PMP Committee PMIX Phase I

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PMP CommitteePMIX Phase I II Projects -
Survey of State PMPs -
John EadiePresident, Eadie ConsultingJohnLEadie_at_
aol.com Scott SerichPMP Project Manager, IJIS
Institutescott.serich_at_ijis.org
National Alliance for Model State Drug Laws4th
National Conference Washington, DC December 7,
2007
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PMP Information Exchange (PMIX) Project

• BJA/IJIS -- PMIX Program Primary Goal
• Create a model standard for
• exchange of Prescription
• Monitoring Program (PMP)
• information among states

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PMP Information Exchange (PMIX) Project

• IJIS PMP Committee - representatives from
• 8 State PMPs
• AL,CA, KY, MA, NV, NY, OH , OK
• 3 Federal agencies
• DEA, BJA, and SAMHSA
• Technology firms - through the IJIS Institute
• Policy assistance from the National Alliance for
  Model State Drug Laws (NAMSDL) and their Model
  Interstate Compact

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PMIX Phase I Project

• Developed a Concept of Operations document to
• support the existing model standards
• describe the exchange of PMP information between
  states
• Developed a system architecture for states to
  implement in support of such information
  exchanges
• Produced final report including recommendations
  for updates to the GJXDM to support PMP
  information sharing

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PMIX Phase II Project

• Pilot demonstration of PMP information sharing -
  California Nevada
• Executed an exchange of patient data
• Created a test facility to assist in validation
  of future exchanges
• A single focal point for the leading IT edge in
  the PMP community
• Empirical feedback from diverse sample points
• Created reference documents describing a model
  standard for the exchange based on the GJXDM
  (NIEM)
• Information Exchange Package Documentation
• Reusable architecture design artifacts

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PMIX Technology Physical Architecture
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Survey of State PMPs

• 32 Surveys sent out
• 32 Completed surveys returned
• 19 PMPs in full operation
• 6 PMPS under development
• 7 PMPs not yet started

• Data Submitted
• 2,681 data points
• 937 comments and notes
• Tabulations
• 58 printed pages

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PMP Total Requests Fulfilled2001 - 2006
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PMPs Fulfilling More Than 200 Total Requests
2001 - 2006
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PMP Out-of-State Requests Fulfilled2001 - 2006
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PMPs Fulfilling Out of State Requests2001 - 2006
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Intrastate Sharing Practices Permissions
Solicited
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Intrastate Sharing Practices and Permission
Unsolicited
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Interstate Sharing Practices and Permission
Solicited
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Interstate Sharing Practices and Permission
Unsolicited
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Federal Sharing Practices and Permission
Solicited
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Federal Sharing Practices and Permission
Unsolicited
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• Dear Colleague, August 31, 2007
• Research by Simeone Associates, Inc., on behalf
  of the BJA, has
• concluded that state sponsored prescription drug
  monitoring programs
• are effective at decreasing the supply of
  abusable drugs and at
• reducing the probability of prescription drug
  abuse. 
• Additionally, the study reveals that proactive
  "law
• enforcement oriented" programs, which identify
• cases and initiate their own investigations, are
• more effective at combating prescription drug
• abuse than reactive "health-oriented" programs
• which only investigate cases at the request of
• authorized third parties. 

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Other Exchange Partners

• Medicaid Medicaid Fraud Units
• Medicare
• Health Practitioner Intervention Program
• Workers Compensation
• Medical Examiners
• Bureau of Investigation

• Inspector General
• Child Protective Services - drug related
• Probation Dept. of Corrections - drug related
• Probation Parole
• Judge administering drug diversion or probation
  program

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Authentication - UsersRequesters must submit
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Memoranda of Understanding
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Interstate Requests - Physician or
PharmacistFilled through PMPs

• Can fill requests via other state's PMP?

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Interstate Requests - Physician or
PharmacistFilled through PMPs

• Comments
• 1 Plans legislation to authorize data to other
  PMPs
• 4 Require signed request direct to PMP
• 1 Requires certification of patient -
  practitioner/RPh relationship
• 1 Requires drivers license

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Potential Features of PMIX System

• Want PMIX hub to do initial screen?

• Comments
• A technological hubnot a person or agency
• Prefer hub if
• disclosing PMP's rules apply
• security HIPAA compliant
• privacy
• Depends on of requests
• With hub, disclosing PMP will still screen

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Massachusetts PMP Harold Rogers Grant Initiative
Survey A CS Rx Collected 2005 - 21 PMPs

• State Rx
• CA 19,130,394
• HI 702,827
• ID 1,770,401
• IL 1,954,747
• IN 3,912,500
• KY 8,520,012
• MA 2,716,466
• ME 1,948,192
• MI 14,355,989
• MS 5,277,121
• NV 3,342,324

• State Rx
• NM 772,803
• NY 9,926,312
• OK 885,673
• PA 4,490,032
• RI 949,906
• TX 3,112,181
• UT 4,113,435
• VA 892,744
• WV 4,023,063
• WY 615,693

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Massachusetts PMP Harold Rogers Grant
Initiative

• Survey A Results
• 93.4 million controlled substance Rx collected by
  PMPs in 2005

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Massachusetts PMP Harold Rogers Grant Initiative

• Survey B CS Rx issued by out-of-state
  prescribers
• KY 7
• ME 8
• MA 5
• RI 10
• Prescribers in all 50 states, D.C.,
  territories

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Massachusetts PMP 2006Combined Survey A B
Results

• Between 5 and 10 of 2005 Rx collected by PMPs
  were issued by out-of-state prescribers
• Therefore, the number of 2005 Rx in PMPs files
  that were filled for out-of-state prescribers is
• 4.7 - 9.3 million Rx

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Massachusetts PMP Harold Rogers Grant
Initiative Survey A B Postscript

• Major increase in Rx since 2005
• - 12 more PMPs operational by 2008
• - 6 PMPs have expanded to
• all C-II to C-IV
• - VA has expanded to whole state
• - Several states only collected part of 2005
• PMIX is important

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Massachusetts PMP Harold Rogers Grant Initiative

• Northeastern States Meeting
• September 2007
• NE PMPs agreed to initiate
• data exchange projects

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Massachusetts PMP Harold Rogers Grant Initiative

• Example ME PMP data shared with MA
• 30,548 CS Rx dispensed in ME were
• Issued by 4,489 MA prescribers 6/2005 5/2007
• From 1 to 1,400 Rx, each prescriber
• Prescribers in every part of MA
• 84 of patients from ME

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Massachusetts PMP Harold Rogers Grant Initiative

• NE States also agreed to explore
• Common formats for reports to users
• Annual reports contents
• Standard authentication procedures
• NE will request information
• from all PMPs