In-Depth: Kick-starting a National Prescription Monitoring Network

Jan 19, 2012

LEXINGTON, Ky. – The effect of Kentucky's prescription drug abuse problem reaches beyond the state's borders. In the final segment of our three-part series, Brenna Angel reports on the challenges of launching a nationwide prescription monitoring network.

Kentucky started its prescription monitoring program in 1999, and the system known as KASPER became a model for other states. Leaders here are calling on other state governments to follow suit in cracking down on doctors who overprescribe and patients who abuse controlled substances like OxyContin, Percocet, and other pain medication.

"Right now there are 39 states that have an operational prescription monitoring program, nine states that are working towards becoming operational," says James Giglio, Executive Director of the Alliance of States with Prescription Monitoring Programs. "Missouri and New Hampshire are two states, along with the District of Columbia, that have not yet passed legislation."

Currently physicians and dentists can use a monitoring program to check where a patient gets medication only within individual states. That makes it difficult to track doctor shoppers, or patients who happen to live near a state border. Dr. Jennie Hahn is a northern Kentucky psychiatrist with patients in Ohio and Indiana.

"Even people who I'm not necessarily trying to see if they're doctor shopping, you can actually see their pattern of pharmacies that they go to. That can be an issue as well, how honest they're being with their prescriptions."

Hahn uses KASPER every day, so she was eager to sign up for a pilot project last summer to test a data exchange between Kentucky's system and the prescription monitoring program in Ohio. The project allowed her to log on to just one system to check patient information.

"It was very simple to use, it wasn't much different from the KASPER system. I found it useful. It worked well."

"One of our pilot users said that they actually got information that altered a prescribing decision, based from Ohio," says Dave Hopkins, who oversees KASPER in the Kentucky Cabinet for Health and Family Services.

Following several years of development, the pilot project proved that information could be quickly and securely shared between two states, but after only a couple of months, Hopkins says Ohio put things on hold.

"They basically informed us that until a different system that they're going to be working with called the PMP Interconnect, until that system is up and running and sharing information, they won't be able to share data with us currently."

Ohio decided to go with a data hub called the PMP Interconnect, which was launched by the National Association of Boards of Pharmacy virtually at the same time as Kentucky launched its hub, now called the RxCheck.

There's not much of a technical difference between the two hubs, but the level of governance and funding sources are different. The Interconnect is free to states for at least five years thanks to funding from a pharmaceutical company, while the RxCheck uses a federal grant. There's also a third data hub emerging called Health Information Designs.

Because of all the options now available, James Giglio with the national alliance says his group is working on an overarching framework for the different systems to follow. The alliance calls it the Prescription Monitoring Information Exchange National Architecture.

"Whatever hub a state chooses, it knows that it will be able to communicate with a state that has chosen a different hub," says Giglio.

A technical committee is working out final details of the architecture.

Dave Hopkins is confident that KASPER will soon be back to sharing valuable information about prescriptions with Kentucky's border states.

"Regardless of whether they decided to use the PMPInterconnect or if they want to use the RxCheck hub. It won't matter. We hope within 12 months we'll be sharing with all of them."

That's good news for doctors like Jennie Hahn, who depends on prescription monitoring programs to help treat and protect her patients.