Michigan tackles opioid abuse with data-sharing platform

To tackle and prevent opioid abuse in the state, Michigan has replaced its electronic prescription monitoring program (PMP) with a fully hosted and maintained platform that integrates into electronic health records (EHRs) and gives prescribers and physicians near-instantaneous access to patients’ drug histories.

“What used to take five to 10 minutes for a practitioner to query the system and run a patient report now takes on average less than half a second,” said Kim Gaedeke, Michigan’s PMP director.

Officials replaced the Michigan Automated Prescription System (MAPS) with Appriss Health’s PMP AWARxE, a scalable software-as-a-service platform, and then added MAPS to EHR and pharmacy management systems at hospitals, physician groups and pharmacies. That second stage uses Appriss’ PMP Gateway, a managed service for integrating prescription drug monitoring program (PDMP) data and analytics into EHRs.

During the six-month process, Michigan migrated more than 120 million records from MAPS to Appriss’ platform. Since going live on April 4, the new MAPS has garnered about 28,000 users, including 3,000 delegate users, who are people that registered users designate to access their records.

This fall, the state will begin using Appriss’ next-generation substance abuse tracking platform: NarxCare. Part analytics tool, it automatically analyzes MAPS data and a patient’s health history to provide a patient risk score, or NarxScore. That score -- which looks at all the risk factors for abuse of narcotics, sedatives and stimulants -- is embedded into EHRs, said Brad Bauer, vice president of business development at Appriss.

In a NarxReport, prescribers can immediately see predictive risk scores, red flags, a prescription graph and PDMP data, which alerts them to patients at risk for drug addiction or overdose or a dangerous drug interaction.

“That’s absolutely critical so that the practitioner can remain within his or her workflow and [does] not have to exit out to pull a report,” Bauer said.

What’s more, care teams can communicate with one another through the platform, and it can return information on treating drug addiction and the locations of treatment centers, which practitioners can provide to patients.

“It’s much more robust by way of prevention,” Bauer said. “It’s taking our state’s PDMP and making it a medical tool.”

Previously, when users needed to query MAPS, it could take up to 10 minutes “so long as our system didn’t crash,” Gaedeke said. “You’d have multiple users trying to access the system, and we didn’t have the bandwidth. And so now with the Appriss host system that we have, we don’t have that issue.”

Now, users log in via a web portal. A dashboard shows patient or clinical alerts -- such as someone who has seen several doctors or drug dispensers in a short period of time for opiate-based controlled substances. Users can also see any recent reports they requested and any delegate users who have been designated.

“Behind the scenes, whenever we receive a request, that is going to hit the data repository that we maintain for the state,” Bauer said. “We have a proprietary means of patient clustering and how we clean and match the data, which is very important in terms of the quality of the data. That enables us to see the request for a patient report. We’re able to accurately match that to the data that’s in the system so we are returning records for that patient.”

Search terms include partial and full names, dates of birth and time parameters so that users can see a history of prescriptions for Schedule II to V drugs, such as Percocet, codeine, and anti-depression and anti-anxiety medications.

Besides prescription history, the reports include prescriber and dispenser information. Additionally, data uploads happen in real time, as opposed to the nightly batch updates that happened previously.

Users can also use the PMP InterConnect hub, which lets PMP AWARxE users query other states’ prescription drug monitoring data. Appriss maintains the hub for the National Association of Boards of Pharmacy, and it currently has data from 42 states. For instance, if a prescriber suspects a patient of drug abuse, they can check InterConnect to see if that person has visited practitioners in other states.

Opioid abuse is rampant nationwide. In Michigan, deaths from opioid use grew by 13.3 percent from 2014 to 2015, according to the Centers for Disease Control and Prevention. In 2015, Gov. Rick Snyder created the Michigan Prescription Drug and Opioid Abuse Task Force, which recommended replacing or enhancing MAPS. As a result, the state appropriated $2.47 million to the Department of Licensing and Regulatory Affairs, whose Bureau of Professional Licensing oversees MAPS, to replace the system and another $2.02 million for maintenance.