K-TRACS
Marty Singleton Assistant Director
Kansas State Board of Pharmacy 800 SW Jackson, Ste. 1414
Topeka, KS 66612 Ph: 785.296.4056 Fax: 785.296.8420
marty.singleton@pharmacy.ks.gov
KANSAS TRACKING AND REPORTING OF CONTROLLED SUBSTANCES
Creating K-TRACS
SB 491- 2008 Legislative Session -Enacted prescription monitoring program (PMP)-38th state to enact legislation
Provided no funding for the program
Obtained Federal grant funding in late 2009
Fully Operational in 2011 (Rx data back to 7/1/10)
Original software vendor was HID
K-TRACS Basics
Dispensers required to report to K-TRACS daily as of January 1, 2013
Dispensing information on Schedule II-IV drugs as well as drugs of concern
Includes drug, dosage, frequency, number, days’ supply
Includes identifying information about prescriber and dispenser
Includes identifying information about patient
Emergency dispensing for a 48 hour supply of the prescription or less does not have to be reported
Medications dispensed to inpatients do not have to be reported
Drugs of Concern
68-21-7. Drugs of concern. (a) Each of the following shall be classified as a drug of concern:
(1) Any product containing all three of these drugs: butalbital, acetaminophen, and caffeine;
(2) carisoprodol; and
(3) tramadol.
(4) Board just voted to add Promethazine with Codeine
(b) The stakeholders of the program shall be notified by the board if a drug is to be considered by the board for classification as a drug of concern.
(c) Any individual who wants to have a drug added to the program for monitoring may submit a written request to the board.
Who is Currently Reporting?
KSA 65-1682
‘‘Dispenser’’ means a practitioner or pharmacist who delivers a
scheduled substance or drug of concern to an ultimate user, but does not include:
(1) A licensed hospital pharmacy that distributes such substances for the purpose of inpatient hospital care;
(2) a medical care facility as defined in K.S.A. 65-425, and amendments thereto, practitioner or other authorized person who administers such a substance;
(3) a registered wholesale distributor of such substances;
(4) a veterinarian licensed by the Kansas board of veterinary examiners who dispenses or prescribes a scheduled substance or drug of concern; or
(5) a practitioner who has been exempted from the reporting
requirements of this act in rules and regulations promulgated by the board.
Data Reporter Highlights
DISPENSING PHYSICIANS- Required to Report (hard to track
compliance)
Reports required weekly from April 2011 to Jan 2013
Beginning Jan 1, 2013 Pharmacies Required to Report within 24 hours of
Dispensing a Controlled Substance or Drug of Concern
System contains retroactive data back to July 1, 2010
Most Kansas pharmacies in compliance
Data Delivery Methods
Acceptable methods of data submission to K-TRACS:
Secure FTP over SSH (shared service provider)
Encrypted File with Open PGP Via FTP
SSL Web Site
Physical Media (Tape, Diskette, CD, DVD)
Universal Claim Form (UCF) Submission
Paper Submission
Who Can Request PMP Data
Board is authorized to provide PMP data to
Prescribers and Dispensers “for the purpose of providing medical
or pharmaceutical care to their patients”
Individuals for their own information
Individuals from administrative oversight agencies
Law enforcement officials-with grand jury or inquisition
subpoena, for a case they are currently investigating, regarding a
given suspect
KDHE regarding Medicaid recipients
PMP staff and Board staff
De-identified data can be given for statistical, research, or
educational purposes
Threshold Letters
In addition to solicited reports through the K-TRACS portal, letters are sent to prescribers and dispensers when threshold have been reached or exceeded by a patient during a given quarter. Current threshold is 5/5/90.
We encourage prescribers to review Patient PMP Report to confirm whether or not they wrote the prescriptions shown on the reports
If the report is accurate, prescribers and dispensers are advised to discuss their concerns with the patient. If records on a report appear to be inaccurate,
prescribers are asked to contact the dispensing pharmacy to correct the record in error.
One goal of these reports is to help identify patients who may need substance abuse treatment. Clinicians are asked to assist such patients in finding
K-TRACS
KANSAS TRACKING AND REPORTING OF CONTROLLED SUBSTANCES
Threshold Data
Threshold data (5/5/90) for 2013 and 1Q14:
1Q13: 78 - HID
2Q13: 13 - HID
3Q13: 308 - Appriss
4Q13: 276 – Appriss (10.4% decrease)
1Q14: 223* – Appriss (19.2% decrease)
* Top diverter saw 27 prescribers and 20 dispensers (new record!). Has been in the top 20 for three straight quarters.
K-TRACS
KANSAS TRACKING AND REPORTING OF CONTROLLED SUBSTANCES 0 50 100 150 200 250 300 350 1Q13 2Q13 3Q13 4Q13 1Q14
Patients Meeting 5/5/90 Threshold
K-TRACS
KANSAS TRACKING AND REPORTING OF CONTROLLED SUBSTANCES
PMP Stats
K-TRACS contains 22.1M Rx records as of 5/5/14 (KS pop: 2.89M)
Web requests: 1/1/14 – 4/29/14 = 97,015 (24.3K/month average)
Feb report was 17.5K/month average (28% increase).
Web + PMPi: 1/1/14 – 4/29/14 = 191,962 (48K/month average)
Feb report was 36.6K/month average (24% increase)
For 2014 YTD PMP is averaging about 1600 patient queries per day including PMPi. When all “integration partners” are in production in 2015 with EHR integration, we are estimating at least 12000 patient queries per day including PMPi.
“Technology”
Third party data repository – vendor is Appriss.
Utilizes proprietary system developed in house called AWARxE.
Optimized for interoperability, performance and scalability
Ideal for integration into EMRs where “transactions” increase
significantly (Access through PMPi)
System uses Ruby language with JavaScript on the front end and
some Java on the back end.
Data is stored in dual server locations – “instantly”.
Offsite tape backup daily and all data is encrypted.
K-TRACS
Data Repository Features
Data submitted by dispensers is processed immediately (requires no “batching”) ASAP 3.0, 4.1, or 4.2 accepted (can accept all at once)
Data is available for patient queries immediately
Software constantly matching patients for consolidation
Uses multi factor algorithm that utilizes fuzzy logic for name and DOB. Version 2 will use name analytics (up to 13 factors).
Data errors immediately reported back to dispensers
Dispensers can make error corrections online
Multi state AWARxE dispensers (Pharmacy chains) can report to one location
Kansas PMP Receives SAMHSA Grant
(Substance Abuse and Mental Health Services Administration)
$450K used to make PMP more accessible in three targeted areas:
Integrate PMP into EMRs with an HIE (LACIE & KHIN)
Integrate PMP into Pharmacy workflow
Integrate PMP into Hospital Emergency Room EMRs
Kansas PMP Grant
LACIE (Lewis And Clark Information Exchange)
Cerner finishing software development work.
Starting first hospital pilot by mid May.
Children’s Mercy Hospital in Kansas City.
Will begin with 10 ER Physicians/APRNs.
Working with key staff to establish credentialing process
Kansas PMP Initiatives
LACIE Process & Workflow
1a. EMR queries LACIE
1b. LACIE Loads in EMR
2a. K-TRACS link is clicked & LACIE ‘calls’ K-TRACS
2b. K-TRACS Pop-Up Window displays
18
LACIE User’s View
K-TRACS PDMP REPORT
19
KHIN (Kansas Health Information Network)
MOU has been signed with KHIN. Cannot allow storage of PMP data.
Technology / method is available going through VCH. All involved have reviewed the plan and agree it will work. Test message was successful.
IT has developed a proposal and cost estimate to present to VCH leadership for approval to use VCH IT resources.
SAMHSA grant funds are available to fund development.
Development would begin in July, with a pilot in 4Q14.
Kansas PMP Initiatives
Pharmacy Partner Integration
SAMHSA grant funds are available to help fund development.
Have draft MOU in review process with legal and Pharmacy Board.
Ohio and South Carolina are two other states working with this partner.
Goal is to have PMP available in Pharmacy software at DUR.
Goal is to make software “generic” to be used by any pharmacy software.
Information is delivered in standard format to pharmacy “porch”. Then formatted to specific pharmacy software for displaying in work flow.
Kansas PMP Initiatives
Kansas PMP Initiatives
Via Christi Hospitals
Emergency room partner for PMP EMR integration VCH has single sign on
3Q13 pilot with one ER
4Q13 production with multiple ERs
1Q14 continuing to ramp up more ERs and clinics
Grant funds passed on for development work
Grant funds now paying for PMPi access
K-TRACS
123456 1234567891 0
Mouse, Mickey 16 0 Ott, M Jacob J Michael Patton 987654 9876543210
9
Duck, Daffy B1 0 3 / 2 Stangl, Robert
Donna E Sweet 234567 2345678910
1
Pig, Porky 1A 0 6 / 5 Meinecke, Curt Andrew M Barcla 200000 2000000001 0 Leghorn, Foghorn 05 0 Botros, Maged Henwood, John 800000 8000000000 1
Bunny, Bugs 22 0 Chang,
Howard
Val J Brown Jr 456789 45678910111 Fudd, Elmer 20 0 Rogers, Mark Larry R Hund
Indicates no scripts within last 100 days
Indicates warning: scripts dispensed within last 100 days (less than 5) Indicates threshold exceeded: 5 or more scripts dispensed within last 100 days Number of scripts dispensed Number of physicians dispensing
Wichita Hospitals Integration
29
• When the physician clicks on the cell with the PDMP score the detail data
from the PDMP query is rendered and displayed. Queries are performed automatically when patients are admitted to the Emergency Department
Physicians click the KTRACS button to
request a PDMP query be performed
PDMP score is displayed with a color coded Red / Yellow / Green
button.
Clicking the button opens the full report
All methods open the detailed report showing PDMP data
retrieved from KTRACS
The Future of K-TRACS
K-TRACS migrating from MIME (Multipurpose Internet Mail Extensions)
Most PMPs currently use MIME to communicate
K-TRACS going to “PMP Gateway” with Appriss
API (Application Programming Interface) will be XML (Extensible
Markup Language) for patient query request responses (reports back
to prescribers/dispensers)
Can easily communicate with Hospitals, HIEs or Pharmacy Chain’s
systems ( via HL7 (Health Level 7) or NCPDP (National Council for
Prescription Drug Programs))
The Future of K-TRACS
SB 134 Signed into Law:
Allows Coroners and Medical Examiners Access to Data
Creates “peer review” process to identify problem prescribers and dispensers and help them get the education they may need
Identify problem patients and refer them to treatment facility or worst case scenario (obvious doctor shopping and selling situation-to law enforcement)
Harold Rogers Grant:
Working with Department for Children and Families (SRS) to have Social Workers meeting with patients identified as diverting to offer services and rehabilitation. 2Q14
Working with Kansas Bureau of Investigation (KBI) to review patients diverting with thresholds of criminal proportions. 3Q14
K-TRACS
Marty Singleton Assistant Director
Kansas State Board of Pharmacy 800 SW Jackson, Ste. 1414
Topeka, KS 66612 Ph: 785.296.8717 Fax: 785.296.8420
marty.singleton@pharmacy.ks.gov
KANSAS TRACKING AND REPORTING OF CONTROLLED SUBSTANCES
