By Lauren Bates-Rowe, Senior Director of Health Policy - Medical Society of Virginia
Our nation is suffering from a prescription drug abuse epidemic that is claiming the lives of too many Americans. Drug overdose death rates in the United States have increased five-fold since 1989, with opioid-related overdose deaths now outnumbering overdose deaths involving all illicit drugs such as heroin and cocaine combined.
Fortunately, there is a growing awareness among healthcare professionals, government officials, and the public about the scale of this tragic and costly public health crisis. This has led to growing pressure on elected officials and leaders across the nation to do something. One obvious step is to improve the collection and sharing of prescription information so that clinicians have a better understanding of what medications a patient is taking, how much, for what purpose, and who is prescribing them.
Of course, the way in which these programs get implemented differs greatly depending on who is leading the charge. Many states have gone the route of mandating that prescribers check their state's Prescription Drug Monitoring Program (PDMP) before issuing a prescription. As explained in the CDC guidelines, checking the PDMP can provide prescribers with useful information when considering or managing opioid therapy. Most clinicians agree that if they had access to this type of comprehensive prescription information, it would greatly benefit them and their patients. All of this seems to be a "no brainer."
A Roadblock to Maximizing the Functionality of PDMPs
Unfortunately, this has not turned out to be the case, primarily due to a lack of robust integration with Electronic Health Records (EHRs). Traditional methods make it difficult to integrate PDMP software programs with EHRs and achieve meaningful interoperability. As a result, most states have not been able to maximize the functionality of PDMPs. Most commonly they lack comprehensive, real-time data including information from other states. Worse yet, healthcare providers are forced to work in two different systems that don't talk to each other; leading to frustration as they attempt to access critical patient information by switching back-and-forth between their EHR and a web browser.
Of course, these problems with state PDMPs are just the tip of the HIT iceberg and one example of the many problems that come with the lack of EHR integration. Virtually every healthcare IT application faces the same limitations. It's just too darn hard and painful to integrate with EHRs and yet, it is vitally important since this is where most clinicians do their work.
Interoperability is all Around Us
Let's set aside health care for a minute to consider how interoperability affects your everyday life. Imagine for a moment that you're headed to your favorite lunch place before a big meeting. You order and go to pay for your meal. As you pull out your credit card, the cashier tells you the credit card machine is down. No problem, you run to the ATM next door to get cash and hurry back. Now, what if your ATM card only worked at your bank? What if your bank was a 15-minute drive in the opposite direction? Now you can begin to appreciate the positive impact of interoperability: it powers the digital economy and makes it possible for things, like your ATM card, to work cohesively anywhere in the world.
EHR Integration and the Future of Healthcare
Imagine how much better the PDMP system could be if we had EHR integration. Prescription information could be automatically sent from the EHR to the PDMP, providing real-time prescribing information while simultaneously eliminating the need for any manual entry. Patient-specific reports based on all the information in the PDMP could be posted to the patients' records within the EHR where healthcare providers could easily findand use them in real time. As you can see, lack of interoperability in health isn't a "little" tech glitch or just an inconvenience; it can impact the delivery of safe, effective, and efficient care. Solving state PDMP challenges caused by poor interoperability will enhance access to necessary patient information and, in turn, allow clinicians to lead efforts to combat prescription drug abuse.
So how do we achieve this vision? The answer can be found by looking outside of healthcare to the way the rest of our digital economy works: open APIs and web services. This why your ATM card works anywhere and why Amazon can tell you that UPS just dropped off your package. The good news is that this same approach can be used to achieve deep integration and true interoperability in healthcare too. Today, solutions exist that represent major advances over traditional approaches. This is no longer a technical problem. It is now a question of will and leadership. So it is up to all of us, from physicians to HIT vendors to elected officials and patients, to come together and fulfill the promise of advancing health care through technology. Together, we can solve this problem and advance the practice of medicine to improve the lives of millions of Americans.