Michigan uses prescription monitoring to fight opioid crisis

Fighting opioid crisis from cloud

After a major opioid task force report three years ago, the state Department of Licensing and Regulatory Affairs (LARA) replaced its aging on-premises prescription monitoring system with a cloud-based platform from Appriss Health, a division of Appriss Inc., a data analytics vendor.

Kim Gaedeke

Appriss said its software powers prescription monitoring programs (PMPs) in 45 states.

The Appriss PMP Aware system enables physicians to check patients' prescription history usually in less than five seconds, compared to the old server-based system that took five or 10 minutes to do the same thing, said Kim Gaedeke, acting deputy director at LARA.

Meanwhile, the new Appriss NarxCare system runs analytics on patients' health histories to determine likelihood of abusing prescription opioids and becoming addicted. The module also does interactive visualizations of drug use patterns.

ROI on big investment

The greater efficiency of the Appriss systems has allowed LARA to reduce through attrition its IT staff for the prescription monitoring program from about 13 to about four. Combined with lower overall system maintenance costs, Gaedeke said, the state is saving about $1 million a year compared to the old PMP system.

"That's a significant return on investment," Gaedeke said.

The problem is at such a scale now that this is data that should be available and visible to the physician in every single patient encounter.

Michigan's Appriss system, which went live in April 2017, didn't come cheap, though.

Under a publicly bid contract, LARA is paying the Louisville, Ky., vendor about $900,000 a year for two years, with two two-year extension options, for maintenance, support and upgrade, according to the state. The state agency paid $570,000 for installation of the prescription monitoring system.

LARA is also paying Appriss another $1.8 million to help it integrate with its PMP, EHR and other data systems of various pharmacies, healthcare systems and providers across the state.

State officials felt they needed the modern tech firepower to stem a rapidly widening crisis that saw overdose deaths spike 24.5% from 2015 to 2016, according to the Centers for Disease Control and Prevention.

Appriss established in PMP world

Gaedeke said Appriss' experience in the PMP field helped the state communicate the benefits of participating in the new prescription monitoring program to the 28,000 or so Michigan health professionals, including doctors and pharmacists, registered in the PMP.

"We were excited to get the vendor that has a strong presence and the expertise needed for running these types of programs," Gaedeke said.

Appriss has roots in the pharmacy information system business and got into prescription drug monitoring in the mid-2000s when the federal government began to strictly regulate pseudoephedrine, a crucial ingredient of methamphetamine.

Rob Cohen

Then, after 2010 when many states started to put in PMPs, the company began to develop software, now called PMP Interconnect, to help share controlled substance prescribing information across state lines and integrate pharmacy information with most major EHR and pharmacy IT systems.

"There's a lot of data flowing both among the states, as well as directly into EHRs and pharmacy systems," said Rob Cohen, president of Appriss Health.

From law enforcement to public health

The evolution of the company, Cohen said, has paralleled the gradual change in approach for prescription monitoring as the technology is becoming less of a law enforcement tool for catching overprescribing and "pill-shopping" and more of a public health tool.

Also, in the past, PMPs and electronic prescribing systems have been fairly limited tools restricted to looking up data to prevent overprescribing or use related to specific physicians and patients.

Now, Cohen said, the technology is scaling up to make prescription data more open and available, largely in response to the gravity and breadth of the opioid crisis across the country.

"The problem is at such a scale now that this is data that should be available and visible to the physician in every single patient encounter," he said.

Under the traditional system, if a patient came in for, say, a urinary tract infection, and a physician prescribed an antibiotic, there would be little reason to check a drug database.

"We have the exact opposite viewpoint, which is this is an opportunity," Cohen said. "This person sitting in front of you, while they're here for a UTI, they may have a substance abuse disorder, or they may be on the road to one, and we have to take every opportunity to help these folks."