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Policy Innovation Profile

System Gives Authorized Users Access to Interstate Information on Controlled Substance Prescriptions, Assisting Them in Identifying Cases of Potential Misuse


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Snapshot

Summary

Owned 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 prescription 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). As of June 2014, the program has enhanced access to interstate prescription monitoring program data for authorized users in 25 States, who have collectively accessed the system nearly 6 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.

See the Description of Innovative Activity for updated information about the number of participating States, Results for the number of States and authorized users who have accessed the system, and Tools and Other Resources for more information about prescription monitoring programs. (Updated June 2014.)

Evidence Rating (What is this?)

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.
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Developing Organizations

National Association of Boards of Pharmacy
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Date First Implemented

2011
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Patient Population

Vulnerable Populations > Substance abusersend pp

Problem Addressed

Increased 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.
  • 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 drugs,3 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 out-of-State activity: To reduce drug abuse and diversion, the State PMPs 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 and one jurisdiction have a PMP that is either operational or in development or have passed legislation authorizing development of such a program (updated June 2014). However, because 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), it has been difficult to identify patients who cross State lines to obtain controlled substances from multiple sources.

What They Did

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Description of the Innovative Activity

Owned 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 2014, 26 State-run PMPs have completed the MOU process and 25 of those States now securely exchange prescription data with each other via NABP InterConnect: Arizona, Arkansas, Colorado, Connecticut, Delaware, Idaho, Illinois, Indiana, Kansas, Kentucky, Louisiana, Michigan, Minnesota, Mississippi, Nevada, New Jersey, New Mexico, North Dakota, Ohio, South Carolina, South Dakota, Tennessee, Virginia, West Virginia, and Wisconsin. By the end of 2014, approximately 30 States are expected either to be participating or to have signed the MOU authorizing them to do so. (Updated June 2014.)
  • 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 an authorized user: Any participating State PMP can authorize its users to access 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 approximately 7 seconds. Providers receive a single report that contains all 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 Innovation

Founded 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 from accessing patient-specific information from another State.

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 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.

Did It Work?

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Results

The program has enhanced access to interstate data for authorized users in 25 States (as of June 2014) who have collectively accessed the system nearly 6 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.
  • Enhanced access to interstate data: As of June 2014, nearly 6 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.

Evidence Rating (What is this?)

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.

How They Did It

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Planning and Development Process

Selected 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. 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.
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Funding Sources

National 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.end fs

Tools and Other Resources

More information about PMPs is available from the the following:
More information about NABP InterConnect is available on the NABP Web site at http://www.nabp.net/programs/pmp-interconnect/nabp-pmp-interconnect.

Adoption Considerations

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Getting Started with This Innovation

  • Involve key stakeholders: Program developers should 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 interviewing vendors enables developers to 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: As the program expands, varying perspectives from representatives of newly participating States are introduced. To maintain effective governance, program leaders continually emphasize the common purpose of the system, the value of participation, and the need to be flexible in working out professional or policy inconsistencies.
  • 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 updating key stakeholders on program-related developments and activities is important.

More Information

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Contact the Innovator

Carmen A. Catizone, RPh, MS, DPh
Executive Director/Secretary
National Association of Boards of Pharmacy
1600 Feehanville Drive
Mount Prospect, IL 60056-6014
(847) 391-4406
E-mail: governmentaffairs@nabp.net

Innovator Disclosures

Dr. Catizone reported having no financial interests or business or professional affiliations relevant to the work described in the profile.

References/Related Articles

The NABP InterConnect Web site is available at: http://www.nabp.net/programs/pmp-interconnect/nabp-pmp-interconnect/

Footnotes

1 Von Korff M, Saunders K. Evaluation of Group Health’s chronic opioid therapy (chronic opioid therapy) risk mitigation initiative: a learning health care system responds to a national prescription drug abuse epidemic. 2012 Feb 23. Unpublished manuscript.
2 Ridpath J. A learning health care system mobilizes to improve opioid prescribing safety. Group Health Research Institute. 2011 Aug. Available at: http://www.grouphealthresearch.org/news-and-events/newsltrs/2011/08/feature.html.
3 U.S. Department of Justice. National drug threat assessment. 2011. Available at: http://www.justice.gov/archive/ndic/topics/ndtas.htm.
4 Substance Abuse and Mental Health Services Administration. How young adults obtain prescription pain relievers for nonmedical use. The NSDUH Report. 2006. Available at: http://www.samhsa.gov/data/2k6/getPain/getPain.pdf (If you don't have the software to open this PDF, download free Adobe Acrobat ReaderĀ® software External Web Site Policy.).
5 Bureau of Justice Assistance, U.S. Department of Justice. Prescription drug monitoring program [Web site]. Available at: https://www.bja.gov/ProgramDetails.aspx?Program_ID=72.
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Original publication: June 05, 2013.
Original publication indicates the date the profile was first posted to the Innovations Exchange.

Last updated: September 10, 2014.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.

Date verified by innovator: June 20, 2014.
Date verified by innovator indicates the most recent date the innovator provided feedback during the annual review process. The innovator is invited to review, update, and verify the profile annually.