A U.S. Government Accountability Office report found that while prescription drug monitoring programs (PDMPs) are useful in preventing drug misuse and potentially dangerous drug prescribing, physicians identified the lack of integration of PDMP information into EHR systems as a key challenge.
PDMPs are state-operated electronic databases that track prescriptions patients receive for opioids or other medications that are at risk of being misused. GAO interviewed 31 physicians in 10 selected states and PDMP officials in nine of the 10 states. The selected states vary geographically and by other factors such as overdose death rates. GAO selected physicians from medical specialties that prescribe opioids. GAO also conducted interviews with relevant national organizations, organizations representing pharmacists, and officials from federal agencies that support PDMPs, and reviewed relevant federal strategy documents and grant announcements.
Most of the 31 physicians GAO interviewed said PDMP information helped them identify potential doctor shopping (when patients inappropriately seek medications from multiple physicians) and avoid potentially dangerous drug prescribing (such as dangerous drug combinations or high cumulative amounts). About half of the physicians also found PDMPs useful for providing overall patient care. Some of these physicians said their PDMPs provided more comprehensive information on patients’ prescription histories than was available in patients’ EHR. Physicians described how they could use PDMP information to determine which medications a patient had received and to discuss with patients the risks or benefits of treatment options.
Physicians identified the lack of integration of PDMP information into EHR systems as a key challenge for most effectively using PDMPs for patient care. With integration, physicians can access PDMP information within the EHR systems they use, rather than accessing the PDMP separately. Most of the physicians GAO interviewed said their PDMP was not integrated with their EHR system and accessing the PDMP separately was a challenge. GAO noted that some stakeholders knowledgeable about PDMPs said the extra time it takes to search the PDMP without integration could place a significant time burden on some physicians, such as those working in an emergency department in which time may be limited.
State and federal agencies are taking steps to improve PDMP integration with EHR systems, GAO said. For example, state officials from nine of the 10 states in GAO’s review described efforts to facilitate integration of PDMP information into EHRs. Federal agencies that support PDMPs, including the Department of Justice and Department of Health and Human Services, have also made funding and technical support available to states to help improve integration.
Physicians across all of the seven specialties in GAO’s review also said that PDMPs had positive influences in their practice beyond reducing duplicate opioid prescriptions. Some physicians described the dangers of prescribing opioids in conjunction with certain other medications, such as benzodiazepines, and how in using the PDMP they were alerted to medications a patient was prescribed by another physician that could cause potentially dangerous interactions.23 Some physicians also noted that they specifically used the PDMP to screen patients for these potential medication interactions. Physicians stated that when they saw such information in the PDMP, they would talk with the patient or other prescribing physician to discuss alternate treatment options or discuss with the patient the potential risk of overdose if no other treatment options were available.
The four pharmacists interviewed described how using PDMPs in the pharmacy setting played a role in preventing patient misuse of prescription drugs and potentially dangerous prescribing. Pharmacists stated that information in PDMPs could help them verify patients’ needs. Pharmacists also described how the PDMP allowed them to see if patients were receiving concurrent opioid prescriptions.
Pharmacists also noted that the PDMP could help them see prescriptions for dangerous drug combinations from multiple physicians. With this information, they can alert the prescribing physicians to their concerns about these prescription combinations.