Matthew M. Eschelbach, MS, DO, FACEP, FAAPL, CPEMedical Director of EMS and Trauma

Medical Director of Physician RelationsSt Charles Medical Center, Redmond

Central Oregon District Hospital

Mountain Medical Immediate Care

Mountain View Hospital

Dr. Robert Bomengen

OHA appoints eleven individuals to the PDMP Advisory Commission (four year term).

The purpose of the Advisory Commission is to study issues related to PDMP, review the PDMP annual report and develop criteria that should be used to evaluate program data.

The eleven members that serve on the Advisory Commission are currently represented by 4 females, 7 males of varying ages and professional backgrounds.

Chris Apgar, CISSP, Apgar & Associates, LLC, Public Member, Portland

Matthew Eschelbach, MS,DO, FACEP, FAAPL,CPE, (OPSO) Redmond

Paul Brannen, DMD, Dentist, Salem

Sara Love, ND, Naturopathic Physician, Portland

John McIlveen, PhD, LMHC, Addictions and Mental Health, Salem

Paul Coelho, MD, Physician, Coburg (OMA)

Clare Midson, OD, Optometric Physician, Tigard

Michael Millard, MSRPh, Pharmacist, Hillsboro

Carrie Schreibman, MSN, FNP, Nurse, Portland

Laura Scobie, PA-C, OR Pain Management Commission, Portland

Tyler Swift, ND, MPH, Multnomah County Health Department, Public Member, Portland

I believe clinicians can make the best care decisions when they have easy access to relevant clinical data at the point of care. A patients history of medications dispensed is extremely relevant clinical data for a clinician to know when prescribing new medications. And if we can make it easy (saving up to 4 min/encounter) and more efficient (not having to leave clinical workflow), I believe we will increase the usage of PDMP data at the point of care and will have a positive impact on the opioid crisis in Oregon and reduce drug overdose deaths.

Laureen O'BrienOregon Health Leadership Council

Heart Rate Blood PressureTemperature Oxygen Saturation

US Surgeon General Viveck Murphy, MD

AOA PresidentBoyd Buser, DO

• ~20% of Oregonians have chronic pain (760,000)

• In 2016, almost 1 in 4 Oregonians received a prescription for opioid medications (>900,000)

Non-Medical Use of Prescription Opioids

• Tied for 2nd in the nation in 2012-2013; 1st in 2010-2011.1

• 212,000 Oregonians (5% of population); 9% of 18-25 year olds

Pain Treatment with Prescription Opioids

Hospitalizations

• 330 hospitalizations for overdose; • 4300 for opioid use disorder• $8 million in hospitalization charges in 2014

Death Rate

• 180 deaths (4.5 per 100,000 residents) for pharmaceutical opioid overdose in 2015

Source: National Survey on Drug Use Health (NSDUH)1

REDUCE RISKS TO

PATIENTS BY MAKING

PAIN TREATMENT SAFER

AND MORE EFFECTIVE,

emphasizing non-opioid

and non-

pharmacological

treatment

REDUCE HARMS FOR

PEOPLE TAKING OPIOIDS

AND SUPPORT RECOVERY

FROM SUBSTANCE USE

DISORDERS by making

naloxone rescue and

medication-assisted

treatment (MAT) more

accessible and affordable

Protect the community

by REDUCING THE

NUMBER OF PILLS IN

CIRCULATION through

implementation of safe

prescribing, storage, and

disposal practices

2

OPTIMIZE OUTCOMES BY MAKING STATE AND LOCAL DATA AVAILABLE for informing,

monitoring, and evaluating, policies and targeted interventions

Aim: Reduce deaths, non-fatal overdoses, and harms to Oregonians from

prescription opioids, while expanding use of non-opioid pain care

1 3

4

Oregon Prescription Drug Monitoring ProgramInjury and Violence Prevention Section Oregon Public Health Division

Support medically necessary uses of controlled substances

Identify risks to patient safety

Facilitate coordination of care among providers

Aid in the identification of potential misuse, abuse, or diversion of prescription drugs

Assist in initiating compassionate conversations

Help the intervention and treatment of people addicted to prescription drugs

Help provide safer and more effective pain management for persons with chronic pain and limit risky prescribing to opioid naive

Oregon Prescription Drug Monitoring ProgramInjury and Violence Prevention Section Oregon Public Health Division

• Prescribers (MD, DO, NP, PA)

• Pharmacists

• Delegates (non-licensed staff of prescribers and pharmacists)

• Licensing Boards

• Patients

• Medical Examiners

• Law enforcement (with a court order)

• Evaluation and research

Oregon Prescription Drug Monitoring ProgramInjury and Violence Prevention Section Oregon Public Health Division

Registration starts online with a second step of printing out a registration form and sending it to the PDMP office

Authorized account holders - prescribers and pharmacists (or their delegates) can query a 3 year prescription history of their patients◦ Can also query their DEA number to see all

prescriptions filled under that number

Patients can request their own prescription history

A Public/Private Partnership to govern high priority, statewide health information technology (HIT) initiatives

Accelerate/Advance HITOC’s vision of an HIT-optimized health system in Oregon

Build off of Oregon’s history of successful collaboration such as EDIE/PreManage

Intended to help connect existing HIT systems, support statewide solutions

Integrating Prescription Drug Monitoring

Program (PDMP) and Health IT Systems

• Passed HB 4124 (2016) with broad stakeholder support– Allows for integration of the PDMP with Health IT systems so

authorized prescribers, pharmacists and their delegates can query the Oregon PDMP from within their clinical workflow

• Oregon PDMP has contracted with Appriss for their PMP Gateway product which allows HIT systems to connect to the PDMP

– Went live July 2017 – organizations can apply to participate:

http://www.orpdmp.com/or-pdmp-gateway-health-it-integration/

• Oregon PDMP has requirements for Health IT system access

– Individual prescribers, pharmacists and delegates must have active, valid PDMP user accounts

– Eligible entities must go through application process with PDMP & Appriss

– Once connected, entities must meet ongoing requirements

Current State - PDMP

Fees

Prescribers must use separate login to access

PDMP database through a web portal

• $25 annual access fee per authorized

prescriber

Benefits

• Authorized prescribers can access Oregon’s

prescription drug information

Future State – STATEWIDE PDMP

Providers access PDMP database through their

normal workflow in their EHR via Gateway (no

separate login). Results come back to patient

record

Fees

Benefits

• $25 annual access fee per authorized

prescriber

• Statewide PDMP assessment fee (82%

covered by State/CMS funding)

• Direct access to PDMP information as part of

normal workflow: saves time, increases

adoption, reduces redundancy, better informs

clinical decisions in real time

• Access to other state database information

through Gateway

Prescriber

EHR

Separate LoginManual Query

PDMP Database PDMP

Gatewa

y

EHR

Prescriber

PDMP Database

PDMP Gateway

Statewide PMP Data Flow

Provider Selects patient in their

EHR/HIE/Rx system and

reviews clinical data

Provider prepares to order.

Select PDMP review.

Credentials passed

with PDMP Query

Appriss PMP

Gateway sends

credentials and

Query to OR PDMP

Oregon PDMP

processes request

and sends results to Appriss

Gateway

Appriss PMP

Gateway

PDMP report

displayed in

Providers EHR/HIE/

Rx

within clinical

workflow

• Data is then eliminated from the EHR/HIE system. The PDMP Statute requires that information from the Oregon PDMP is not stored long-term in an HIT System other than the patient’s record (e.g., providers can copy/paste into EHR).

• EDIE and Reliance eHealth Collaborative expecting to connect to PMP Gateway • Authorized health systems, independent clinics and pharmacists can connect for

a per provider annual subscription fee• A statewide PMP Gateway license will allow for shared 90/10 funding model so

all health systems, independent providers and pharmacist to connect

Major advantages of PMP Gateway integration

More secure access to PMP Data• No searching by entering patient demographics, i.e. no

“text boxes”• Prescribers can only view PMP data on persons within their

facility which are their patients• Pharmacists can only view PMP data on persons for which they

are in the process of filling a prescription

Dramatic decrease in time to review PMP Data• No need to pull up web browser and navigate to state

PMP web site, enter login credentials, navigate to and enter patient search criteria in web form

• Results of studies are showing dramatic time savings

Oregon Prescription Drug Monitoring ProgramInjury and Violence Prevention Section, Oregon Public Health Division

Password resets and general help desk◦ (866) 205-1222◦Orpdmp-info@hidinc.com

Prescription Drug Monitoring Program◦ (971) 673-0741◦ Pdmp.health@state.or.us

House Bill 3440: Prescription Drug Monitoring

Program Implementation

1.Establish a clinical review subcommittee of the PDMP

Advisory Commission to review PDMP data and

recommend training or education for providers.

2. Include dispensed Naloxone and patient phone number in

the PDMP.

3.Establish Interstate data sharing with select states.

4.Provide quarterly overdose report via data dashboard and

an annual report to legislature.

House Bill 3440: Establish a Clinical Review

Subcommittee

• Goal: Develop criteria to determine which prescribers may

benefit from additional opioid prescribing.

• Details:

• Subcommittee made up of experienced prescribers

• Subcommittee review de-identified data provided by PDMP

staff

• Determine criteria for receiving additional training

• Provide prescriber names to respective boards to provide

training

• Limitations:

• Lack of diagnosis codes

• Lack of specialties

House Bill 3440: New PDMP Field and Naloxone

• New Field – Phone Number

• Improved patient matching

• Identified Naloxone

• More data for targeted interventions

• Provider knowledge benefits

• OR PDMP partnering with NABP to

utilize PMPi data sharing hub.

• Most data sharing states partnered

with NAMP.

• OR PDMP will prioritize connections

with neighboring states

House Bill 3440: Interstate Data Sharing

MA's should obtain delegate status and learnhow to check the PDMP for ALL patients the night before their visit. Download the PDF files, print them, highlight the

medication and check to see if the patient is co-prescribed a benzodiazepine or carisoprodol(Soma),

Has the patient seen > 4 prescribers in the prior year?

It also upskills the MA's so that they can start to initiate some 'difficult conversations' and thereby off load their prescribers.

Paul Coelho, MD, Rehabilitation Medicine

46 year old male with history of chronic low back pain presents to the ER complaining of spasms in his legs after lifting a car engine off the floor and moving it to his work bench.

He states his pain is 10/10 and he needs something to help him get through the night until he can see his pain doctor tomorrow.

He says a valium usually helps with the spasm Meds Include◦ Fentanyl patch 75◦ Dilaudid 2mg tab 4 times a day◦ Oxycodone 5 mg, QID for “ Break-through” pain

https://www.oregonpainguidance.org/opioidmedcalculator/

https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm

• OHA Opioids Website: http://healthoregon.org/opioids

– Interactive Data Dashboard

– Community Information

– Guidelines

• Oregon Prescription Drug Monitoring Program Website: http://www.orpdmp.com/

• Statewide PIP website: http://www.oregon.gov/oha/hpa/csi/Pages/Performance-Improvement-Project.aspx