126 The Effect of Prescription Drug Monitoring Program Electronic Medical Record Integration on Prescription Drug Monitoring Program Utilization and Opioid Prescribing

Abstract

Prescription drug monitoring programs (PDMPs) are state-based databases that report patients’-controlled substance prescription histories to providers. Use of PDMPs prior to writing an opioid prescription is mandated in over half of all states. However, PDMP data frequently must be obtained by accessing a Web portal which is external to a hospital’s electronic medical record (EMR). The goal of this study was to determine the effect of implementation of direct, one-click, PDMP integration into a health system’s EMR on the number of queries and opioid prescriptions overall and specifically by emergency medicine prescribers (based on self-reported specialty). This was a study in the state of Massachusetts. One-click integration with the PDMP was introduced in a large health system EMR, which includes 9 EDs, including 2 at large academic centers and 7 at community hospitals. One-click integration of the PDMP began on May 16, 2018. The pre-intervention study period was November 15, 2017 to May 15, 2018, and the post-intervention period was May 16, 2018 to November 15, 2018. National Provider Identifier (NPI) numbers for all providers in the studied health system who wrote at least one opioid prescription during the study period were provided to the state PDMP. For each of these prescribers, the number of searches, reported schedule II and III opioid prescriptions, and the average of the total morphine milligram equivalents (MMEs) per patient was compiled before and after integration began. State PDMP data indicate that there were 332,748 searches before vs. 470,984 searches after integration (+41.5% change). Numbers of opioid prescriptions filled were 207,978 before vs. 202,053 after integration (-2.8% change). Amongst emergency medicine prescribers, there were 8,868 searches before vs. 16,682 searches after integration (+88.1% change). The numbers of filled opioid prescriptions by emergency physicians were 5,800 before vs. 5,621 after (-3.1% change). The average total MME per patient across all specialties was 1,493 mg before integration and 1,425 mg after integration (-4.6% change). For emergency medicine prescribers, the average MME per patient was 137 mg before integration and 113 mg after (-17.4% change). A one-click integration of PDMP into an EMR markedly increases the search rate but has a negligible effect on the overall numbers of prescriptions for schedule II and III opioids that are filled.