Thursday, January 29, 2015

Design Prescription Monitoring for Operability

By Doug Brockway
January 29, 2015

A key reason that Prescription Monitoring Programs (PMPs) are inadequate to the task of prevention of opiate abuse is a matter of consistent, enthusiastic participation and use.  People will flock to technology based products or services with superior user experiences.  The Apple suite is a commonly cited example that takes advantage of what is known as “design thinking.”  In contrast, PMPs are user-experience clunkers, designed for data analysis, not for quick, easy, universal use in an active medical office.

When considering prescribing prescription pain killers PMPs oblige doctors and pharmacists to manually examine a data base. According to recent testimony from the Massachusetts Medical Society (MMS) each lookup takes 3 to 7 minutes. This doesn’t sound like much unless you’re in the middle of a busy day at a medical practice or in an emergency room or any one of a number of situations where speed is important.

It’s as if in your day-to-day life when buying clothes at a store the sales clerk stops the sale to check your credit history.  They’d have to be sure you’re the person referred to on the screen, so they’d ask you a set of authentication and validation questions, then they’d look at your credit history and make their decision whether you’re able and willing to pay for those pants.

Instead they swipe a card (or use a mobile service like Apple Pay) and all that is done in seconds by an independent, objective, consistent third party. If on-average each retail purchase was 5 minutes longer than it is today sellers and buyers would be unhappy, grumpy, and un-cooperative with the process and each other.

With many uses of pain killers the 5 minute investment in the PMP is easily seen as too burdensome. The hospice setting is one.  So are small amount prescriptions, especially for patients well known to the physician. Emergency care, many inpatient settings so-called “immediate treatment” also might fall in this category.  Policy makers and the medical community spend much time discussing how to manage the efficiency of the process for such situations.

A process engineer will tell you that excepting uses is not advisable.  You want to collect all uses of pain killers and do your analyses from there.  You can’t/shouldn’t presume to know where the patterns are.  That same process engineer will tell you that putting a multi-step, multi-minute process in front of all data collection will sink under its own weight. This is a big part of the reason, in the case of retail, the data collection is just a swipe of a card.  For PMPs to be widely used and widely accepted in all prescription writing and fulfilling they need to create a similar capability. 

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