Review of Prescription Drug Monitoring Programs in the Unite(3)

resources and thus incurs additional cost

d.The type of state agency housing the PDMP

e.Method of analyzing the data

3.Number of pharmacies reporting prescription information to the PDMP

4.Number of providers and law enforcement agencies requesting prescription

information

5.Number of staff required to ensure smooth operation of the PDMP

6.Number and type of outside contractors required to run the PDMP Transmission of Prescription Drug Monitoring Program Data

The transmission of prescription information(patient identifier,drug dispensed,date of dispensing,quantity dispensed,prescriber,and dispenser)from dispensers to the PDMP administrator is a multi-step process.Most states with active PDMPs have employed external vendors to collect prescription information from pharmacies,the primary dispensers of controlled substances.The data is verified and checked for errors then transmitted to the PDMP.Some state PDMPs have mechanisms that allow providers who dispense controlled substances infrequently to submit information via paper format,or via secure websites that allow data entry for a single dispensing transaction.

The data is checked for errors at many different levels.For example,in Kentucky when data is transmitted to the authorized vendor,it is automatically scanned for errors such as missing patient identifier or incomplete prescription information.When this process is complete,the data is automatically uploaded into the PDMP system,which again checks for errors.Only after the data has undergone this sequence of checks is it made available to registered users.

At this time,no state has implemented a program that requires real-time data transmission at the point of controlled substance dispensing.Currently,the most common time frame for data transmission is bi-weekly.The state of Oklahoma,however,is hoping to reach real-time data transmission by the year2011.

Confidentiality of Prescription Drug Monitoring Program Data

Prescription drug monitoring programs collect and house sensitive,patient-specific information that is governed under the Health Insurance Portability and Accountability Act(HIPAA).To safeguard patient information,there are numerous security measures that come into play,with checks and balances taking place at multiple levels.First of all,there is the physical security.

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The PDMP is physically in a place with limited access,where only a select few authorized personnel are allowed to enter.Hardware and software encryption,to prevent encoding of information should any breech in security occur,is also a standard feature of PDMPs.In addition,there is a rigorous registration process for authenticating users.Prior to granting access,practitioners’DEA numbers are checked and verified and their standing with the respective licensing board is investigated.After access is granted,there are other security measures in place to help protect patient information.An audit trail is created for every user that records when and where the data were accessed,the frequency of access,and for which patients.There are checks in place that“time-out”a user if the system is left idle.Some programs also deny access to users if they have not accessed the system in a specified number of days.These and many other security measures are employed to help securely maintain the database and protect patient information.

Since the inception of PDMPs in the1930’s,there have been no reports of confidentiality breeches until very recently.On April30th2009,the Virginia Department of Health Professions was informed that their PDMP database was accessed by an unauthorized user.Currently an ongoing investigation of this incident is being conducted by both federal and state law enforcement agencies(14).Patients whose prescription record contained Social Security numbers were contacted via email to explain the potential breech in information,and were cautioned to pay particular attention to activities involving their Social Security numbers over the next year(14).

Accessibility and Currency of Prescription Drug Monitoring Program Reports

Access to PDMP reports varies by state(15).Some states only allow law enforcement agencies involved in drug-related investigations and regulatory boards to access the information.In other states,a variety of groups are authorized to access the prescription information,including prescribers and pharmacists who use the information at point-of-care to make prescribing and dispensing decisions.

For most states the PDMP is electronic and available online.Authorized users have direct access to the online system,and when requested,a report is generated within seconds to minutes.Some states,such as Michigan,North Dakota,and Utah,also accept requests via fax. This process takes a bit longer,generally one to two days,as requester information must be authenticated.In other states,a report may take as long as14days.

As discussed previously,the time frame in which prescription data is transmitted to PDMPs also varies from state to state.For the vast majority of states,dispensers are required to report prescription data to the PDMP system every7-14days.Therefore,when a prescriber or dispenser requests a report on a patient,the information in the report may be up to14days

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old.Many state PDMPs are moving toward requiring more frequent transmission of prescription information in hope of increasing the currency of information to improve reporting.Table2,compiled from a variety of sources,provides a summary of groups authorized to access PDMP reports by state,the process by which the reports are accessed and the currency of the reports(3,7,15-16).

Table2.Accessibility and Currency of Prescription Drug Monitoring Program Reports by State

State Groups Authorized to Access Mechanism of

Access Currency of Reports

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