The Challenges of Interstate Data Sharing

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1 The Challenges of Interstate Data Sharing 2016 Harold Rogers Prescription Drug Monitoring Program National Meeting August 17 19, 2016

2 Background The Challenges of Interstate Data Sharing Prescription Monitoring Information exchange Working Group (PMIX) Kentucky All Schedule Prescription Electronic Reporting System (KASPER) Differences in statute and regulation Patient matching Impetus for interstate querying Other challenges

3 Goal of Interstate Data Sharing The goal of PDMP data sharing is to ensure healthcare professionals are able to get a complete picture of their patient s controlled substance history, regardless of in which state the patient had the prescription filled. Chad Garner, OH To effectively share PMP data across state lines in order to improve health outcomes and protect against the diversion of controlled drugs. Don Vogt, OK The goal of PDMP data sharing is to provide a more comprehensive patient controlled substance history report to authorized users. The report would not only include dispensing history within the state of residence but also outside the resident state. Denise Robertson, AR To improve patient safety and protect public health with the goal of reducing overdose deaths, hospitalizations, and other related prescription drug abuse issues. Gary Garrety, WA

4 Differences in Statute and Regulations

5 Differences in Statute and Regulations A doctor is a doctor is a doctor, or are they? States require one or more of the following: a state license to practice medicine, a state license to prescribe controlled substances, or a DEA # for controlled substances. Every state requires at least licensure in a recognized jurisdiction.

6 Differences in Statute and Regulations A doctor is a doctor is a doctor, or are they? Some considerations: This role may include Oral and Maxillofacial Surgeons and Podiatrists. If your state requires a DEA or the ability to prescribe controlled substances would you limit sharing with states that allow any physician to have access regardless of prescriptive authority? The circumstances under which a state allows the prescriber to look up a patient may differ.

7 Differences in Statute and Regulations Drugs Monitored Data Collected Additional identifiers such as SSN, phone number, etc. Dispensers required to report

8 Differences in Statute and Regulations

9 Differences in Statute and Regulations Mandatory vs. voluntary use Reports are different depending on the role for healthcare professionals The requirements for accessing a patient record vary From state to state In state depending on the user s roles

10 Differences in Statute and Regulations Adds complexity when: Determining the ability to share Educating our users about interstate sharing Resolving issues with interstate data sharing Querying across state borders

11 Finding a Patient Match Seeking individuals who have a high probability of being the same person No universal patient identifier KY: SSN/Driver s license as an identifier Quality of data submitted by pharmacies Patients don t always give correct information

12 Finding a Patient Match Chance of Duplicates (Blends) Most commonly used fields for patient matching in interstate data querying: First Name Last Name Date of Birth

13 Finding a Patient Match Whitepaper: Barr, Coggeshall, Zhao, The Trouble with Names/Dates of Birth Combinations as Identifiers,2011, id:analytics, Performed an analysis on a database with 308+ million persons Identified the top full name matches Found in the top 3 full name matches that they could only uniquely identify using First Name, Last Name and DOB 21% of the time 79% of the time Fname, Lname and DOB were insufficient In the top 1.164M, 6.12% of the time it was not sufficient information

14 Consequences: Finding diversion 1 to 1 match* KY: John Smith, DOB 10/24/1959 = VA: John Smith, DOB 10/24/1959 Questionable, hopefully, not bad patient matches* Jay Shipman, DOB 1/12/1967 James Shipman, DOB 1/12/1967 Brenda Davis, DOB 5/15/1972 Brian Dalton, DOB 5/15/1972 Finding a Patient Match Missing patients who are the same person Patient who previously lived in IN, now lives in KY new address resulted in no patient records *These are fictitious names used to illustrate real issues in interstate data sharing (KY)

15 When is enough? Who should our users query and when? Every state, every time Border States The saga of the Kentucky Border State button Dramatic increase in complaints Significant increase in volume Significant decrease in percentage of matches Know your data! Know your problem!

16 Border States, 54,334 All States, 72,247 Average Interstate Requests per week AL IL IN ME MI MN NM OH SC TN VA WV 0 Average Requests As of 7/30/2016

17 How Successful Are Your Requests? Requests to Kentucky Border States Error/Deferred 1% Disallowed 12% Data Provided 6% No Data Found 81%

18 How Successful Are Your Requests? Requests to All States From KY Disallowed 13% Error/Deferred 1% Data Found 5% No Data Found 81%

19 Who Should We Query? KASPER Records - Border States Residents IL, 8,214 IN, 25,919 All, 157,772 Unique Persons VA, 3,413 WV, 17,273 TN, 19,271 Total number of unique persons from other states = 189,591 This represents 8.5% of the unique persons in our database for the OH, 83, , , , ,000

20 Border States, 54,334 All States, 72,247 Average Interstate Requests per week AL IL IN ME MI MN NM OH SC TN VA WV 0 As of 7/30/2016 Average Requests

21 Schedule II CS Dispensed in KY 80% Unique Border States Residents 70% 60% TN, 66% VA, 67% WV, 61% IN, 57% IL, 66% 50% 40% All, 39% 30% 20% OH, 19% 10% 0% 14,803 % of Unique Persons with a CS II Rx

22 Who Should We Query? KASPER Records - Border States Residents IL, 8,214 IN, 25,919 All, 157,772 Unique Persons VA, 3,413 WV, 17,273 TN, 19,271 Total number of unique persons from other states = 189,591 This represents 8.5% of the unique persons in our database for the OH, 83, , , , ,000

23 Other Challenges Ensuring appropriate use of data/protecting the data Resolving issues Making the most of the data and our relationships/working together

24 What are we doing right? More states sharing, where they can, when they can Working together to identify solutions PMIX Working Group Collaboration sharing ideas, cross border analysis

25 Schedule II CS Dispensed in KY 80% Unique Border States Residents 70% 60% TN, 66% VA, 67% WV, 61% IN, 57% IL, 66% 50% 40% All, 39% 30% 20% OH, 19% 10% 0% 14,803 % of Unique Persons with a CS II Rx

26 VA Residents: CS II Dispenses in KY

27 Pharmacies Dispensing to VA Residents