Patient drug use data at your fingertips
Every time Dr. Gina Huhnke writes a prescription for opioids, she first consults a number in the patient’s electronic health record. That number, a risk score that providers can use to gauge a patient’s risk for a substance-use disorder, tells her whether she should prescribe the drug or instead have a conversation about drug addiction.
“Sometimes even the patients themselves are surprised,” said Huhnke, director of medical affairs and emergency medicine at Deaconess Health System, based in Evansville, Ind. The score is algorithmically generated by a platform created by Appriss Health with information from prescription drug monitoring programs and patient health histories.
Providers like Huhnke say it could help curb skyrocketing opioid abuse and death rates in the U.S. In 2015, 12.5 million people misused pain relievers, according to that year’s National Survey on Drug Use and Health.
To help combat the misuse and lower the death rate, states have adopted prescription drug monitoring programs that log the medications dispensed within their borders. Forty-two of the 52 prescription drug monitoring programs in the U.S. use Appriss Health to access state data, drawing on the company’s Awarxe database, which catalogs all of a state’s controlled-substance prescriptions.
That information is integrated into pharmacy and clinical workflows with Appriss’ PMP Gateway, for which Appriss Health charges a fee per provider—except in several states, such as Indiana and Virginia, that have purchased licenses for all the providers and dispensers within their borders.
Appriss Health’s Narxcare analyzes the data. Whereas a basic PDMP report might contain a historical list of prescriptions for, say, the last two years for a patient, Narxcare visualizes that information and produces risk scores so providers don’t have to sort through heaps of raw data—and it does so from within the pharmacy management system or EHR, including in those made by Epic, Cerner, Allscripts, eClinicalworks and Athenahealth. Narxcare has been around since early 2017 after growing out of software Appriss first released in 2011.
“These numerical scores are awareness triggers,” said Dr. Jim Huizenga, Appriss’ chief clinical officer. However, providers still need to talk with their patients, he said.
The data make those discussions with patients easier, said Rob Cohen, president of Appriss Health. “They can now say, ‘I’ve got this score that was produced through machine learning, and based on this score, I think you should be concerned,’ ” he said. It takes the judgment out of providers’ hands and patients react better.
And the risk scores make patients more amenable to conversations, Huhnke said, especially when most patients have no idea that their doctors have this kind of information in the first place. Since Deaconess began using Narxcare in May 2017, “I’ve had several patients who were not happy that I was able to access this information,” she said. “The risk score changes the conversation from, ‘We’re the police, and we’ve caught you doing something bad’ to ‘We’re the healthcare providers, and we’re here to help.’ ”
For instance, after Huhnke found out from Narxcare that one of her elderly patients had opioid prescriptions from multiple providers, she advised the patient to change her medications. She’s also referred patients to treatment programs after Narxcare helped her identify their substance-use disorders.
There’s even more Appriss can do to help patients with substance-use disorders, Cohen said. The company’s software already offers a medication-assisted treatment locator.
“Where we’re really just dipping our toe is in how you help physicians help patients and help patients help themselves,” Cohen said. So instead of just printing out a list of nearby providers, the software might, in the future, enable appointment-scheduling.
Medication-assisted treatment is crucial, said former Rep. Patrick Kennedy, who serves on the Commission on Combating Drug Addiction and the Opioid Crisis. But it must dovetail with mental health and spiritual approaches—as well as a change in the provider community.
“I’m disheartened by the response to this public health crisis,” he said, noting that only a small fraction of providers offer medication-assisted treatment. “Physicians had no problem prescribing opiates, and now they’re turning their backs on people with addiction.”