It is no secret that millions of Americans are struggling with opioid addiction, and the number of addicts is only increasing. This continued struggle led the President to declare a state of emergency to fight the opioid epidemic earlier this month.
Battling the opioid epidemic is especially difficult because prescription medications are more accessible than ever before, resulting in patients exploiting the medical system to gain access to them. According to Information Management, “Some individuals abuse the system by getting appropriately prescribed medications from friends and family. Others are counting on the fact that providers are not aware of their addiction as they hop from one healthcare system to another to get their fix.”
The exploitation of the medical system has resulted in 49 out of 50 states implementing prescription drug monitoring programs (PDMP). A PDMP is used to document and track the prescribing and supplying of opioid and other controlled prescription drugs. When PDMP data is combined with electronic health record (EHR) system data, medical providers can use data monitoring and analytics to identify potential patterns of suspect utilization and potential exploitation of the system.
Calculating the Risk
To calculate the likelihood that a patient is abusing the system, healthcare providers should monitor PDMP and EHR data. Monitoring the number of providers a patient has accessed, the number of pharmacies serving a patient, the total active prescriptions, and the amount dispensed per prescription can all help indicate if a patient is exploiting the system or not.
This data can then be analyzed to determine if a patient has a legitimate, ongoing medical need for a prescription pain medication, or if they may have developed an addiction that needs intervention. For example, if a patient has seen four different providers and received four different prescriptions for similar medication in the matter of two weeks, the likelihood that they are abusing the system is high. However, if a patient has only seen one provider in the last year and the patient doesn’t have any active prescriptions, then that patient is highly unlikely to be taking advantage of the system.
This is a great first step in the battle against opioid addiction, but without quality medical data populating PDMP and EHR systems, it will fail.
Managing Opioid Addiction through Data Quality
To ensure data quality across PDMP and EHR systems, healthcare providers will need a solution that allows them to detect bad data as early as possible across any type of data environment. The solution should continually monitor PDMP and EHR data to ensure that bad data is immediately flagged and stopped before it impacts patients.
In healthcare, duplicate files are a common occurrence. When files are being received daily, the previous days’ files are often sent in error. Duplicate files can easily impact risk calculations. For example, if the same file was sent five times it may look like a patient has five active prescriptions, leading the provider to think they are likely abusing the system, even though they are not. On the other hand, it can also look as if one customer is actually multiple. A proper data quality solution can execute business rules to ensure the correct day’s file will be processed, or in the case of an incorrect file being received, an exception report will be immediately flagged and the process will prevent the incorrect file from processing.
To learn more about ensuring data quality, download this eBook.
For a deeper dive into this topic, visit our resource center. Here you will find a broad selection of content that represents the compiled wisdom, experience, and advice of our seasoned data experts and thought leaders.