MassPAT: New, simplified Rx database
Retrieved from the Betsy Lehman Center for Patient SafetyWhen one of his primary care patients called in recently seeking a pain prescription, Dr. Alain Chaoui was not surprised. The family practitioner from Peabody had referred the patient for surgery a few weeks earlier.
September 23, 2016
But when Chaoui checked the person’s records through the Massachusetts Prescription Awareness Tool (or MassPAT), the state’s new prescription monitoring database, he learned within seconds that the surgeon had already prescribed oxycodone to his patient.
Under state law, doctors must avoid writing overlapping opioid prescriptions.
“This was not a patient who was ‘doctor-shopping,’ ” Chaoui explained, using the term for narcotic-dependent patients who hop from doctor to doctor seeking opioid prescriptions. “He had just used up his first set of pills, and it was easier to call his usual provider than go back down to Boston for a refill.”
Chaoui asked his patient to call the surgeon directly, and also sent his colleague a message. He received a thank-you back. “The surgeon said he prefers to handle post-op pain himself so he can make sure the patient is tapered off the drug,” Chaoui said.
While hardly dramatic, the story illustrates why the state’s revamped prescription monitoring program, rolled out by the Department of Public Health (DPH) last month with the backing of physicians, pharmacists, and other health care providers, is vital to patient safety.
Research is clear that over-prescribing opioids (and other Schedule II through V controlled substances, including stimulants and sedatives) can lead to addiction, overdoses, and death. So besides helping doctors identify opioid-dependent individuals and direct them to treatment, the new system prevents ordinary patients from falling into the addiction trap.
“We know that safe prescribing practices must be part of a multidimensional response to this public health crisis,” said Monica Bharel, commissioner of DPH. “As we address the stark reality of losing four Massachusetts residents per day to the opioid epidemic, we must support evidence-based, innovative approaches like the improved MassPAT system to reverse this deadly trend.”
It is fair to say that health care providers and state regulators do not routinely agree on oversight measures. When prescription monitoring programs were first introduced by states like Massachusetts more than a decade ago, many physicians and medical groups balked at the idea that government was monitoring their prescribing practices. Since then, the discussion has moved from whether to do it to how to do it well.
Launched on Aug. 22, the MassPAT system has the distinction of being a government project that was born of intense public-private cooperation, was ready on time, and has gotten positive reviews from stakeholders. It’s an outcome worth emulating in the field of patient safety and error reduction. So how did it happen?
MassPAT fulfills a goal laid down about a year ago when Gov. Charlie Baker’s Opioid Working Group called for an overhaul of the state’s existing Prescription Monitoring Program, or PMP, which was faulted for being slow and complex and plagued by inaccurate and outdated data.
Tasked with fixing it, the DPH’s Bureau of Healthcare Safety and Quality, led by its director, Eric Sheehan, called together representatives from the Massachusetts Medical Society, the Massachusetts Hospital Association, pharmaceutical trade organizations, the Attorney General’s office, and others, for advice and support.
“We were impressed that the state was so clearly ready to invest the resources and personnel required ensure that the transition to the new enhanced program was seamless for all stakeholders,” said Patrick Huntington of the Massachusetts Chain Pharmacy Council, which made dozens of volunteer testers available to ensure that the new tool functioned in a business setting.
“It’s no longer a clunky system that takes a long time to connect to or get information,” he said. “It’s now very efficient and easy to use.”
Under a tight deadline, the DPH and its partners set out to create a system that offered:
Simple sign-in and easy navigation, while providing far quicker search results.
Nearly real-time prescription information (to prevent patients from “doctor shopping,” which was possible under the older system which was slow to update).
Shared data with a growing U.S. network of state-based prescription monitoring programs.
Easy enrollment procedures for prescribers and their “delegates” – staff members who could input patient data, helping busy practices cope with the workload.
The first decision was hiring an experienced vendor who could collaborate with DPH and state Information Technology (IT) officials to launch MassPAT in a short window of time without dropping any data from the soon-to-be-outdated system.
Appriss, a Kentucky software company that has prescription monitoring programs in 25 states and the District of Columbia, was awarded the $6 million contract over five years. Planners liked the software’s interstate sharing capacity, which for now connects Massachusetts to databases in a dozen other states; its average 1.8-second search response time; and its security measures.
In addition to fulfilling those core needs, Appriss also provides users with a 24/7 help desk.
Pharmacy practices input data that reflect filled prescriptions for Schedule II through V medications into the MassPAT system. Prescribers can then query the database to review a 12-month medication history for patients before writing or renewing their prescriptions.
Read more at the Betsy Lehman Center for Patient Safety website.