SummaryOwned and operated by the National Association of Boards of Pharmacy®, NABP PMP InterConnect® is a data exchange platform that links prescription monitoring programs operated by various states, allowing authorized users, including health care practitioners and pharmacists access to patient-specific controlled substance prescription information from across State lines. After signing a memorandum of understanding with the association, State-run prescription monitoring programs implement an interface with NABP InterConnect. Authorized users log into their state’s prescription monitoring program, enter a patient’s name, and receive a single report summarizing that patient’s drug-seeking activities in all participating states. They then use this information to assist in identifying patients who appear to be crossing State lines to obtain drugs for potential personal misuse or drug diversion (the transfer of drugs from lawful to illegal purposes). The program has enhanced access to interstate prescription monitoring program data for authorized users in 15 states who have collectively accessed the system more than 2 million times since its implementation. In anecdotal feedback, users report valuing this information, believing it helps them make better clinical decisions that improve safety and reduce the risk of drug abuse and diversion.Suggestive: The evidence consists of post-implementation data on the number of times users have accessed the system and anecdotal feedback from these users on the value of the system and its impact on their decisionmaking.
Developing OrganizationsNational Association of Boards of Pharmacy
Date First Implemented2011
Problem AddressedIncreased use of controlled substances (such as prescription opioids, narcotics, depressants, and stimulants) for legitimate health conditions has led to major public health concerns about the potential for more drug abuse and drug diversion. Many states have a prescription monitoring program (PMP) that allows prescribers and pharmacists to monitor patients’ controlled substance use. However, these programs do not track activity across State lines, limiting their usefulness.
- Increased use of controlled substances: Since the 1980s, the use of controlled substances such as prescription opioids, narcotics, depressants, and stimulants has increased significantly for the management of various health conditions.1 For example, between 3 percent and 4 percent of all American adults who do not have cancer and are not receiving end-of-life care (roughly 5 million to 8 million adults) now use prescription opioids on a long-term basis to manage chronic pain.2
- Leading to drug abuse and diversion: Expanded use of controlled substances has led to problems with drug abuse and drug diversion. Approximately 7 million people age 12 years and older used controlled prescription drugs for nonmedical reasons in 2009, a 12-percent increase from 2008.3 Opioid pain relievers are the most widely misused or abused controlled prescription drugs3, with approximately 12 percent of American adults age 18 years to 25 years using them for nonmedical reasons.4 Drug diversion is also a growing problem; 13.9 percent of State and local law enforcement agencies reported controlled substance diversion as their greatest drug-related problem in 2010, up from 9.8 percent in 2009.3
- Inability of State-run programs to detect across-State activity: To reduce drug abuse and diversion, 46 states (plus 3 additional states, which have passed approval legislation) have operational PMPs that facilitate the collection, analysis, and reporting of information regarding prescriptions of controlled substances. These programs help pharmacists and physicians identify “doctor shoppers,” or patients who visit various providers to obtain multiple prescriptions for personal use or sale to others. With the exception of Missouri, all states have a PMP that is either operational or in development, or have passed legislation authorizing development of such a program. However, PMPs historically have not communicated with each other (because of a lack of interoperability and legal issues related to sharing prescription data with out-of-state providers), making it impossible to identify patients who cross State lines to obtain controlled substances from multiple sources.
Description of the Innovative ActivityOwned and operated by the National Association of Boards of Pharmacy (NABP®), NABP PMP InterConnect is a data exchange platform that links PMPs operated by various states, allowing authorized prescribers and dispensers of controlled substances to access patient-specific information from across State lines. After signing a memorandum of understanding (MOU) with the association, State-run PMPs implement an interface with NABP InterConnect. Authorized users log into their State PMP, enter the patient’s name and other information, and receive a single report summarizing that patient’s prescription list in participating states. They then use this information to assist in identifying patients who appear to be crossing State lines to obtain drugs for potential personal misuse or drug diversion. Key program elements include the following:
- MOU between state and NABP: A representative of the PMP in each participating state signs a formal MOU with NABP. Crafted with the assistance of NABP attorneys, the MOU outlines the responsibilities of the State PMP and NABP. For its part, NABP agrees to maintain the functionality of the system, protect the participating state’s data, and implement all State-specific requirements related to PMP access. In turn, participating states agree to maintain their PMP, share all access and use requirements with NABP, let authorized users of out-of-state PMPs access their data, and investigate reports of unauthorized disclosures of information. NABP lawyers work with the relevant legal contacts in the state to incorporate State-specific language into the MOU when necessary. As of June 2013, 24 State-run PMPs have completed the MOU process and 15 of those states now securely exchange prescription data with each other via NABP InterConnect: Arizona, Colorado, Connecticut, Illinois, Indiana, Kansas, Kentucky, Louisiana, Michigan, New Mexico, North Dakota, Ohio, South Carolina, South Dakota, and Virginia. By the end of 2013, a total of 25 states are expected to be either participating or to have signed the MOU authorizing them to do so.
- Linking to NABP InterConnect system: NABP InterConnect does not house data, but rather provides an interface that securely links PMPs from each participating state. NABP works with national system vendors to make an interface available to states that use these vendors. States that use local vendors or in-house information technology departments build an interface with the system with assistance from NABP and the vendor that developed NABP InterConnect (Appriss, Inc.).
- Becoming authorized user: Authorized users of any participating state's PMP can use the NABP InterConnect system. To become an authorized user, physicians, nurse practitioners, pharmacists, and other qualified individuals must go through a detailed, State-specific application process that typically involves providing their license number and other identifying information. The state confirms the information provided and grants authorization to qualified providers.
- Using system to identify and address potential misuse: Prescribers and pharmacists may access the system any time they are considering prescribing or dispensing a controlled substance. After logging into the participating State PMP, the user sees data on the patient in question from other participating states, with the information available in roughly 7 seconds. Providers receive a single report that contains all prescribing and dispensing activity regarding controlled substances for that patient. If a prescriber notices a potential addiction or abuse problem, he or she can decide on appropriate action with the patient, refuse to prescribe a controlled substance, or prescribe it in smaller doses or for shorter durations to allow for closer monitoring. Pharmacists noticing questionable activity can contact the prescribing physician to discuss their concerns.
Context of the InnovationFounded in 1904, NABP is a not-for-profit organization that provides support to State boards of pharmacy on issues related to regulations, education, license transfer, and competency assessment. Beginning in fiscal year 2002, Congress appropriated funds to the U.S. Department of Justice (Public Law 107-77) to support the development of PMP systems.5 As noted, however, these systems did not interface or communicate with each other, thus preventing authorized prescribers and dispensers of drugs in one state to access patient-specific information from another.
The impetus for this program came after various barriers arose for efforts to make interstate data exchange a reality. To share data, each participating state had to pass legislation authorizing such activity, a process that proved quite difficult and cumbersome. At the same time, information could not be shared without a data exchange platform, and efforts to build one hit several roadblocks. Faced with these hurdles, the leaders of several State PMPs who were interested in sharing information across states approached NABP leaders in 2010 to request that the organization take a leadership role in making this possible.
ResultsThe program has enhanced access to interstate data for authorized users in 15 states who have collectively accessed the system more than 2 million times since its implementation. In anecdotal feedback, users report valuing this information, believing it helps them make better clinical decisions that improve safety and reduce the risk of drug abuse and diversion.
Suggestive: The evidence consists of post-implementation data on the number of times users have accessed the system and anecdotal feedback from these users on the value of the system and its impact on their decisionmaking.
- Enhanced access to interstate data: As of June 2013, more than 2 million search requests for patient-specific activities in and across states have taken place. Program developers view this high level of use as an indicator of the value of the system to these users.
- Better decisions that ensure safety and reduce drug abuse: In anecdotal feedback, prescribers and pharmacists who use the system report valuing the information it provides, believing it helps them make better clinical decisions with respect to individual patients, thus enhancing patient safety and reducing the risk of drug abuse and drug diversion.
Planning and Development ProcessSelected steps included the following:
- Designing and contracting for system: Beginning in January 2011, a group of State PMP administrators and representatives from the U.S. Department of Justice met with NABP representatives to outline the design and functionality of the proposed NABP InterConnect system. The group specified functional requirements (such as a rules engine to ensure that each state’s requirements related to access can be enforced) and designated elements of the MOU to be signed by all participants. Once the group completed its work, NABP contracted with a software developer (Appriss Inc.) to build the data exchange platform.
- Forming joint steering committee: NABP created a joint steering committee made up of representatives from each of the State PMPs participating in the system. This committee serves as the central governing body and oversight entity for NABP InterConnect. Meeting at least once a year, the committee sets policy, defines standards for shared data elements, approves NABP InterConnect functionality and enhancements, discusses issues related to new State members, appoints dispute resolution committees, and ensures that NABP InterConnect information remains useful in medical decisionmaking.
- Developing interface with State systems: The software developer completed NABP InterConnect in May 2011, after 7 months of development work. NABP and the vendor then worked with State-based software vendors to create an interface between their systems and NABP InterConnect.
- Enhancing program over time: The association launched NABP InterConnect in July 2011, and program leaders have been evaluating and refining it over time. Currently, NABP is testing new software to improve the compatibility of the system with the State PMPs. After a five-state pilot test of the new software, NABP's goal is to roll out the software to all participating states. On an ongoing basis, the steering committee will continue to explore the merits of further enhancements to the system, including integration with emergency department and health system software.
Resources Used and Skills Needed
- Staffing: NABP did not hire new staff until after the program development phase, hiring a full-time program manager to work with the steering committee on policy issues and manage technical aspects of the system.
- Costs: Development costs totaled approximately $1 million, the vast majority of which funded the development of the data exchange platform.
Funding SourcesNational Association of Boards of Pharmacy
NABP paid for all costs associated with development and implementation of NABP InterConnect and is funding 5 years of annual participation fees for each participating PMP. After year 4, NABP will evaluate whether to continue funding beyond this 5-year period. NABP also makes funds from a $1 million unrestricted grant from Purdue Pharma L.P. available to states requiring financial assistance to modify their PMP software to allow participation in NABP InterConnect.
Tools and Other ResourcesMore information about PMPs is available from the U.S. Department of Justice, available at: https://www.bja.gov/ProgramDetails.aspx?Program_ID=72.
Getting Started with This Innovation
- Involve key stakeholders: Involve all key stakeholders in upfront planning and development activities, including State PMP program staff. Staff involved in State PMP programs are extremely knowledgeable about prescription monitoring systems and processes and can provide valuable input on technology and policy issues related to creating a data exchange platform.
- Identify reliable vendor: Carefully interview and select a vendor that has the requisite technical expertise to develop the platform, as well as a track record of providing ongoing technical assistance to clients.
- Encourage flexibility: The leaders of individual PMP programs have to recognize the needs of their peers in other states and accept that sometimes compromises need to be made on contentious issues (e.g., uniformity of tracked data elements) to allow them to work together effectively.
Sustaining This Innovation
- Identify and approach potential sources of ongoing funding: The vast majority of PMP programs receive funding from Federal grants. Consequently, program leaders need to find stable sources of ongoing funding so that these individual systems remain in place if and when this funding ends. Without alternative sources of funding, this type of program could be negatively affected if participating states are forced to disband their PMP systems.
- Solicit additional State participants: NABP InterConnect becomes more valuable to users as more states come on board. Consequently, program leaders plan to continue working to encourage additional states to join.
- Manage governance structure carefully: Program leaders have faced challenges in managing the steering committee as the program expanded and brought representatives from newly joining states onto this governing body. To maintain effective governance, continually emphasize the common purpose of the system, the value of participating in it, and the need to be flexible in working out professional disagreements.
- Refine program over time: NABP InterConnect program leaders continue to review ways to improve the system's usefulness. For example, they reviewed the format of clinician reports to see if improvements could be made to enhance the readability of information coming from multiple sites and providers.
- Maintain communication: Regularly update key stakeholders on program-related developments and activities.
Contact the InnovatorCarmen A. Catizone, RPh, MS, DPh
National Association of Boards of Pharmacy
1600 Feehanville Drive
Mount Prospect, IL 60056-6014
Innovator DisclosuresDr. Catizone reported having no financial interests or business or professional affiliations relevant to the work described in the profile.
References/Related ArticlesThe NABP InterConnect Web site is available at: http://www.nabp.net/programs/pmp-interconnect/nabp-pmp-interconnect/.
Original publication: June 05, 2013.
Original publication indicates the date the profile was first posted to the Innovations Exchange.
Last updated: June 19, 2013.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.