In July 2017, Georgia passed House Bill 249, transitioning the state’s Prescription Drug Monitoring Program (PDMP) from the Drug and Narcotic Agency to the Department of Public Health. “The goal of the Georgia PDMP is to reduce the misuse of controlled substances and to promote proper use of medications used to treat pain, as well as to help diminish duplicative prescribing and overprescribing of controlled substances,” said Georgia Department of Public Health Commissioner Patrick O’Neal, MD. The new mandates call for providers to utilize the PDMP system for prescriptions of opioid and benzodiazepine medications. Now, prescribers of CII medications are required to review a patient’s PDMP information every 90 days, unless the patient meets specific criteria. Pharmacy Monitoring Systems are regulated by individual states, each imposing its own unique requirements for reporting.
Under Georgia’s Department of Public Health’s PDMP system, prescribers receive an alert when treating a patient who takes a high number of prescriptions, or when there is a potentially dangerous combination of medication being administered across providers. Law enforcement agencies can also utilize information from the database, after obtaining a subpoena, to investigate prescribing patterns of physicians who are not compliant. States vary in what medications are required to be monitored, the duties of providers in terms of warning patients about combinations of medications or being over-prescribed, or which providers can view the database. Despite the widespread variation, the data obtained through the PDMP monitoring system can be utilized to identify trends in prescribing patterns and at-risk areas, a step towards combatting the opioid epidemic, a national community health initiative. Critics of PDMP’s establishment complain about the lack of user friendliness of the database. To resolve this, some providers, for example Southeast Permanente Medical Group, have integrated their network Electronic Health Record (EHR) system with the PDMP. By combining the systems, usability can become more widespread which encourages compliance with the new mandate.
Nation-wide, companies are integrating state monitoring systems with patient EHR’s and pharmacy management systems however, questions arise about patients’ privacy rights and conflicting state laws. While PDMP programs do not fall under HIPPA, providers accessing the programs are still subject to regulatory guidelines pertaining to access of patient information. Traditionally, a personal healthcare relationship was required in order to access a patient’s medical record. The Privacy Rule, established under the Affordable Care Act, is being put to the test as more people can gain access to a patient’s medical record of integrated EHR’s and PDMP databases. As providers face new requirements being implemented by states to monitor prescription drug utilization to promote safety, policy makers will need to continue to weigh the costs and benefits of utilizing databases to monitor patient care for community health and drug abuse purposes, with privacy rights and imposing more responsibilities on providers.
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