The Wisconsin Prescription Drug Monitoring Program
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1 The Wisconsin Prescription Drug Monitoring Program DHS 2018 WI Opioid Forum April 12, 2018 Learning Objectives 1. How the WI epdmp supports healthcare professionals in making informed prescribing, dispensing and treatment decisions 2. How the WI epdmp can be used as a self assessment tool for prescribers 3. Using the WI epdmp Public Statistic Dashboard 1
2 PDMP Overview WI PDMP Timeline January 2013 WI PDMP operational April 2017 WI epdmp operational changes October 2017 WI epdmp Public Statistics Dashboard launched October 2013 WI PDMP joins PMP InterConnect January 2017 WI epdmp launched January 2018 Continued WI epdmp enhancement 5 What is a PDMP? Pharmacies and other dispensers of monitored prescription drugs submit data Data is added to a statewide database 1)Authorized users access PDMP data to verify prescription information 2
3 Authorized Users WI epdmp Clinical Decision Support Prescribing Practice Assessment Investigations 1)Public Health Analysis Prescribers Delegates Pharmacists Delegates Registered Nurses Individuals who treat substance abuse Prescribers Medical Coordinators Law Enforcement Employees Government Employees Medical Examiners Researchers (de identified) Public Statistics Individuals Who Treat Substance Abuse DSPS License types Clinical Substance Abuse Counselor 132 Substance Abuse Counselor 131 Substance Abuse Counselor In Training 130 DSPS License with specialty designation Advanced Practice Social Worker 121 Independent Social Worker 122 Licensed Clinical Social Worker 123 Licensed Marriage and Family Therapist 124 Licensed Professional Counselor 125 Marriage and Family Therapist Training License 228 Professional Counselor Training License 226 Social Worker 120 PDMPs Across the Nation National 49 states have PDMP Varying levels of use requirement and allowable access Wisconsin First established in 2013 Wis. Stat WI epdmp connected to PDMPs in 15 other states including MN, IL, MI and IN Nationally recognized PDMP 3
4 Wisconsin s PDMP Department of Safety and Professional Services Credentialing and Licensing Controlled Substance Board Related Boards: Medical Examining Board, Pharmacy Board, Board of Nursing, Optometry, Podiatry Division of Legal Services and Compliance WI epdmp Enhanced system launched January 2017 Over 2,000 dispenser submitters Over 46,000 healthcare users Data for controlled substances in schedule II V dispensed in Wisconsin Over 9 million records submitted each year WI epdmp Components Clinical Healthcare Tool Patient Prescription Histories Prescribing, Treatment, Dispensing Decision Support Interdisciplinary Communication Tool Law Enforcement Alerts Law Enforcement Investigations Prescribing Practice Assessment Tool Prescriber Metrics Report Medical Coordinator Access Public Health Tool Interactive Statistics Dashboard Dispensing Data Trends (State and County Level) H.O.P.E. Agenda Legislation 2015 Act 266 Effective April 2017 Dispensers required to submit to the PDMP by the end of the next business day (previously 7 days) Prescribers required to review PDMP prior to prescribing a monitored prescription drug Medical Coordinator access to PDMP Law enforcement and prosecutorial units allowed to request PDMP data without a court order 4
5 Exceptions To Review Requirement Patient is receiving hospice care Prescription order is for 3 days or less and is not subject to refill Drug is lawfully administered to the patient Emergency situation PDMP system is down or other tech failure Healthcare Users Daily Patient Queries December 2016: 4,800 queries/day August 28, 2017: 32,855 queries Monthly Patient Queries January 2017: 101,000 queries January 2018: 640,200 queries Healthcare Decision Support 5
6 Enhanced Patient Report Patient History Report WI epdmp Alerts Data Driven Alerts Multiple Prescribers or Pharmacies High Current Daily Dose of Opioids Concurrent Benzodiazepine and Opioid Long Term Opioid Therapy with Multiple Prescribers Multiple Same Day Prescriptions Early Refill Law Enforcement Alerts Suspected Violation of Controlled Substance Act Suspected Narcotic Related Death Suspected Opioid Related Overdose (Non Fatal) Report of Stolen Controlled Substance Prescription Prescriber Led Alerts Treatment Agreement Violation of Treatment Agreement Overdose Event 6
7 WI epdmp uses sophisticated data analytics to assess a patient's controlled substance prescription history Data Driven Alerts 1. Multiple Prescribers or Pharmacies 5 or more in the last 90 days 2. High Current Daily Dose of Opioids Exceeds 90 morphine milligram equivalent (MME) 3. Concurrent Benzodiazepine and Opioid Active prescriptions for both drugs 4. Long Term Opioid Therapy with Multiple Prescribers 1 opioid or more from 2 or more prescribers for more than 90 days 5. Multiple Same Day Prescriptions Same controlled substance drug from multiple prescribers or pharmacies on the same day 6. Early Refill Filled 2 or more days earlier than expected Law Enforcement Alerts Alert Detail 1. Name 2. Date of Birth 3. Type of Event (dropdown) 4. Date of Event 5. Additional Detail 6. Prescription Detail (if available) Communication of Law Enforcement Alerts Notice: Prescriber(s) Alert Icon: Prescriber(s) Alert Banner: Patient History Alert Detail: Patient History 7
8 Healthcare User View Law Enforcement Alerts Prescriber Led Alerts Prescriber Led Alerts Treatment Agreement Violation of Treatment Agreement Overdose Event Prescriber Led Alerts 8
9 WI epdmp Patient Report Patient History Report Direct EHR Integration 9
10 Patients Panel Prescribing Practice Assessment Prescriber Metrics Report 10
11 Prescriber Metrics Report Created pursuant to 2015 Wisconsin Act 266 Medical Coordinator Role Non patient identifiable information to a person who: Medically coordinates, directs, or supervises a practitioner Establishes standard operating procedures for a practitioner Evaluates the job performance of a practitioner Performs quality assessment and improvement activities, including outcomes evaluation or developing clinical guidelines Law Enforcement Access 11
12 Law Enforcement PDMP Access Prior to April 2017 Law enforcement agencies and prosecutorial units could only obtain PDMP data with a court order April 1, Act 266 became effective Removed requirement for court order Attestation document required for each request: PDMP data requested is reasonably related to an active and specific investigation or prosecution or monitoring patient as part of a drug court Law Enforcement PDMP Access Patient Report Access Released after review and approval by DSPS staff (2 3 business days) Records about schedule II V controlled substance prescriptions dispensed in Wisconsin Information should correspond to original records kept by prescribers and dispensers Potentially useful information to help guide investigations of drug diversion or overdose Not evidence and should not be used in isolation to make any determinations about a patient, prescriber, or dispenser Types Of Reports Individual/Patient Name (alias) Date of Birth Household Address Prescriber DEA Number 12
13 Law Enforcement Attestation Required Documentation for Each Request Agency Letterhead (Signed,.pdf) Name, DOB of subject, or Household address, or Name, DEA# of prescriber Date range for PDMP data requested Explanation of how the information requested is reasonably related to an active and specific investigation, citations of violations being investigated, case number Specific justification required for household WI PDMP Statistics WI epdmp Statistics Dashboard 13
14 Statewide Dispensing Trends Data Driven Alerts ,000 40,000 35,000 30,000 25,000 Decrease Alert Type Q1 to Q4 High Opioid Daily Dose 22% Concurrent Benzodiazepine and Opioid 16% Long Term Opioid Therapy 19% Multiple Prescribers Or Pharmacies 24% Early Refill 17% Multiple Same Day Prescriptions 50% 20,000 15,000 10,000 5,000 High Opioid Daily Concurrent Long Term Opioid Multiple Prescribers Dose Benzodiazepine and Therapy Or Pharmacies Opioid Early Refill Multiple Same Day Prescriptions Q1 Q2 Q3 Q4 Questions 14
15 For More Information Andrea Magermans Managing Director Sarah Bradley Deputy Director Website: 15
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