Overall strategy responding to the opioid crisis (in addition to PDMP integration)
MEDITECH is committed to providing our customers – all of whom are healthcare organizations – with tools that support their efforts in reducing opioid-related harm. With this vision in mind, MEDITECH has launched an Opioid Stewardship Toolkit, providing both evidence-based and experience-based tools and optimal workflows which align with the 12 CDC recommendations for prescribing opioids as it pertains to chronic pain management. These tools, along with optimal workflow recommendations include:
- In-workflow access to Prescription Drug Monitoring Programs
- Collaborative solution for Electronic Prescribing of Controlled Substances
- Embedded opioid risk tool
- Chart review tools for longitudinal tracking
- Streamlined order sets to guide appropriate therapies
- Templates for tracking the patient’s opioid use and outcomes in the physician’s note
- Patient registries to identify patients and monitor compliance
- Patient education provided in departure packet and accessible via patient portal
- Opioid treatment agreements accessible via patient portal
- Outcomes monitoring (including opioid prescribing patterns) available in MEDITECH’s Business and Clinical Analytics solution
Overall approach to PDMP integration
Point to point, hub and spoke
MEDITECH is addressing physician concern over laborious reporting of controlled substances by integrating direct, one-tap access to the Prescription Drug Monitoring Program (PDMP), directly within MEDITECH Expanse. Leveraging our relationship with DrFirst for PDMP integration, MEDITECH created an integrated PDMP link, accessible to prescribers throughout their EHR navigation to provide on-demand access to a patient’s-controlled substance history.
Where in workflow? EPCS, Other – for example: all encounters vs EPCS only
Providers using MEDITECH and DrFirst are able to immediately access a patient’s PDMP report throughout their chart review and e-Prescribing workflow. MEDITECH has created an integrated PDMP link, available in the chart and patient reference region of MEDITECH Expanse. Providing multiple access points, such as in the reference region, allows prescribers the ability to access the PDMP wherever the prescriber navigates within the patient’s chart. The PDMP link can be accessed from the patient’s chart whether on an active visit or not. Prescribers have expanded views of a patient’s-controlled substance history with a multiple-state PDMP view as allowed by cooperating states, within the EHR prior to transmitting prescriptions. The immediate access removes the need to link separately to multiple PDMP’s and is crucial for improving workflow and clinical decision making, and safely managing patient drug use.
Plans and progress in interoperability with state PDMP’s
State-specific successes and challenges
- The goal of MEDITECH and DrFirst’s PDMP collaboration is to provide a PDMP solution for all states, regardless of data source, regardless of the changing regulatory landscape, with the same seamless interface for the user. To accomplish this, DrFirst has created a data source-agnostic platform that is seamlessly integrated into MEDITECH Expanse. MEDITECH and DrFirst currently have available integration with 35 states and growing, to obtain PDMP data from both Appriss and non-Appriss data sources. Recent connectivity to California CURES 2.0 PDMP represents a key success as this was a new program run specifically by the state with a new infrastructure.
- The constantly changing PDMP landscape involving differing requirements, formats, and jurisdictions remains the most difficult challenge to overcome. DrFirst maintains an assertive regulatory outreach program and development process with the ultimate goal of nation-wide PDMP data coverage.
Interoperability with Appriss.
Formal agreement? Describe. NarxCare resale?
- DrFirst has a long-standing and valued relationship with Appriss and provides data from all of their supported states to MEDITECH Expanse. DrFirst continues to work closely with Appriss to expand the availability of data and to refine the registration and provisioning processes necessary to connect clinical users nationwide. DrFirst is in the late stages of securing an agreement to provide NarxCare and expect to have it available shortly.
Alternate risk model and analytics availability? Describe.
Native development and/or 3rd party eg PastRx
- Utilizing PDMP data to perform analytics and provide clinical decision support would be of high value. At this time, states which provide discrete PDMP medication data and allow long-term storage and analytics to be performed on that data are extremely limited. MEDITECH and DrFirst continue to weigh in and provide input on the changing regulatory landscape in order to support such valuable tools in the future.
Direct link to PDMP? Describe.
- Our MEDITECH/DrFirst connection to Appriss supports the ability to receive an HTML report pre-formatted by Appriss which is presented for display within MEDITECH Expanse.
Data import from PDMP? Describe.
- Our MEDITECH/DrFirst connection to non-Appriss states such as California, Illinois, and Maryland support the ability to receive discrete PDMP medication data. We request and display the data upon demand within the prescriber workflow, but do not store it long-term in MEDITECH Expanse due to state requirements.
Interoperability with alternate PDMP solutions
- As stated above, MEDITECH and DrFirst’s goal is to provide a PDMP solution that is supplier-agnostic, easy-to-access, and seamlessly integrated. DrFirst has designed their solution to scale and adapt as state, federal, and other initiatives continue to evolve. Their multi-data source architecture already accommodates state data sources that do not work with Appriss. DrFirst maintains custom integrations to state platforms and will continue to support and grow these as the market dictates.
Custom integration with state portal(s)
- DrFirst has direct, state-specific connections in California and Maryland and is actively working with other states. These PDMP connections are therefore accessible in MEDITECH Expanse.
RxCheck/PDMP Assist –
- MEDITECH and DrFirst are interested in connecting to additional data sources in pursuit of our goal to obtain nationwide coverage, but no official agreements to report at this time.
- Logicoy –
MEDITECH via DrFirst is connected to Logicoy in Illinois.
- HIE as link to Appriss or others.
MEDITECH has been speaking to Collective Medical about their ED notifications which incorporate state PDMP data.
Client case studies – include 2-3 representative client examples
We will note 3 key client examples here:
- The first MEDITECH customer to go live with in-workflow, one-click PDMP integration was War Memorial Hospital in Sault Ste Marie, Michigan, in June 2018. Prescribers at War Memorial are accessing PDMP data from both ambulatory and acute care settings.
See published success story: https://blog.meditech.com/integrated-prescription-drug-monitoring-supports-smarter-opioid-prescribing
- The first MEDITECH Expanse customer to go live with the Illinois PDMP (which uses Logicoy) was Swedish Covenant Hospital in Chicago, Illinois.
- Salinas Valley Memorial Hospital (in Salinas Valley, California) is currently testing the new connection to CURES 2.0 in California. Dr. Kasting from Salinas Valley was a major proponent of this initiative and is actively involved in testing.
See published article:
All of our physician users have noted a significant time savings when accessing PDMP data from within their workflow in MEDITECH Expanse as opposed to logging into and searching the state PDMP web sites manually. We are working with our clients to collect metrics to further validate.
Optional: Economic model in provision of these services to the provider client
- MEDITECH does not charge for PDMP integration. DrFirst fees vary from state to state as the state data charges vary.