By Deborah Borfitz  

March 6, 2019 | Nearly all states require physicians to access a prescription drug monitoring program (PDMP) before writing prescriptions for controlled substances to help red-flag opioid “doctor shopping” by patients. But some doctors prefer to trust their gut, or simply can’t find the time. “The level of effort required to consult a PDMP registry is very high, almost prohibitive for physicians,” says G. Cameron Deemer, president of e-prescribing software provider DrFirst.

Physicians typically must drop out of their electronic health record (EHR) to log into the PDMP database to enter a patient’s demographic information, after presenting two-factor authentication, and then drop back into the EHR to manually enter in relevant information. “The whole thing is just a nightmare from a workflow perspective,” says Deemer.

It’s also the leading cause of noncompliance with state PDMP laws.

Deemer says DrFirst’s integrated solution with the MEDITECH Enterprise Health Record, seamlessly connecting prescribers to their state’s PDMP registry, effectively removes that barrier. Registry information “just appears” whenever they’re writing an e-prescription for a controlled substance.

California is the latest state where the integrated technology is available, and Salinas Valley Memorial Health System was the first to start using it last week, Deemer says. The PDMP in California is known as Controlled Substance Utilization Review and Evaluation System (aka CURES 2.0) and, as of last October, healthcare practitioners authorized to prescribe, order, administer, or furnish a controlled substance were required to consult it. In 2016, over 2,000 people died from opioid-related overdoses in California and more than 42,000 nationwide.

DrFirst and MEDITECH offer similar integrations with PDMPs in about 40 other states across the country, Deemer notes. At least half of the 30,000 doctors registered to use DrFirst’s controlled substance technology are already accessing a PDMP via their EHR. Other vendor partners of DrFirst—the company works with about 300 different ambulatory and acute care electronic medical record systems—are expected to follow MEDITECH’s lead, he adds.

“Once physicians become exposed to this, it’s like night and day for them,” says Deemer.  Accessing a PDMP registry becomes “part of their standard practice, like checking medication history.”

Hospitals like that the software provides physician-centric workflow for clinically appropriate care while addressing patients’ legitimate pain relief needs, says Deemer. The opioid epidemic crisis has started to become “a crisis of access to pain alleviation for patients,” with many physicians opting to stop prescribing controlled substances entirely. At his last primary care visit, Deemer was informed of the new policies instituted at the practice, including a $15 charge every time a doctor prescribed a controlled substance—to cover the unreimbursed cost of time spent checking Arizona’s PDMP. It was a bit much, considering he had only gone in for a physical, he says.

Within the next year, DrFirst hopes to produce the first hard evidence that PDMP checking correlates with improved patient outcomes, says Deemer. That’s likely what it will take to spur widespread physician adoption and put an end to displeasing workarounds.