Pa­tient drug use data at your fin­ger­tips

Modern Healthcare - - INNOVATIONS - By Rachel Z. Arndt

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.”

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