Wisconsin doctors are getting used to a new tool that could bring about a change in how they do their jobs: A digital prescription drug monitoring system that can predict when a patient may be developing an addiction.
Tracking drug prescriptions in and of itself isn't new. Every state in the country except Missouri has its own prescription database that physicians, pharmacists, and law enforcement agents use to identify patterns of drug abuse.
Wisconsin has had such a prescription drug monitoring program, or PDMP, since 2013. But following a fresh volley of legislation targeting opioid abuse pushed by Rep. John Nygren, R-Marinette, and signed into law in early 2016, the state has launched a new version of the online database.
The new system, called the "enhanced prescription drug monitoring program" or ePDMP, does much more than simply spit out raw data upon a patient search request. Rather, it uses sophisticated tools built out by the Madison data quality firm MIOsoft to bring doctors' attention to the most critical information.
"Instead of merely providing users with a data table to manually review and interpret, the ePDMP provides multiple views into the data," explained Alicia Bork of Wisconsin's Department of Safety and Professional Services in an emailed statement.
When physicians search for a patient's name in the new website, notifications about things like current opioid dosage levels and potentially hazardous combinations of drugs pop up at the top of the page as large, colorful alerts.
The new system also alerts users when a patient may be developing an addiction based on predictors cataloged by Centers for Disease Control researchers.
"It's a clear improvement over the new system," said Donn Dexter, the chief medical officer of the Wisconsin Medical Society, a physician advocacy group. "There's no doubt that the new PDMP is better."
"The ePDMP has more functionality than the first version," said Gregory Love, a pain management specialist at an SSM Health facility on Park Street. "It really helps a lot to check and see that we're not having patients getting narcotics from one provider, and that they're getting good amounts."
Abuse of painkillers and their relationship with heroin addiction have come into focus over recent years as one of Wisconsin's biggest public health issues. Data from the National Household Survey on Drug Use and Health indicates that about 4.3% of Wisconsin adults use heroin or another opiate for non-medical purposes. State-collected data also shows that the number of overdoses and deaths related to heroin have been on the rise over the past 10 years.
The state said it hopes that the new ePDMP will be a new "central hub" in its fight against opiate and heroin abuse. The system is one of the first of its kind to incorporate tools that belong to the realm of "big data" analytics.
But perhaps the biggest change that the new system brings will be the rules for how doctors use it: Starting on April 1, physicians will be legally required to visit the site before ever prescribing opiates.
Dexter said that physicians around the state are taking time to acclimate to the new system before the requirement kicks in. He has no doubt that once more physicians are using it, patterns of abuse will be rooted out more frequently.
"When the PDMP goes active, and we have to look at everybody's prescription habits, we're going to find some people who have not been completely honest with their providers," he said.
But Dexter does also have concerns.
With the advent of electronic medical records, more physicians are concerned about the amount of time they spend entering data into a computer instead of interacting with a patient. Dexter said that the ePDMP presents physicians with a whole new computer-based task to incorporate into their workflow.
"What you see is a doctor working on a computer all the time, and not talking to you," said Dexter.
Dexter said that he hopes that state ultimately works toward a system where a PDMP becomes embedded within EHR software to keep doctors from "going insane" from data entry, and to help preserve patient-physician interaction.
"I don't think we're at the ideal state yet," he said. "This is a step in the right direction."
Love said that as a doctor who frequently deals with pain medication, he's long used the old PDMP as a reference point when prescribing narcotics. But for other doctors, incorporating something like the ePDMP into their workflow may be more of an adjustment.
"For those people, it will be a little bit more of a learning curve," he said. "That's why pre-planning the workflow is really important."
Ultimately, he said that the general consensus among his peers is that the ePDMP will be a boon to the fight against opiate abuse. Pharmacists will also be required to enter prescription data into the system within 24 hours after dispensing drugs, resulting in a system that will be more up-to-date.
"Generally speaking, this has been well received," he said. "This is being looked at as a tool that can help us do our job."
Numbers would suggest that Wisconsin doctors are already rolling back prescriptions as it is. The state's Controlled Substances Board recently announced that 8.2 million fewer opioids were prescribed in the third quarter of 2016 compared to the previous year.
The launch of the new system also comes as Gov. Scott Walker has proposed a special legislative session to take up a slew of new bills to address the state's opioid problem.