When one of his primary care patients called in recently seeking a pain prescription, Dr. Alain Chaoui was not surprised. The family practitioner from Peabody had referred the patient for surgery a few weeks earlier.
But when Chaoui checked the person’s records through the Massachusetts Prescription Awareness Tool (or MassPAT), the state’s new prescription monitoring database, he learned within seconds that the surgeon had already prescribed oxycodone to his patient.
Under state law, doctors must avoid writing overlapping opioid prescriptions.
“This was not a patient who was ‘doctor-shopping,’ ” Chaoui explained, using the term for narcotic-dependent patients who hop from doctor to doctor seeking opioid prescriptions. “He had just used up his first set of pills, and it was easier to call his usual provider than go back down to Boston for a refill.”
Chaoui asked his patient to call the surgeon directly, and also sent his colleague a message. He received a thank-you back. “The surgeon said he prefers to handle post-op pain himself so he can make sure the patient is tapered off the drug,” Chaoui said.
While hardly dramatic, the story illustrates why the state’s revamped prescription monitoring program, rolled out by the Department of Public Health (DPH) last month with the backing of physicians, pharmacists, and other health care providers, is vital to patient safety.
Research is clear that over-prescribing opioids (and other Schedule II through V controlled substances, including stimulants and sedatives) can lead to addiction, overdoses, and death. So besides helping doctors identify opioid-dependent individuals and direct them to treatment, the new system prevents ordinary patients from falling into the addiction trap.
“We know that safe prescribing practices must be part of a multidimensional response to this public health crisis,” said Monica Bharel, commissioner of DPH. “As we address the stark reality of losing four Massachusetts residents per day to the opioid epidemic, we must support evidence-based, innovative approaches like the improved MassPAT system to reverse this deadly trend.”
It is fair to say that health care providers and state regulators do not routinely agree on oversight measures. When prescription monitoring programs were first introduced by states like Massachusetts more than a decade ago, many physicians and medical groups balked at the idea that government should monitor or legislate their prescribing practices, particularly in the area of pain management. Since then, the discussion has moved from whether to do it to how to do it well.
Launched on Aug. 22, the MassPAT system has the distinction of being a government project that was born of intense public-private cooperation, was ready on time, and has gotten positive reviews from stakeholders. It’s an outcome worth emulating in the field of patient safety and error reduction. So how did it happen?
MassPAT fulfills a goal laid down about a year ago when Gov. Charlie Baker’s Opioid Working Group called for an overhaul of the state’s existing Prescription Monitoring Program, or PMP, which was faulted for being slow and complex and plagued by inaccurate and outdated data.
Tasked with fixing it, the DPH’s Bureau of Healthcare Safety and Quality, led by its director, Eric Sheehan, called together representatives from the Massachusetts Medical Society, the Massachusetts Hospital Association, pharmaceutical trade organizations, the Attorney General’s office, and others, for advice and support.
“We were impressed that the state was so clearly ready to invest the resources and personnel required ensure that the transition to the new enhanced program was seamless for all stakeholders,” said Patrick Huntington of the Massachusetts Chain Pharmacy Council, which made dozens of volunteer testers available to ensure that the new tool functioned in a business setting.
“It’s no longer a clunky system that takes a long time to connect to or get information,” he said. “It’s now very efficient and easy to use.”
Under a tight deadline, the DPH and its partners set out to create a system that offered:
Simple sign-in and easy navigation, while providing far quicker search results.
Nearly real-time prescription information (to prevent patients from “doctor shopping,” which was possible under the older system which was slow to update).
Shared data with a growing U.S. network of state-based prescription monitoring programs.
Easy enrollment procedures for prescribers and their “delegates” – staff members who could input patient data, helping busy practices cope with the workload.
The first decision was hiring an experienced vendor who could collaborate with DPH and state Information Technology (IT) officials to launch MassPAT in a short window of time without dropping any data from the soon-to-be-outdated system.
Appriss, a Kentucky software company that has prescription monitoring programs in 25 states and the District of Columbia, was awarded the $6 million contract over five years. Planners liked the software’s interstate sharing capacity, which for now connects Massachusetts to databases in a dozen other states; its average 1.8-second search response time; and its security measures.
After launching its MassPAT network last month, Massachusetts joined 12 states (marked in green) that have interconnected prescription monitoring programs, allowing providers to check patients for overlapping opioid prescriptions or other unwarranted medications across multiple jurisdictions. Nationally, the goal is to unite at least 43 states.
In addition to fulfilling those core needs, Appriss also provides users with a 24/7 help desk.
Pharmacy practices input data that reflect filled prescriptions for Schedule II through V medications into the MassPAT system. Prescribers can then query the database to review a 12-month medication history for patients before writing or renewing their prescriptions.
Strong push for sign-ups
After ensuring that the new software would work for health care professionals and state IT specialists, the project leaders set a goal of getting more than 1,300 pharmacies and nearly 40,000 physicians and their delegates signed up within a few months. Veterans Administration prescription data is also included, which the state describes as “a major win for physicians who did not have insight into VA prescribing” practices.
To do so, DPH created webinars, tutorials, and other training tools to familiarize the health care community with MassPAT. The stakeholder groups began evangelizing, touting the 3-to-5-minute sign-up time and the speedy search results.
The Bureau of Healthcare Safety and Quality reached out to pharmacies by emails, paper letters, and phone calls. At one point, says Suzanne Cray, the bureau’s director of health integration, teams of staffers spent hours phoning state pharmacies – some more than once – to remind them of the August deadline. “Our staff was very happy to do it.” Cray said. “It was a labor of love.”
As the accompanying chart shows, 95 percent of the state’s 1,348 pharmacy store fronts had signed up as of September; those outlets dispense 98 percent of all prescriptions for Schedule II through V drugs, officials said.
Physician buy-in has also been high, according to the state and the Massachusetts Medical Society.
“We knew as soon as we saw this system that we were off to a good start,” said Brendan Abel, legislative and regulatory affairs counsel for the medical society. “But we knew we needed to get all prescribers in the state to sign up, which is no small undertaking considering all the regulatory and administrative matters that take up the time and attention of the busy practitioner.”
So far, 10,000 searches per day
so far are strong. According to DPH, MassPAT is averaging more than 10,000
searches per day since going live, double the number under the older system.
Now the stakeholders are looking for ways to integrate MassPAT into their
clinical work flows, including user-friendly steps like linking the monitoring
system to their desktop programs.
“One goal would be for providers to be able to hit the ‘MassPAT’ button and have seamless access,” a DPH official explained.
All parties agreed that MassPAT would lead to safer prescribing practices and fewer erroneous repeat or unwarranted prescriptions.
“The Massachusetts Medical Society really commends the Department of Public Health, first in their selection of this new system, in their response to physicians’ input, and their goal of linking us up with other states, all crucial steps toward combatting prescription dependency,” Abel said.
Bharel said MassPAT fits well with the department’s goal of applying data to health-care policy.
“At the micro-level this is a clinical tool assists doctors, other prescribers and dispensers to safely care for their patients,” she said. “On the macro-level, MassPAT is a powerful analytical tool that allows us to look at trends so that we can understand different patterns of prescribing and use. We can then use that data to make evidence-based decisions on public health policies and interventions."
For more, see “Five Questions with James S. Gessner, MD,” president of the Massachusetts Medical Society.
To directly register for the program: https://massachusetts.pmpaware.net/identities/new
For more information: http://www.mass.gov/eohhs/gov/departments/dph/programs/hcq/drug-control/pmp/