Q&A with Bob Pack (Part 2): System Could Flag Troubled Patients and Troubling Docs

Published on
March 17, 2013

Bob Pack had some interesting ideas for how to improve California’s prescription drug tracking system -- California’s Controlled Substance Utilization, Review and Evaluation System (or CURES). Most of them remain just that: interesting ideas. On Friday, I posted the first part of my interview with the software innovator. The second part is below. It has been edited for space and clarity.

Q: One of the biggest innovations that you proposed, if I understand it correctly, was that CURES be used not just to flag patients who were doctor shopping, but also to flag doctors who were over-prescribing. What would it take to tweak CURES to make that possible, and why do you think that hasn't happened?

A: Yes, CURES could serve as a two-part reporting system. The first would allow doctors or pharmacists to instantly access a patient’s prescription history to see if they are doctor shopping for narcotics prior to writing a prescription. The second would serve as a reporting tool for law enforcement in the attorney general’s office to review the red flag system to find so called dirty doctors who are over prescribing illegally for financial gain. It would be a matter of additional software upgrading to build the automatic red flag system about doctor prescribing patterns and produce reports for law enforcement on some kind of regular schedule. It hasn't happened because the CURES program is badly underfunded, and unless a new Senate bill for funding is passed this year, the whole program will shut down.

 Q: To my mind, this sounds similar to the way abnormal credit card purchases send a red flag to banks who then stop payments on the card or contact the customer. Is that a good comparison, or what would you think would be a better way for people to understand the type of technology you wanted to put in place?

A: The prescribing information collected by CURES could be sliced and diced in many different ways to create a red flag system. It would need to match the efforts of law enforcement so they could proactively pursue dirty doctors. For example, law enforcement could use it to investigate the top 50 prescribing doctors by type of drug, like hydrocodone or oxycodone.

Q: Does it even make sense to continue spending money on CURES if it doesn’t serve the purpose it should? Is it worse, in a sense, to create a false sense in the public that painkillers are being effectively tracked when they are not?

A: This is really a question the politicians need to answer. They have CURES, and if it is promoted falsely to the public, they need to inform everyone of this false sense of security. It makes sense to fund CURES properly, as it is the best and most effective tool in combination for tracking prescribing, abuse, doctor shopping, and dirty doctors.

Q: Have you seen the type of system you proposed effectively created and implemented elsewhere?

A: This is the area where politicians and the media are confused. About 40 states have PDMPs, prescription drug monitoring programs, like CURES. However, they are not all  real-time systems with instant access. Only about six states have any sort of instant access to them, and even that is limited by who has the access. Each state manages their databases differently.

Q: What type of investment do you think would be necessary to upgrade the CURES system to have the capabilities you describe?

A: The current Senate bill by Senator Mark DeSaulnier requests about $9.8 million, with about $3 million in upgrades. The other money would be used for law enforcement and education.

Q: Assuming that CURES could work well with the additional investment, what do you think would be the best and fairest way for the state to fund it?

A: SB 809 mandates that once CURES is capable of accommodating all prescribers and pharmacists, they must enroll and use the program. Resources are needed to upgrade the Web-based CURES system before all users can be accommodated. The goal of SB 809 is to enhance and modernize CURES to do the following:
- Streamline the program and system enrollment process.
- Integrate with the state’s major health information systems. 
- Provide timely patient activity reports to prescribers and dispensers.
- Provide law enforcement and regulatory boards with inquiry and reporting capabilities.
- Provide a method of secure data exchange among PDMP users and the Department of Justice.
- Provide alerts, notices and news items to program participants.

The current bill requires money from the General Fund of California, a tax on prescription narcotics paid by the drug manufacturers who sell in the state, and a medical license fee increase of $9 dollars annually on each doctor in the state.