HEALTH INFORMATION TECHNOLOGY: A POWERFUL TOOL IN ATTACKING THE OPIOID CRISIS PAUL L. UHRIG CHIEF ADMINISTRATIVE, LEGAL & PRIVACY OFFICER Copyright 2018 2017 by by Surescripts, LLC. All All rights reserved.
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ELECTRONIC PRESCRIBING OF CONTROLLED SUBSTANCES (EPCS) Proven One efficient Technology workflow and for Risk all prescriptions Analysis Reduced fraud and abuse Secure electronic records Improved safety and patient care Permitted by DEA since 2010 & states by 2015 Annualized Cost Savings Potential of $700 Million Reduced pharmacy/prescriber phone callbacks Reduced need to store paper prescriptions Economic Impact Analysis of the Interim Final Electronic Prescription Rule DEA, U.S. Department of Justice, March 2010 3 Copyright Copyright 2018 2017 by Surescripts, by Surescripts, LLC. LLC. All rights All rights reserved. reserved.
73% OF MEDICATIONS ARE E-PRESCRIBED, BUT WE HAVE OPPORTUNITIES TO IMPROVE. NATIONAL +82% OF NON-CONTROLLED SUBSTANCES ARE E-PRESCRIBED. NATIONAL 19% OF CONTROLLED SUBSTANCES ARE E-PRESCRIBED. 4 Copyright 2018 2017 by by Surescripts, LLC. All All rights reserved.
EPCS TODAY 100.0% 90.0% E-Prescribing Enablement Status as of Feb 2018 97.1% 97.8% 95.5% 92.4% 94.4% 95.0% 91.0% 80.0% 70.0% 70.5% 66.0% 75.7% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 23.6% 14.6% 0.0% National Ohio New York % Active E-Prescribers % EPCS Enabled Prescribers % erx Enabled Pharmacies % EPCS Enabled Pharmacies 5 Copyright Copyright 2018 2017 by Surescripts, by Surescripts, LLC. LLC. All rights All rights reserved. reserved.
6 Copyright 2018 2017 by by Surescripts, LLC. All All rights reserved.
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Optimizing Patients' Health by Improving the Quality of Medication Use PQA Patient Safety Measures for Inappropriate Prescription Opioid Use Norris Turner, PharmD, PhD Vice President, Strategic Alliances and Measure Implementation Pharmacy Quality Alliance
Who is the Pharmacy Quality Alliance? Mission Statement: Improve the quality of medication management and use across health care settings with the goal of improving patients health through a collaborative process to develop and implement performance measures and recognize examples of exceptional pharmacy quality. Created in 2006 as a public-private partnership Multi-Stakeholder, Member-Based, Non-Profit Transparent & Consensus Based Process Nationwide Measure Developer 9 Pharmacy Quality Alliance
Rationale for PQA Opioid Prescribing Measures Nearly half of US opioid overdose deaths involve prescription opioids 1. CDC. Wide-ranging online data for epidemiologic research (WONDER); 2016. Available at http://wonder.cdc.gov. 2. Rudd RA, et al. MMWR Morb Mortal Wkly Rep. epub: 16 December 2016. DOI: http://dx.doi.org/10.15585/mmwr.mm6550e1 10 Pharmacy Quality Alliance
Rationale for Opioid Prescribing Measures (cont.) Nearly 1 of 4 people who receive long-term prescription opioids for noncancer pain struggles with addiction 1. SAMHSA. Highlights of the 2011 Drug Abuse Warning Network (DAWN) findings on drug-related emergency department visits; 2013. Available at: http://www.samhsa.gov/data/2k13/dawn127/sr127-dawn-highlights.htm 2. Boscarino JA, et al., Addiction 2010;105:1776 82. http://dx.doi. org/10.1111/j.1360-0443.2010.03052.x Pharmacy Quality Alliance 11
PQA Opioids Measures 1. Use of Opioids at High Dosage in Persons without Cancer (NQF #2940) * 2. Use of Opioids from Multiple Providers in Persons without Cancer (NQF #2950) * 3. Use of Opioids at High Dosage and from Multiple Providers in Persons without Cancer (NQF #2951) * 4. Concurrent Use of Opioids and Benzodiazepines ** NQF = National Quality Forum * PQA-endorsed May 2015; NQF-endorsed March 2017 ** PQA-endorsed December 2016; seeking NQF endorsement in 2018 12 Pharmacy Quality Alliance
Multiple Providers Multiple prescribers or pharmacies associated with increased risk for potentially fatal overdose Risk increases with number of prescribers and pharmacies In West Virginia (2005-2007), 4 prescribers and 4 pharmacies in previous 6 months increased risk of drug-related death 3.6-fold 1 In Tennessee (2008-2011), 4 prescribers and 4 pharmacies increased risk of opioid-related overdose death 6.5- and 6.0-fold, respectively 2 1. Peirce GL, et al. Med Care. 2012;50(6):494-500. doi: 10.1097/MLR.0b013e31824ebd81. PubMed PMID: 22410408. 2. Gwira Baumblatt J et al. JAMA Intern Med 2014;174:796 801. PMID: 24589873. 13 Pharmacy Quality Alliance
Concurrent Use with Benzodiazepines Concurrent use of benzodiazepines with opioids increased overdose death risk 4-fold among US veterans (2004-09) 1 Concurrent use increased by nearly 80% (9% to 17%) among privately insured patients (2001-13) 2 Increased risk of ED visit or hospital admission for opioid overdose 2-fold Eliminating concurrent use could reduce population risk by 15% CDC guidelines: Avoid concurrent prescribing whenever possible 3 FDA added boxed warning to product labeling 4 1. Park et al. BMJ. 2015;350:h2698. doi: 10.1136/bmj.h2698. PMID: 26063215. 2. Sun et al. BMJ. 2017;356:j760. doi: 10.1136/bmj.j760. PMID: 28292769 3. CDC Guideline for Prescribing Opioids for Chronic Pain United States, 2016. Available at: https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm 4. FDA Drug Safety Communication. August 31, 2016. Available at: https://www.fda.gov/drugs/drugsafety/informationbydrugclass/ucm518110.htm 14 Pharmacy Quality Alliance
Use of PQA Opioid Measures in Medicaid Medicaid Adult Core Measure Set High Dosage (#1) added to measure set in 2016 1 Concurrent Benzodiazepines (#4) conditionally supported (pending NQF endorsement) by the Measures Application Partnership for addition 2 NQF = National Quality Forum 1. Medicaid Adult Health Care Quality Measures. Available at: https://www.medicaid.gov/medicaid/quality-of-care/performancemeasurement/adult-core-set/index.html 2. Measures Application Partnership. Medicaid Adult Draft Report for Comment. August 8, 2017. Available at http://www.qualityforum.org/map_task_forces.aspx 15 Pharmacy Quality Alliance
Conclusion There is wide variation in opioid prescribing PQA opioid measures address high-risk opioid prescribing among persons without cancer Performance measures are one tool to address the US prescription opioid crisis Use of opioid measures in performance programs will be monitored for possible unintended consequences PQA will continue to evaluate the need for potential changes or additional measures 16 Pharmacy Quality Alliance