Prescription Drug Monitoring Program Integration in the Electronic Health Record

The adoption of prescription drug monitoring programs (PDMPs) has been a central pillar in the U.S. response to the evolving opioid epidemic. PDMPs are state-administered centralized electronic databases that collect and report controlled substance prescriptions. These data systems are used by a variety of stakeholders including clinicians, who can log into an online portal to review prescribing histories for their patients. Reports on the effectiveness of PDMPs and policies governing their use have been mixed. This likely reflects heterogeneity of programs, their evolution over time, and differences in study designs evaluating these programs. A common barrier cited by clinicians to using PDMP data in practice involves the time and effort required to register, log in to website portals, and navigate and interpret PDMP reports. A promising approach to enhance PDMP use and effectiveness is integration within the EHR or other health information technology platforms. As such, state and federal health authorities have made integration of PDMPs a focus of infrastructure funding. Studies from several of these early integrations have shown that EHR integration can significantly improve how often clinicians query the PDMP.

In 2019, Oregon Health & Science University (OHSU), the state’s only academic medical center, underwent PDMP integration within its EHR platform in primary care clinics over a 6-month period. Researchers used this opportunity to evaluate the impact of this integration on clinician query rates of the PDMP and controlled substance prescribing behavior.

The specific aims of the research were as follows:

• Determine the effect of PDMP EHR integration on provider PDMP use.
• Evaluate the effects of PDMP EHR integration on controlled substance prescribing.

The study was conducted in all twelve ambulatory primary care clinics affiliated with the OHSU academic medical center located in the Portland, Oregon metropolitan region. Using a stepped-wedge observational design, researchers evaluated the effect of the PDMP EHR integration on monthly PDMP queries by clinicians (including physicians, nurse practitioners, and physician assistants) practicing within study clinics as well as opioid prescribing.

They found that integration of the PDMP in the EHR was associated with nearly a 3-fold increase in the number of PDMP queries requested, which is consistent with the growing number of studies that have assessed the effect of EHR integration on PDMP use. There was no association between integration of the PDMP and overall opioid prescribing; however, they did see a significant decline in patterns of opioid polypharmacy. This suggests that PDMP integration may have a role for improving coordination of opioid prescribing across providers.