Medical lobby warns against mandatory drug database

Michael Gerstein
The Detroit News

Lansing — In the midst of a heroin and prescription overdose epidemic, Michigan lawmakers and a medical lobby are sparring over the best way to use a new online system aimed at better tracking powerful opioid painkillers.

The lobby group, the Michigan State Medical Society, and Republican state Sens. Dale Zorn of Ida and Tonya Schuitmaker of Lawton are at odds over whether doctors should be required to use a new drug tracking system for monitoring the administration of drugs throughout the state. The tracking system should be operable in early April.

The legislators are sponsoring separate bills that would require doctors to make the new system mandatory. The society, which lobbies on behalf of doctors, would prefer that using the new drug tracking system remain voluntary. Other prescribers also use the current system on a voluntary basis.

The new computing system and the proposed legislation are part of a continuing effort to curb opioid abuse in Michigan where heroin- and opioid-related overdose deaths increased to 1,001 in 2014 from 99 in 1999, according to statistics from the Department of Health and Human Services.

No hearings have been scheduled on the legislation as staffs of the lawmakers and the medical group discuss the proposals, said Schuitmaker and Paul Egnatuck, Zorn’s chief of staff.

“We’ve been working with the sponsors in both situations to try to come up with language we can both support, which is the natural course of any legislative process,” said Colin Ford, state and federal government relations senior director for the medical society.

Ford said the group prefers voluntary use of the system until it sees how it functions, although “that’s not necessarily an intractable position.”

The computing upgrade to the Michigan Automated Prescription System was a key part of Gov. Rick Snyder’s plan to curtail an opioid epidemic. Several groups representing doctors, pharmacists and hospitals have all hailed the update as a way to fight addiction by helping doctors and law enforcement identify those who might be going from doctor to doctor to get pills.

The new system is cloud-based, updates in real time and is supposed to be much easier to use, according to those familiar with it.

Legislation signed last year by Snyder allotted $2.5 million for a new cloud-based database and did not require doctors to check the system before prescribing addictive painkillers to patients. Although some in the industry say the proposal could help fight the state’s opioid abuse epidemic, the medical society has voiced strong concerns that requiring use of the new system would be time consuming and add more work for doctors.

“Mainly our concern … is the sequencing of things,” Ford said. “And right now, when you look at the MAPS system ... it’s not very user-friendly. It’s not something that is easily integrated into physician work flow.”

It can take 10 minutes to get a patient’s prescription history with the current system, according to those familiar with it.

That’s “on a good day,” said Peter Graham, a doctor with Physicians Health Plan in Lansing, a subsidiary of Sparrow Health System.

Critics said doctors often avoided using it because it was cumbersome and did not update in real time. Getting a report on the new system will take only a few seconds, state officials say.

A Snyder-appointed opioid task force in 2015 recommended mandatory use of the prescription tracking system once the upgrade was complete. The task force also recommended mandatory registration on the new system for all licensed prescribers so doctors will be ready to use it as soon as it comes online. Neither has happened.

Graham, who has tested a beta version of the new system, said it is “much easier,” but cautioned that mandatory use “has a lot of pitfalls.”

Schuitmaker balked at assertions the new system would attract more users if doctors are not forced to check it.

“If you really want to save lives you have to make it mandatory,” Schuitmaker said. “I think you’d have about the same success rate as now (if not), which is not good and it’s certainly not cracking down on the people who are problems in the system.”

Data obtained from a Freedom of Information Act Request shows a steady increase in doctors accessing the system since it came online in 2003. By 2009, the state recorded 444,485 queries on the database. In 2016, the number of queries had jumped to more than 4.6 million.

It’s impossible to say what proportion of doctors actually use the system regularly, however, because the state keeps track of how many licensed prescribers are registered, not how many actually use it.

State data show 38.2 percent of all licensed prescribers have a registered account with the program. The data also show that doctors made more than 4.6 million queries in 2016, but authorized 21.26 million prescriptions. It’s not clear how many of those prescriptions were opiates because state reports don’t break down prescriptions by drug type, according to the state Department of Licensing and Regulatory Affairs.

Most doctors have a vendor that pulls prescription data from their record system and uploads it onto the MAPS database, but doctors are not required to check that information after it’s uploaded, according to LARA.

Too few doctors check patients’ prescription history, said Kim Gaedeke, director of the Bureau of Professional Licensing. Gaedeke said the number of doctors registered to use the system might be even lower than indicated because some are registered multiple times.

Others in the health care industry agree.

“The trend is something we would consider positive. (But) it’s not a substantial number,” said Eric Roath, director of professional practice for the Michigan Pharmacists Association. His organization supports legislation to require that doctors use the new database.

“It’s important for prescribers to know everything that their patients are taking,” he said.

Tracking

prescriptions

The Michigan Automated Prescription System logs how many times the system is checked by doctors or their designees, but does not break down the types of drugs administered. Here are the number of queries into the database by year.

Year

Total MAPS queries

2009

444,485

2010

560,220

2011

855,267

2012

1,264,841

2013

1,816,932

2014

2,701,676

2015

3,774,549

2016

4,653,784