NABP. ASAP 2014 Annual Industry & Technology Issues Conference January 16, 2014

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1 ASAP 2014 Annual Industry & Technology Issues Conference January 16, 2014 Robert T. Cowan, Chief Operating Officer National Association of Boards of Pharmacy

2 Robert Cowan is an employee of the National Association of Boards of Pharmacy. The conflict of interest was resolved by peer review of the slide content. He declares no other conflicts of interest or financial interest in any product or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria. ASAP s and NCPA s education staff declares no conflicts of interest or financial interest in any product or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria.

3 Following this presentation, attendees should be able to: 1. Describe what prescription monitoring programs (PMPs) are and why they are needed and used. 2. Discuss what NABP s PMP InterConnect is and what it does. 3. Describe what the PMIX Architecture is. 4. Discuss how NABP InterConnect is evolving to meet the needs of consumers of PMP information. 5. Describe how PMPs are an essential tool in combating America s prescription drug abuse problem.

4 Describe what prescription monitoring programs (PMPs) are and why they are needed and used. Discuss what NABP s PMP InterConnect is and what it does. Describe what the PMIX Architecture is. Discuss how NABP InterConnect is evolving to meet the needs of consumers of PMP information. Describe how PMPs are an essential tool in combating America s prescription drug abuse problem.

5 47 states/jurisdictions have functional PMPs or are at least collecting data 2: MD and NH gearing up to implement 2: DC and MO no authorizing legislation (DC expected 2014) Where the PMPs are housed: 18 Health/Substance Abuse/Consumer Protection 26 Board of Pharmacy/Professional Licensing agency 7 Law Enforcement

6 Persons engaging in doctor shopping do not stay in one state, particularly when they are from areas that border other states Querying the state PMP may not give a complete picture to a physician or pharmacist of the controlled substances a person is obtaining Low utilization/lack of integration PMPs lack function and analytical tools

7 NABP s mission is to support boards of pharmacy and assist other regulators to protect the public health Fall 2010, NABP was approached by several members Members requested a low cost, easy to implement, highly enhanced solution for interstate data sharing

8 Creates interoperability for individual state PMPs via a hub system Physicians and pharmacists log into their own state PMP and check boxes for other participating states from which they want data The hub routes the requests to the various states and the information back to home PMP for delivery to the physician or pharmacist in one collated report

9 Username: Mallain Password: 27%9874M

10 Pharmacist Patient Request Patient Response Patient Request Patient Response Physician

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13 All protected health information is encrypted and not visible to the hub, is secure, and is Health Insurance Portability and Accountability Act (HIPAA) compliant. No protected health information is stored by the hub; the hub is just a pass through from one state to the authorized requestor in another state. Easy for states: Only sign one memorandum of understanding (MOU)/contract with NABP do not have to sign one for every other state to exchange data. Each state s rules about access are enforced automatically by the hub. July 2011 went live and since the launch, NABP InterConnect has processed over 3 million requests in an average of 5.5 seconds to process a request.

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15 22 PMPs Arizona, Arkansas, Colorado, Connecticut, Delaware, Illinois, Indiana, Kansas, Kentucky, Louisiana, Michigan, Minnesota, Mississippi, Nevada, New Mexico, North Dakota, Ohio, South Carolina, South Dakota, Tennessee, Virginia, and Wisconsin are actively sharing data. 3 additional states have signed MOUs and 4 are in some stage of reviewing the MOU to participate

16 $0 participation costs through at least June 30, 2016, although states may incur some costs from their own PMP software vendors NABP is paying from its own revenues (exams/accreditations): All development and implementation costs for the program Annual maintenance fee to the contractor to house the hub Annual participation fees for states that cannot accept funding from pharmaceutical manufacturers NABP is using unrestricted grants from third parties To date, Purdue Pharma L.P. and Pfizer have provided grants To assist states with developing needed software to connect to the hub and other costs for participation for states that can accept these funds

17 The PMIX Architecture is a set of standards governing how PMP data is exchanged between participating PMPs. Supported by and required by the Bureau of Justice Assistance as a condition for Harold Rogers Grant assistance.

18 NABP awaiting infrastructure deployment in order to test and document compliance. Under the control of the Integrated Justice Information Systems Institute. Translation from differing security standards part of the deployment proposal. Upon successful testing, legal and operational agreements will have to be finalized before data can successfully flow between hubs. Anticipated in 2014.

19 Continue to onboard states into NABP InterConnect Assist states with legislation to allow interstate sharing Integrate NABP InterConnect into health information exchanges, including message translation as necessary Integrate PMP requests into workflow processes such as pharmacy software systems and hospital system emergency departments, including message translation as necessary Provide access to analytical tools to automate analysis of PMP reports to increase efficiencies, eg, NARxCHECK Develop software that works seamlessly with NABP InterConnect as well as meets the day-to-day needs of administrators, requestors, and data submitters

20 Leveraging the growing national network Guided by PMP InterConnect Steering Committee Working with Office of the National Coordinator for Health Information Technology pilots Third-party Inquiries Networks Electronic Medical Records Pharmacy Health Information Exchanges

22 NABP PMP InterConnect Web Portal PMP N PMP Aware N

23 PMP 1.0 Single state; non-workflow; raw data PMP 2.0 Comprehensive data (multistate) Workflow ready (integrated)

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25 No separate registration No additional username/password No data entry No added steps No delay

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2012 The MITRE Corporation. All rights Reserved.

29 58% reduction in either prescriptions written or number of pills prescribed 72% of cases there was more information in the report than the physician was aware of 100% reported that integrated report was easier to use The major obstacle to using the database is the time needed to access the information. During a busy shift, it is not always possible to stop and access the Web site. Anything that puts this information in front of me quicker, or more simply, will only benefit patient care. Wishard ER Physician I have to say that this is probably one of the more genius moves of the 21 st century. Having easy access to [PMP data] without going to a totally different Web site and have it pop up instantly has taken a lot of time off of decision making for me. Thanks for spearheading it. Wishard ER Physician Do you need specific case anecdotes or just for me to say that it s great! I ve never used [the State PMP] before because of the extra step, but I have used it on many patients in just a few shifts since this change. Wishard ER Physician

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34 Health care sites Allows prescribers and pharmacists to meaningfully participate in efforts to reduce the misuse of controlled substances in an economically efficient way Reduces confirmatory communications with providers to only those where behaviors indicate risk of misuse; more cooperation between pharmacists and doctors

35 Insight into patient s access to controlled substances from PMP records from all pharmacies Information on patient behavior patterns with multiple providers, who may be unaware of this fact today Identifies patients with behavior patterns that may be indicative of misuse, allowing further interaction with the patient and/or practitioners regarding the situation, prior to dispensing

36 1. PMPs are maintained for which of the following purposes? a. To provide information for doctors considering writing/dispensing a controlled substance prescription. b. To provide information for pharmacists considering dispensing a controlled substance prescription. c. To provide information to law enforcement officials investigating diversion of controlled substance crimes. d. Both a and b. e. a, b, and c.

37 1. PMPs are maintained for which of the following purposes? e. a, b, and c.

38 2. The PMIX Architecture is: a. A health care information exchange standard. b. A pharmacy information exchange standard. c. A law enforcement information exchange standard. d. A PMP information exchange standard. e. None of the above.

39 2. The PMIX Architecture is: d. A PMP information exchange standard.

40 3. NABP InterConnect was originally deployed to solve what problem? a. Incompatible data submission standards between PMPs. b. Inability for users of one PMP to obtain patient data from other PMPs in a single request. c. Legal and operational challenges which were preventing effective collaboration between the PMPs. d. Inability for PMPs to exchange information with health care and pharmacy entities. e. All of the above.

41 3. NABP InterConnect was originally deployed to solve what problem? b. Inability for users of one PMP to obtain patient data from other PMPs in a single request.

42 4. How many states are sharing data via NABP InterConnect? a. 15 b. 21 c. 22 d. 24 e. 47

43 4. How many states are sharing data via NABP InterConnect? b. 22

44 5. What are the recent enhancements which are planned or have been made to NABP InterConnect? a. A translation service which will enable communication between PMPs and health care entities using HL7. b. A translation service which will enable communication between PMPs and pharmacy entities using National Council for Prescription Drug Programs. c. A translation service which can facilitate hub-to-hub communication amongst PMPs. d. A data submission clearinghouse to facilitate accurate and rapid data submission by dispensers. e. a, b, and c.

45 5. What are the recent enhancements which are planned or have been made to NABP InterConnect? e. a, b, and c.

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National Association of Boards of Pharmacy PMP Interconnect NABP

National Association of Boards of Pharmacy PMP Interconnect NABP Problems with PMPs: Persons engaging in doctor shopping don t stay in one state, particularly areas that border other states Querying the