December 8, 2004
Eastern Kentucky's legacy of prescription drug abuse has been well publicized over the past few years, making both local and national headline news. Back in April 2004, after 211 alleged drug dealers were arrested in Hazard, Kentucky, the largest drug bust in the state’s history, it prompted MSNBC to call eastern Kentucky the "...ground zero of prescription-painkiller abuse." The media reports got the attention of Kentucky Congressman Hal Rogers. After House Bill 26, which called for the delivery of a pilot pharmaceutical monitoring system in eastern Kentucky, passed in the 2002 Kentucky legislature, Congressman Rogers took action by helping to get that project off the ground in Perry and Harlan counties. The pilot was designed to test a new electronic method of monitoring the prescription drug process. Now the results of that pilot are nearing completion and may prove helpful down the road as the Kentucky All Schedule Prescription Electronic Reporting (KASPER) system continues to look at improvements.
Staff at the Clover Fork Clinic in Perry County work with the new electronic prescription drug monitoring equipment. It's not uncommon for a pharmacist to carry a firearm while on the job.
The Kentucky Cabinet for Health Services implemented a Schedule II-V prescription-reporting program effective January 1, 1999 with the passage of Kentucky Revised Statutes (KRS) 218A.202. The schedules range, for example, from Oxycontin (a schedule II narcotic) to Robitussin AC, a schedule V narcotic. Illicit drugs such as cocaine and heroin are considered schedule I drugs. The system was originally housed in the Cabinet's Public Health Department. With the recent reorganization of state government in Kentucky, the system, along with the entire Drug Enforcement and Professional Practices Branch (DEPPB), was moved to the Cabinet's Office of the Inspector General. The KASPER system currently produces in excess of 475 reports per day. The reports detail Schedule II-V drugs dispensed by pharmacies, dispensing physicians, dispensing veterinarians or other Kentucky licensed dispensers. A private contractor, Atlantic Associates, Inc. (AAI), collects all data and manages the technical aspects of the data collection from the commonwealth’s 2,300 reporting dispensers. The primary focus of KASPER has been to enable physicians and pharmacists to better manage the care of their patients and customers and it is these practitioners who greatly utilize the system. In addition, pharmacists and investigators in the DEPPB review and analyze the data collected. These reviews often identify potential cases of doctor shopping, drug diversion, drug over-utilization, misuse or over-prescribing. Where allowed under the law, suspected patients, prescribers and dispensers are referred to the appropriate practitioners, law enforcement agencies, professional licensing boards or other agencies. Law enforcement and regulatory agencies also request reports to aid in their existing investigations of illegal drug diversion.
All pharmacies, dispensing physicians, dispensing veterinarians or other licensed dispensers in Kentucky who dispense prescriptions in Schedule II, III, IV and V drugs are required under KRS 218A.202 to report. (Reporting is not required for controlled substances dispensed to hospital inpatients, skilled care patients or intermediate care patients.) A record of each Schedule II-V prescription dispensed must be completed and submitted to AAI twice a month. Since the start of the pilot project, but unconnected to the pilot, the KASPER system has undergone modifications which will include more timely and up-to-date reporting by pharmacists to the system. Under a new contract with AAI, the KASPER system will begin collecting data weekly. New regulations are being written to require dispensers to report weekly. This will reduce the delay in data collection by half. Other enhancements to the KASPER system include a secure Web enabled application that will allow doctors and prescribers the ability to request reports online and see the results in minutes rather than the current four hour target. This is known as "real time access" by authorized users, as opposed to "real time reporting" by pharmacists to the system. New features for the traditional users that fax requests into the KASPER office will allow quicker turn around for those requests with reduced staff. The new enhancements will begin to roll out in January 2005.
Closer to "real time reporting" to the system has always been an ultimate goal for the KASPER staff, so that the data is more fresh for those who are authorized to receive. That is where the results of the pilot may be of assistance.
The pilot was designed to gauge the effectiveness, cost, and stake-holder buy-in of developing a system whereby the information would be entered into the database by the doctor at the point of prescribing the medication. Upon prescribing a schedule II-V narcotic, the doctor would utilize a notepad computer to identify the patient, select the appropriate medication and quantity from the database and print the prescription on secure bar-coded paper that would allow the patient to take a copy of the prescription to the pharmacist for filling. Upon being presented the prescription, the pharmacist would then scan the bar-code for positive identification and mark the prescription as filled. This mechanism also provides for a safer transition from doctor to pharmacist in that the prescription information is printed clearly, relieving the pharmacist of having to decode doctor handwriting and chance misfilling. Once the prescription has been filled and the database updated, the data would immediately be made available for reporting via the KASPER system as well, as opposed to being reported to the system on a semi-monthly or weekly basis.
In addition, the pilot effort was designed to identify the cost of enabling each doctor's office with appropriate hardware, software and infrastructure and determine the cost of time spent by the doctor to enter the information that they had not previously been required to do. Identifing HIPPA* issues, concerns and obstacles that may inhibit such a system to be implemented was also important.
Upon completion of the pilot project, the Commonwealth Office of Technology has contracted with the University of Louisville to provide an assessment of the project along with all the issues involved in a possible implementation of an application of this nature. Once the assessment has been completed, the goal will be to provide the information to those associated with the KASPER project in order to determine the feasibility and viability of introducing various enhancements into the KASPER application.
The final Phase III deliverables are being completed during the month of December 2004 with the UL assessment to be completed by the end of December 2004.
HIPPA stands for the Health Insurance Portability and Accountability Act.
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