Due to varying state requirements and laws, integration approaches can differ, even from the same vendor. These requirements are in support of and for the enforcement of the intended uses of the data, which are generally far more specific than other healthcare data privacy rules such as Health Insurance Portability and Accountability Act (HIPAA).
In a few states, the raw data itself is allowed to flow into the electronic health record system. In other states, the data itself is not allowed to flow into the system but the system can store a “view” of the report, such as a PDF. And in other states, systems are only allowed to display the report view, which then disappears. Each scenario has its advantages, but all three are significant improvements over the portal experience.
Additionally, in most situations and unlike the portal, delegates are not allowed access to integrated PDMP reports. This limitation leads to enhanced security, and because the process of accessing and viewing the report is so efficient, delegates are not necessary.
Nationwide, there are several options available for integration of PDMP reports into EHRs. The details of these options vary, and the availability of each option in each state varies as well.
National Association of Boards of Pharmacy/Appriss Health (PMP Gateway)
As referenced above, PMP InterConnect is a national data-sharing hub that connects 49 of the 54 PDMPs to enable the flow of multistate data to clinicians. PMP Gateway is the integration technology and service for InterConnect, enabling the flow of multistate PDMP reports into EHRs and pharmacy systems.
PMP Gateway is natively integrated into over 100 EHRs and almost every major pharmacy system, letting health systems and physician practices enable the integration with minimal effort. As of early 2019, it was approved for use, and in use, in 38 states, and 14 states fully fund it for every prescriber in the state. Across those 38 states, it is used by 300,000 clinicians and delivers almost 25 million PDMP reports into clinical workflow per month.
Operationally, PMP Gateway automatically launches a multistate patient PDMP request upon an event predetermined by the health system or practice, such as upon patient registration or upon chart opening. The report is retrieved and available for viewing, very rapidly appearing when a “View Report” button is pressed. The report is presented in html format, enabling Appriss to automatically ensure that the integration is fully compliant with the individual laws of each state whose data is presented. This ensures that multistate data is never inhibited by an implementation that may violate some states’ requirements. Additionally, using this methodology, Appriss can update the reports as state requirements change so no configuration change is required on the part of the health system or EHR vendor.
Additionally, PMP Gateway can integrate the Appriss NarxCare substance use disorder platform, which is the default integration in some states and optional in others. NarxCare features predictive analytics, visualizations and clinical tools to equip health systems with greater capabilities and more fully integrate with an opioid stewardship strategy. The predictive analytics and visualizations enable clinicians to more quickly evaluate risk, and the clinical tools enable clinicians to more effectively intervene with patients. Additionally, the scores are returned to the EHR as discrete data elements, and most health systems choose to include them directly in the patient’s chart. This enables clinicians to view the scores for every patient and creates awareness for which patients they want to view the full PDMP report.
Most states allow PDMP integration within the EHR, and most EHRs support this integration. Each state determines not only how the PDMP will be established, but also the methodology for how EHRs will integrate with it. There are significant differences between the states on their approach. The first step in the operationalization of PDMP integration with the EHR is to understand how your state has chosen to support this integration.
Making PDMP information available within the EHR is usually accomplished with a National Council for Prescription Drug Programs (NCPDP) interface, or via Single Sign On to a web portal, or both. Again, state regulations will determine which method(s) are supported. Using an NCPDP interface is often advantageous because such technology allows the EHR to consume PDMP data discretely. Such integration allows the EHR to provide decision support and risk scoring. Additionally, if the state allows, the NCPDP query of PDMP can be performed automatically and prospectively, so that the data is readily available for clinician reviewing. Using the Single Sign On (SSO) approach is self-explanatory. The user will click a button in the workflow, and the SSO integration will send user credentials and patient lookup information from the EHR to the web portal that is providing access to PDMP data, which is then opened often as a window within the EHR. While this SSO method is still much more efficient than no integration, the PDMP data is not brought into the EHR discretely, reducing the EHR’s ability to provide decision support with the information.
Sometimes the state will develop and maintain its own PDMP database, but this is rare. Kentucky is an example of this approach. The more common approach is the state will select a PDMP vendor to assist them in managing the integration of the PDMP with EHRs. PDMP vendors include Appriss, NIC and LogiCoy. Appriss, mentioned previously, is by far the most commonly used vendor, currently working with the majority of states. LogiCoy is the PDMP vendor for Illinois, and NIC has worked with Wisconsin and Chesapeake Regional Information System for our Patients (CRISP), a health information exchange serving Maryland, Washington, D.C., and West Virginia.
Interstate sharing of data between each state PDMP database is usually accomplished through one of two mechanisms: PMP Interconnect and/or RxCheck. PMP Interconnect is owned by the National Association of Boards of Pharmacy, and Appriss is their technology solution provider. Appriss offers an API to PMP Interconnect called PMP Gateway. Over 45 states share data via PMP interconnect. In order to participate, the state must sign a memorandum of understanding (MOU) that ensures compliance with multistate requirements but also prevents healthcare systems from consuming data discretely into their EHR. The other interstate sharing solution is RxCheck.
RxCheck is funded by grant funds to provide a no-cost solution to participating states and was developed by the U.S. Bureau of Justice Assistance.
Pros of PMP Gateway
- Delivers multistate data from 49 PDMPs (as of this writing New York was not integrated)
- Proven solution in use by 300,000 clinicians, delivering 25 million reports per month
- Natively integrated with over 100 EHR systems, providing for easy activation by health systems and practices
- Account management and 24/7 customer support included
- Automatically configures and enforces all state rules and regulations, assuring health systems that they remain in compliance
- Automatically captures PDMP access audit trail, providing evidence of compliance with mandatory use laws
- Fully compliant with all mandatory use laws
- Vetted by 38 states and independent auditors for security, privacy and HIPAA compliance
- Accommodates for continuous changes in state PDMP laws, statutes and policy enabling a consistent integration approach on an enterprise level. A consistent approach is enabled in the 38 states in which it is live, and Appriss manages all state-required changes on the back end, preventing health systems or vendors from having to make configuration changes as state requirements change.
Cons of PMP Gateway
- Does not deliver raw data into EHR systems in order to ensure compliance with multistate data requirements
- 14 states fully fund the PMP Gateway solution, providing it at no ongoing cost to every prescriber in the state. Depending on the EHR vendor, the vendor may charge a nominal setup fee to establish the connection.
- In states that don’t fund the solution, EHR vendors/Appriss may charge a fee per prescriber per year for access to the system. Pricing may vary depending on the vendor and whether the health system elects to receive a “basic” PDMP report or the NarxCare solution. Volume pricing is usually available for large numbers of prescribers.
Contact your EHR vendor for specific pricing information.