Steps Taken to Combat the Opiate Epidemic Through Legal And Technological Channels Nick Snyder, Esq.
How Can We Impact Inappropriate Over-Prescribing of Opioids in Maine? What have other States or Organizations done to try to change this concerning pattern of high dose, overprescribing? Year Organization MME Threshold (mg/day) Recommended Action at MME Threshold 2010 American Academy of Pain Medicine >200 Increase frequency and intensity of monitoring 2010 Utah State Clinical Guidelines >120-200 Increase clinical vigilance 2010 Veteran s Affairs/Department of Defense >200 Refer or consult 2010, 2015 Washington State Agency Medical Director s Group >120 Consult from pain management expert 2011 Canadian Guidelines >200 Reassess or monitor 2011, 2014 American College of Occupational and Environmental Medicine 50 Follow up frequently; document improved function 2011 New York City Department of Health and Mental Hygiene >100 Reassess pain status or consider other approaches 2012 American Society of Interventional Pain Physicians >91 Consider pain management consultation 2012 Centers for Medicare and Medicaid Services >120 Consider case management 2014 Medical Board of California 80 Proceed cautiously and consider referral to specialist when higher does are contemplated 2015 California Division of Worker s Compensation 80 Increase clinical monitoring, consider specialty referral, attempt to wean to lower dose
Actions the State has Taken 1. The Legislature, in partnership with the Governor worked to pass Public Law LD 1646. This law is a sweeping change to the Prescription Monitoring Program, and has resulted in limitations on the MME average for a patient. It also requires that Prescribers check the PMP prior to prescription. It increases the role of Dispensers, requiring them to check the PMP, upload additional information, and withhold prescriptions when an exception is not noted on the prescription.
Actions the State has Taken 2. Over the past six months, since the passage of the law, an Opiate Treatment Council has convened on a bi-weekly basis. The purpose of each meeting is to work towards increasing the capability of the web based software utilized by Prescribers and Dispensers. The Council has also focused on writing the rules that implement the changes required by the LD.
Actions the State has Taken 3. In addition to the meetings with the Council, the Department has met with PMP stakeholders. This group has included veterinarians, physicians, nurse practitioners, and pharmacists. These meetings have occurred on a monthly basis.
Enhancements A mechanism or calculator for converting dosages to and from morphine milligram equivalents; A mechanism to automatically transmit de-identified peer data on an annual basis to prescribers of opioid medication; Allowance for a broader authorization for staff members of prescribers to access the program including a single annual authorization for staff members at a licensed hospital and a pharmacy; Improvements in communication regarding the ability of a prescriber to authorize staff members to access the program on behalf of the prescriber;
Enhancements Cont Enhancements Cont d Improvements in communication regarding the ability of a pharmacist to authorize staff members to access the program on behalf of the pharmacist; Improvements in the speed of the program for prescribers and pharmacists required to submit information and check the program, and the ability for prescribers and pharmacists to tailor the functions of the program to fit into the workflow of the prescribers and pharmacists required to access the program; and The establishment of a data modifier for information from a veterinarian prescribing opioid medication to an animal that differentiates the recipient of the opioid prescription from people.
Collaboration Over the course of three months collaboration occurred with representatives from the Office of MaineCare, Office of Substance Abuse and Mental Health, Audit, the Maine CDC and the Office of Information Technology. The goal was to determine what was necessary to make the system less cumbersome, more user friendly, and improve functionality.
Collaboration These meetings resulted in a comprehensive plan with expectations of what would be a better system. Our current vendor was unable to implement the Enhancements from the law. They also were unable to implement our aspirational goals for the system. So..
Collaboration We found someone who could.
Appriss PMP Solution Discussion
Multiple Capabilities Required to Deliver on PMP Vision The platform must leverage diverse data sets and interoperate seamlessly between various modules Data structures must be conducive to a variety of analysis operational, clinical and statistical Capabilities must be modular to fit within the operational and financial constraints of the client Provide a global set of capabilities out-of-the-box while creating pathways for customization and localized innovation To deliver maximum impact, engage multi-disciplinary teams to develop various facets of the platform PMP Insight + Emerging 12
Major Needs Addressed for PMP Stakeholders INFORMATION REQUESTERS Fast response times Reliable patient-linking Tablet compatibility Most up-to-date availability of records Secure delegate workflow Available in physician workflow 13
Major Needs Addressed for PMP Stakeholders DATA SUBMITTERS Flexible data submission methods for pharmacies, large and small Automated workflow for error correction Tools for online error correction Easier rollout of new data format standards A single account and user interface to manage all data submissions for multi-state pharmacy chains 14
Major Needs Addressed for PMP Stakeholders ADMINISTRATORS Automated patient linking with ability for administrators to override 100% online registration to eliminate paperwork Pharmacy and physician compliance reports Delegate-physician linking for compliance checks Business intelligence and ad hoc reporting capabilities 15
Major Needs Addressed for PMP Stakeholders INFRASTRUCTURE & SUPPORT Lowest total cost of ownership High availability & scalability Redundancy Help desk with 24/7/365 support Detailed visibility into all aspects of technology operations 16
27 States and Territories Rely on Appriss PMP Solution 17
Conclusion The goal is to ensure that by providing technological solutions that reduce work load, increase connectivity, and minimize duplicative tasks, the purpose of the law will be achieved. There will be challenges. But it is our goal to provide the tools necessary to overcome these challenges. With your help we can make a difference.
Questions? Nicholas Snyder, Esq. Nicholas.a.snyder@maine.gov Department of Health and Human Services 34