use MIME to communicate K-TRACS going to PMP Gateway with Appriss API (Application Programming Interface) will be XML (Extensible Markup Language) for patient query request responses (reports back to prescribers/dispensers) Can easily communicate with Hospitals, HIEs or Pharmacy Chain s systems ( via HL7 (Health Level 7) or NCPDP (National Council for Prescription Drug Programs)) Much easier to integrate into prescriber/dispenser workflows (EMRs)

The Future of K-TRACS SB 134 Signed into Law: Allows Coroners and Medical Examiners Access to Data Creates peer review process to identify problem prescribers and dispensers and help them get the education they may need Identify problem patients and refer them to treatment facility or worst case scenario (obvious doctor shopping and selling situation-to law enforcement) Harold Rogers Grant: Working with Department for Children and Families (SRS) to have Social Workers meeting with patients identified as diverting to offer services and rehabilitation. 2Q14 Working with Kansas Bureau of Investigation (KBI) to review patients diverting with thresholds of criminal proportions. 3Q14

K-TRACS KANSAS TRACKING AND REPORTING OF CONTROLLED SUBSTANCES Questions? Marty Singleton Assistant Director Kansas State Board of Pharmacy 800 SW Jackson, Ste. 1414 Topeka, KS 66612 Ph: 785.296.8717 Fax: 785.296.8420 marty.singleton@pharmacy.ks.gov