Commonwealth of Kentucky NASCIO Recognition Awards Nomination Category: Data, Information and Knowledge Management. ekasper

Transcription

1 2006 NASCIO Recognition Awards Nomination Category: Data, Information and Knowledge Management ekasper Cabinet for Health and Family Services The Enhanced Kentucky All Schedule Prescription Electronic Reporting system (ekasper) provides a dynamic Web-based tool to help health care providers, law enforcement, and regulatory officials in the fight against prescription drug abuse and diversion in Kentucky. ekasper tracks Schedule II - V controlled substance prescriptions written and dispensed within the state and is used by health care providers to help identify patients who may be at risk for prescription drug abuse. ekasper is the heart of Kentucky s Prescription Monitoring Program (PMP) and has been recognized at both the state and federal level as a leading edge tool to assist health care and law enforcement in the fight against prescription drug abuse and diversion.

2 Executive Summary The Enhanced Kentucky All Schedule Prescription Electronic Reporting system (ekasper) provides a dynamic Web-based tool to help health care providers, law enforcement, and regulatory officials in the fight against prescription drug abuse and diversion in Kentucky. ekasper tracks Schedule II V controlled substance prescriptions written and dispensed within the state and is used by health care providers to help identify patients who may be at risk for prescription drug abuse and to verify compliance with a treatment regimen established by the patient s health care team. ekasper is also used as a tool for law enforcement and regulatory officials during bona fide investigations and other appropriate reviews. The original KASPER system, developed in 1999, was a cumbersome paper and fax-based request and response system that required significant manual effort to prepare and distribute reports, and was frequently backlogged with report requests. In March 2005, The Kentucky Cabinet for Health and Family Services (CHFS) launched ekasper to provide real time access to KASPER data. ekasper was developed and is maintained by a technical team in the CHFS Office of Information Technology, with business support provided by the CHFS Office of the Inspector General, Division of Fraud, Waste and Abuse/Identification and Prevention, Drug Enforcement, and Professional Practices Branch. ekasper is the heart of Kentucky s Prescription Monitoring Program (PMP) and has been recognized at both the state and federal level as a leading edge tool to assist health care and law enforcement in the fight against prescription drug abuse and diversion. In February 2006 President Bush released a national drug control strategy that hailed ekasper as one of the Nation s flagship PMPs. Since the launch of ekasper in March 2005, over 5 million controlled substance prescriptions have been loaded into the database with over 600,000 new prescriptions added each month. In addition 2,300 health care professionals and law enforcement officials have become authorized users of the Webbased system. The number of KASPER reports produced increased 52% from 2004 to Much of this increase is attributable to the ease of use and more timely report availability through ekasper, especially for pharmacists and emergency department physicians, who could not wait for a paper report to be faxed to them under the original KASPER system. With ekasper, authorized users can request a report via the Internet 24 hours a day, 7 days a week and receive the report often in 15 seconds or less, allowing them to make highly informed decisions while the patient or customer is present. Currently 90 percent of KASPER reports are requested via ekasper. Increasing usage of ekasper has allowed staff members in the Drug Enforcement and Professional Practices Branch to focus more of their attention on investigative activities rather than report generation, resulting in a significant decrease in the time required to complete a prescription drug investigation. The ekasper application and data set represents some of the most in depth tools concerning controlled substance prescription drug use across the United States. In the data analysis performed by the Cabinet of Health and Family Services, results have shown significant decreases in the use of several controlled substances across regions of Kentucky. This demonstrates that the Cabinet of Health and Family Services, along with the input of Kentucky licensure boards, Kentucky law enforcement agencies, and health care providers has successfully improved public health and safety. The success of ekasper has had an incredibly positive impact on the citizens of Kentucky by helping to significantly reduce the prescription drug abuse and diversion problem across the state.

3 Project Description The Enhanced Kentucky All Schedule Prescription Electronic Reporting system (ekasper) provides a dynamic Web-based tool to help health care providers, law enforcement, and regulatory officials in the fight against prescription drug abuse and diversion in Kentucky. ekasper tracks Schedule II - V controlled substance prescriptions written and dispensed within the state and is used by health care providers to help identify patients who may be at risk for prescription drug abuse. ekasper is the heart of Kentucky s Prescription Monitoring Program (PMP) and has been recognized at both the state and federal level as a leading edge tool to assist health care and law enforcement in the fight against prescription drug abuse and diversion. Abuse and diversion of controlled pharmaceutical substances has reached alarming levels. The number of individuals abusing controlled pharmaceutical substances now exceeds the total number of individuals abusing cocaine, heroin, hallucinogens, and inhalants combined. The problem is reflected in the increasing number of individuals who are doctor shopping or obtaining controlled pharmaceutical substances through deception, and in the increased level of diversion of these substances. Diversion investigations have progressed from individual abusers or addicts to small enterprises involving multiple individuals. Although the original fax-based KASPER application had an immediate impact on the ability to monitor and control drug diversion (the average age of doctor shopper cases under internal investigation dropped from 156 to 19 days in 1999), the manually intense system of paper requests and faxed responses, the small number of staff members, and unanticipated demand for reports made it difficult to provide timely reports to requestors to maximize the efficiency of their processes. In 2001 requestors began experiencing delays in receiving reports. The Drug Enforcement and Professional Practices Branch (DEPPB) staff became backlogged with paper requests for reports to the point where the investigators were logging requests and faxing reports rather than analyzing data and conducting investigations of drug diversion. By June 2004, the investigative staff was approximately six months behind in processing many report requests. Many health care practitioners were no longer requesting reports due to the processing delays. It was clear that DEPPB needed to drastically improve this manual system to include a Web-based application that allowed real time access to the controlled substances prescriptions for the end user, but also offered a centralized database to house the information for future data analysis. Since implementation ekasper has replaced numerous manual business processes and offered the ability for extensive data analysis on controlled substance prescriptions use across the state. ekasper was launched March 15, Utilizing the latest technologies to provide efficiency and ease of use, ekasper has become the leading Prescription Monitoring Program (PMP) in the United States. An ekasper patient report shows all controlled substance prescriptions an individual has had for a specified time period, as well as the practitioner who prescribed them and the dispenser who dispensed them. Law enforcement and regulatory agency users can request an ekasper provider report that shows the provider s controlled substance prescribing history over a specified time period. Querying and indexing capabilities allow users to query 25 million records to create the report within seconds. ekasper allows over 2,300 users to access the system from any PC with Internet access, 24 hours a day 7 days per week. User access is authenticated using a security model within a specialized Cabinet security server. Once authenticated, the user may access the Report Request Web page residing on the application server. The application server constructs a SQL query to the Oracle database server and Crystal Report Application Server (RAS) to create Dynamic Portable Document Format (PDF) reports that are stored within the application database. The application server processes the status of the report and transmits an notification that the report is ready for the user. The ekasper architecture is stable and highly scalable as demand for the application increases. The front-end is developed in VB.NET with an Oracle back-end database. The servers are Dell servers running MS Windows 2003 Server Edition. ekasper incorporates a DataFlux application component to perform two valuable functions. First, it applies stringent business rules to ensure data

4 received is cleansed as much as possible before being loaded into the database. Second, it standardizes the data to improve data efficiency and querying speed. Development of data matching algorithms utilizing the DataFlux software has decreased the manual effort required by the DEPPB staff to verify that the records included in the reports match the patient identified in the request, allowing ekasper to auto match over 90 percent of the reports requested via the Web. Interfaces have been implemented to assist in the user authorization process. An interface to the Kentucky Board of Medical Licensure (KBML) is used to validate the applicant s DEA license number (when appropriate), and an interface to the Kentucky Department of Transportation is used to validate the applicant s driver s license number. The development team is now working closely with focus groups from law enforcement and the Kentucky licensure boards to incorporate ESRI s Geographic Information System (GIS) software with ekasper to analyze controlled substance prescription data, including data for specific drug categories. Through extensive data mining and analysis we have demonstrated the ability to track controlled substance usage patterns, identify areas of significant usage increases and decreases, and to develop predictive geographic models to assist law enforcement and licensure boards to identify potential controlled substance usage hot spots where they may need to focus their investigative resources. In addition, we are now working on directional analysis to show geographic movement of hot spots over time. The data analysis component of ekasper represents one of the most advanced Prescription Monitoring Program analysis capabilities in the United States. Significance to State Government ekasper has been recognized at both the state and federal levels as one of the most sophisticated and comprehensive tools available in the fight against prescription drug abuse and diversion. ekasper authorized users include: Prescribers for medical treatment, and dispensers for pharmaceutical treatment for a current patient, Law enforcement officers for a bona fide drug related investigation, Licensure boards for an investigation of a licensee, Medicaid for utilization review on a recipient, Grand jury by subpoena, Court order by a judge of competent jurisdiction, and Judges administering a drug diversion or probation program. Since the launch of ekasper in March 2005, over 2,300 health care professionals and law enforcement officials have become authorized users of the Web-based system, requesting approximately 1,000 reports per day. The number of ekasper reports produced increased 52 percent from 2004 to Since ekasper s inception in March 2005, over 275,000 reports have been requested. Much of this increase is attributable to the ease of use and more timely report availability through ekasper, especially for pharmacists and Emergency Room physicians, who could not wait for a paper report to be faxed to them under the original application. With ekasper they can obtain a report while the patient is in their presence, typically in 15 seconds or less. Increasing usage of ekasper has not only allowed DEPPB staff members to focus more of their attention on investigative activities rather than report generation, but has also provided DEPPB staff with time to help identify and guide development of enhancements to ekasper. A major enhancement is the use of the GIS software to develop over 40 trend maps based on patient s zip code starting out with the Average Number of Prescriptions Dispensed for to more advanced trend maps detailing directional distributional analysis, demonstrating the movement of prescription drug use across the state. The maps provide significant detail of the use of controlled substances prescriptions such as Hydrocodone, Oxycodone, Methadone, Morphine, Valium, and Xanax across the state. The ultimate goal is to compare the maps of the patient s zip code to the maps of prescriber s zip code and create a Venn diagram detailing potential prescribers who may be diverting controlled substance prescriptions. Also of interest are dispenser maps that would detail how

5 far a patient is willing to travel to get prescriptions filled. These maps have the potential to enable law enforcement agencies such the Kentucky State Police to take a more proactive approach to controlled substance prescription drug abuse. Prior to ekasper, these agencies did not have enough staff to investigate many of the doctor shopper cases. As a result of ekasper reducing the time required to gather evidence and complete an investigation, these law enforcement agencies are able to handle a significantly higher number of drug investigations with the same staff. Benefits realized by service recipients, taxpayers, agency or state Abuse and diversion of controlled pharmaceutical substances is a critical public health and safety issue, of major concern to government, health care, regulatory, law enforcement, and judicial officials. ekasper provides a valuable tool to help identify potential problems with controlled substance prescription drug abuse and diversion, and intervene with a patient, or take legal action against a diverter as appropriate. In order to most effectively utilize ekasper, the Cabinet for Health and Family Services (CHFS) assembled interdisciplinary focus groups comprised of law enforcement and health care professionals. These focus groups met to discuss a broad range of issues related to the abuse and diversion of controlled pharmaceutical substances and utilization of the ekasper system. From those groups, representatives from law enforcement and professional licensure organizations participated in working groups to discuss investigative issues as well as technical and trend reporting issues. Representatives from the health care community participated in working groups to discuss education and intervention issues for health care professionals. Recommendations developed by these working groups impacted five distinct communities: 1. Professional licensure boards, 2. Health care providers, 3. Law enforcement, 4. Cabinet for Health and Family Services, and 5. General public. Implementation of many of the recommendations from these focus groups has been completed, while others are planned for further investigation and/or future implementation. These focus groups provide an important source of guidance and recommendations from ekasper stakeholders regarding education about the system and its usage, recommended enhancements, and improvements to the system, future data analysis, and direction for the Prescription Monitoring Program. While it is difficult to provide measures of tangible cost benefits to agencies based upon utilization of ekasper, there have been several efforts among CHFS and these agencies that are producing significant benefits. The Kentucky Board of Medical Licensure utilizes DEPPB staff and their expertise with ekasper to conduct investigations of physicians that are under suspicion of questionable prescribing practices or potential drug diversion, providing significant cost savings to the board compared to the cost of hiring staff to conduct their investigations. These law enforcement agencies have confirmed the potential areas of increasing drug usage identified in the trend maps, and are working on processes to determine how the trend maps can be utilized to assist law enforcement with identifying drug usage trends and geographic areas where they need to focus additional investigative resources. The ability to focus investigative resources in these geographic problem areas will allow for increased utilization and efficiency of law enforcement officers, reducing costs to these agencies.

6 Health care providers now have an additional tool to help them understand the warning signs of prescription drug abuse and how they can obtain help for themselves or a loved one who may be abusing prescription drugs. Feedback from health care professionals using ekasper has confirmed that the system provides them an extremely valuable resource in improving their patient care. The Kentucky Medicaid program is able to utilize ekasper reports to identify and investigate potential instances of Medicaid prescription drug abuse and fraud, reducing the cost to the Medicaid program of this type of fraud, and allowing more Medicaid funds to reach those truly in need of assistance. In addition, ekasper data analysis provides CHFS the information for accurate decision making for the development of policies as it relates to controlled substance use across the state. Through its advanced reporting capabilities and data analysis, ekasper has gained a reputation as one of the leading Prescription Monitoring Program systems in the country, and recognition within Kentucky as an indispensable tool in the fight against prescription drug abuse and diversion. Realized return on investment, short-term/long-term payback In 2003 the Kentucky legislature appropriated $1.4 million to develop the Web-based ekasper system, to provide users with real time access to the controlled pharmaceutical substance data. Requirements gathering for ekasper began in 2003 and the system went live in March As a result of ekasper, DEPPB operating expenses decreased from over $1 million to $350,000 annually based upon reduced staffing requirements and operational cost savings resulting from reduced telecommunications, paper and supply costs. Annual operating costs for ekasper are incurred by the Office of Information Technology and are estimated to be $460,000, broken down as follows: Staffing* $225,000 Software 70,000 Server maintenance 8,000 Data collection (vendor) 150,000 Fax/telecomm. charges 7,000 Total $460,000 * Staffing costs include: Project Manager (part time), Business Analyst, Developer, DBA (part time) and Help Desk personnel. The resulting estimated annual net cost savings from ekasper is: Savings realized in DEPPB $650,000 Ongoing system operating expense -460,000 Net annual estimated cost savings $190,000 The long term payback of development costs will be realized in approximately 7 years and 4 months from the system launch date. The estimated annual return on investment is 13.5 percent. The estimated cost savings detailed above represents the savings realized by the Cabinet for Health and Family Services only. Actual and potential cost savings to other users of ekasper are not reported to the Cabinet or factored into this analysis. These potential savings include the following: Reduced fax and paper costs for obtaining reports, Time savings based upon Web access to reports,

7 Savings to state and local agencies by allowing health care providers to proactively address prescription drug misuse and abuse before it becomes a diversion and requiring law enforcement attention, and Savings to law enforcement agencies through increased efficiency in their investigations. Of course, the most significant return on investment is the positive impact to the citizens of Kentucky by proactively fighting prescription drug abuse and illegal sale of prescription drugs that all too often ruins lives and result in tragic endings. Marketing and public awareness strategies CHFS utilizes Federal Hal Rogers Prescription Monitoring Program grants to increase public awareness of ekasper. A team comprised of members of the development team, DEPPB staff and the grant administrator have developed a portfolio of program materials to assist with education, training, and awareness activities for ekasper, with the objective of increasing the number of authorized users and enhancing the ability of current users to understand and utilize the system s capabilities. By focusing on increasing ekasper usage, more data is collected to improve future data analysis and mining capabilities of the prescription information and to also determine if efforts to decrease use are working. The team developed an exhibit used at meetings, conferences, and trade shows to disseminate ekasper information to potential users and other interested groups. Pens with the ekasper access request Web site are available along with a set of brochures designed to provide ekasper information for attorneys, health care providers, the public, and law enforcement. The DEPPB Web site will display 14 of the trend maps to increase public awareness of the problems with controlled substance use across Kentucky. In addition, the team authors ekasper articles for professional association newsletters and journals. The team also conducts ekasper presentations and training sessions for health care, law enforcement, and public interest organizations that are customized for the specific audience. The team works to constantly review and update the presentations to ensure the information is current and relevant. The team participates in or conducts over 30 conferences and training sessions each year. Because of the interest shown in ekasper by other states, and the number of states that have requested site visits to review and discuss how Kentucky has implemented ekasper, we have developed a standard information packet for visiting representatives from other states that includes system specification information for their legislative and technical personnel. Other ekasper training sessions address the scope of the problem with controlled substances, provider shopping, and drug intervention in Kentucky.