Interview Guide

Attachment 4

Interview Guide for End Users (Prescribers and Pharmacists)

Form Approved

OMB No. 0920-XXXX

Exp. Date:

Evaluation of the SAMHSA PDMP Electronic Health Record (EHR) Integration and Interoperability Expansion (PEHRIIE) Program

Interview Guide for End Users (Prescribers and Pharmacists)

Public reporting burden of this collection of information is estimated to average one hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia, 30333; ATTN: PRA (0920-XXXX).

Interviewer’s Legend

	Description of Item	Action Required
Plain text	Mandatory text	State/read out loud
Bolded text	Organizational headers	Nothing/Do not read
(Italicized text)	Place holder for tailoring interview	Replace with appropriate identifying information based on response or respondent
[Probe]	Probe for elaboration, specifying, and additional items	Optional; ask only if information not clear or not yet captured (use as checklist)
[Paraphrase]	Paraphrased question	Rephrase if original question unclear to respondent
[Clarifying Information]	Examples of the type of information desired	Provide clarifying information or examples if unclear to respondent

For each state, the following specific program names will be substituted in place of “the PDMP”:

State Name	PDMP Name
Florida	E-FORCSE
Illinois	The PMP or The PIL
Indiana	INSPECT
Kansas	K-TRACS
Maine	The PMP
Ohio	OARRS
Texas	PAT
Washington	The PDMP
West Virginia	The CSMP or RxDataCheck

Before we begin this interview, I’d like to go over the purpose of today’s interview, and review the relevant informed consent and privacy information pertaining to today’s interview.

Evaluation Project Overview

The Centers for Disease Control and Prevention (CDC) and subject matter experts at Brandeis University are conducting an evaluation of the SAMHSA cooperative agreement program aimed at improving real-time access to PDMP data and strengthening existing PDMPs. Through this program, (insert name of state) has implemented changes to (insert name of PDMP) designed to establish integrated access to the PDMP via Electronic Health Records (EHRs) and/or other health information technology (HIT) systems and to expand the availability of PDMP data across state lines. This evaluation will identify cross-cutting barriers to and facilitators of successful implementation of these two primary program goals and will also examine the impact of these systemic changes on PDMP use and prescription drug overdose related outcomes.

The purpose of today’s interview is for us to understand the processes by which you are accessing the Prescription Drug Monitoring Program data, usability of the program, successes accomplished in integration with clinical operations and systems, challenges that you face as a user of the system, and any recommendations you have for future improvements.

Do you have any questions for us about the planned evaluation or the purpose of today’s interview?

Consent to Proceed with the Interview

This interview will last approximately one hour. Your participation is voluntary, and you do not have to answer any question that you don’t feel comfortable answering. There are no right or wrong answers to any of these questions. Your responses will not affect your standing with either the state or your employer, nor your ability to use the PDMP system in the future. Your answers will merely help us assess the usability and value of the PDMP in clinical practices following this interoperability and integration project and provide us with recommendations to further improve the system. Do you agree to proceed with this interview?

We would like to take extensive notes during our interview. We will keep these notes in a secure location and any identifying information that we collect will not be disclosed unless compelled by law. For our site visit report, we will combine responses across our interviews, and will not attribute comments or observations to any specific individual or interview sessions. Do we have your permission to take notes during today’s interview?

Finally, we would like to record this interview to ensure that we capture everything you say accurately. We will keep the recording in a secure environment. Recordings will not be transcribed but will instead be used to review and clarify our notes and to ensure the information we capture today is accurate and complete. Do we have your permission to record today`s interview?

Do you have any additional questions for us before we start the interview?

1. Background

First, we would like to learn about your background, your perception of the prescription drug overdose epidemic, and your prior experience with using data from the PDMP in your work.

1. What is your current medical practice?

   1. [Paraphrase] What is your role at (insert employer name)?

   2. [Probe] What is your specialty and in what setting do you practice?

   3. How long have you been there?

2. How often do you (prescribe or dispense) controlled substance medications?

   1. [Paraphrase] Do you (prescribe or dispense) more frequently than weekly?

   2. [Probe] How many times per day or per week do you (prescribe or dispense) controlled substance medications?

   3. What specific training in (prescribing or dispensing) controlled substances have you had?

      1. [Probe] Who provided this training? State licensing board? Department of Health? Medical school? Other?

3. What experiences have you encountered or witnessed in terms of prescription drug overdose or abuse issues among patients?

   1. What actions do you take when you suspect a patient may be using prescription drug inappropriately or diverting their prescriptions?

4. Are you aware of the recent changes made to the PDMP under the SAMHSA cooperative agreement program?

   1. [Probe] What do you know about these changes?

   2. [Probe] What do you think about these changes?

   3. [Probe] What was your or your institution’s role in developing and implementing these changes, if any?

2. Current Use

Now, we would like to ask you about your current usage of the PDMP, the procedures used for accessing PDMP data, and the best and most challenging features that you have encountered following the implementation of systemic changes under the SAMHSA cooperative agreement program. Later we will ask you about how it compares to the previous system (e.g., prior to the SAMHSA data integration project that [embedded PDMP data into medical records – substitute what was done in each state].

1. What method(s) do you currently use to access the PDMP?

   1. [Paraphrase] Could you explain step by step how you access PDMP data from the PDMP?

   2. Would you rate this (these) procedure(s) as easy, minimally difficult, moderately difficult, or very difficult?

      1. What makes this (these) process(es) (easy, minimally difficult, moderately difficult, or very difficult)?

   3. Would you rate this (these) procedure(s) as quick, minimally time consuming, moderately time consuming, or very time consuming?

      1. What part of the system makes this (these) process(es) (quick, minimally time consuming, moderately time consuming, or very time consuming)?

   4. In what way is this different than how you used to access the PDMP prior to the recent changes that were made?

   5. Would you say these recent changes have improved this process?

      1. [probe] If yes: In what ways?

2. What training have you received in using the current PDMP access system?

   1. [Paraphrase] Did anyone teach you how to access the PDMP?

      1. [Probe] Was this a formal or informal training?

      2. [Probe] Who provided this training?

      3. [Probe] How many hours were dedicated to this training?

      4. [Probe] Were you able to use the PDMP system without problems after the training?

   2. Did you receive any specific training pertaining to the new integrated system? If yes:

      1. [Probe] Was this a formal or informal training?

      2. [Probe] Who provided this training?

      3. [Probe] How many hours were dedicated to this training?

      4. [Probe] How effective was this training experience?

3. How often do you access the PDMP?

   1. Is this more/less/same as prior to the implementation of these changes to the PDMP?

4. What factors trigger you to check the PDMP data?

   1. [Clarifying Information] For example, do you check it prior to (writing or dispensing) an opioid prescription? Do you check only for new patients being prescribed opioids? Do you check only if you suspect a patient is misusing or abusing controlled substances?

   2. If they are currently using multiple means of accessing the PDMP: How do you decide which method to use to access the report?

   3. Has this changed with the implementation of the new system?

5. What are the most challenging aspects in accessing the PDMP data via the newly integrated system?

   1. [Probe] Does it take too long to access the system?

   2. [Probe] Do you have to access the system through a different portal than what you are using for the rest of your patients’ medical records?

   3. [Probe] Is the system too complicated to use?

   4. [Probe] Is it too complicated to be recognized by the system as a registered user?

   5. [Probe] Are there technical issues with this integrated system?

      1. [Paraphrase] What “bugs” do you run into?

      2. [Probe] Were these technical issues one time occurrences, such as at start up, or are they recurring problems?

      3. [Probe] Have any of these issues been resolved?

         1. [Probe] If yes, how? If no, why not?

   6. [Probe] Is there a lack of access to supporting staff?

   7. [Probe] Have you encountered any other challenges with the new integrated system that we haven’t yet mentioned?

6. What do you feel are the best features of the new integrated PDMP system or the data available through it?

   1. [Probe] Is the system more accessible?

   2. [Probe] Is the PDMP data that you receive for your patients more comprehensive?

   3. [Probe] Is the PDMP data that you receive for your patients more timely?

7. What is your experience with accessing PDMP data from other states?

   1. [Probe] Is this easy/moderately easy/ difficult to access?

   2. [Probe] Do you have confidence that the information was complete?

   3. [Probe] Was this useful in a timely manner?

3. Clinical Impact

Now, let’s talk about how the new system changes have impacted your clinical practice.

1. How does using the PDMP currently fit into your clinical operations or workflow?

   1. [Probe] Is this different than prior to the implementation of the recent changes to the PDMP?

      1. [Probe] How is it different – process, content, and presentation of information?

2. Do you feel that the information that the PDMP returns is of sufficient accuracy and quality to be relevant to your clinical decision-making?

   1. [Probe] Are you getting the PDMP data for the correct patient?

   2. [Probe] Is this different than the accuracy or quality of the data that the PDMP returned prior to the implementation of the recent changes to the PDMP?

   3. [Probe] Are there any data or data fields are missing?

   4. [Probe] Is there any information the PDMP currently does not capture that would help you in your clinical decision-making?

3. How has your use of the new integrated access to the PDMP affected your (prescribing or dispensing) of controlled substance?

   1. [Probe] Do you (prescribe or dispense) controlled substances more frequently, less frequently, or at the same frequency than before these system changes were made?

      1. [Probe] Specifically, why has this change taken place?

   2. Are you more comfortable (prescribing or dispensing) controlled substances since these system changes were made?

      1. [Probe] What specifically has increased your comfort level?

   3. How has the new system influenced how you monitor or manage your patients’ controlled substances prescriptions?

4. How has your use of the new integrated access to the PDMP affected your overall patient management?

   1. [Probe] Are you more likely to have conversations about the appropriate use of controlled substances with your patients?

   2. [Probe – prescribers only] Are you more likely to consider alternative pain therapies for certain patients?

3. [Probe – prescribers only] Are you more likely to screen patients for substance use disorders prior to prescribing controlled substances?

4. [Probe] Are you more likely to recommend a patient to substance abuse treatment?

5. [Probe] Are you more likely to alert law enforcement about a patient exhibiting suspicious behaviors?

5. How has your use of the new integrated access to the PDMP changed your interactions with other prescribers or pharmacists?

   1. [Probe] Have you had more or less conversations with other providers about the care given to specific patients?

   2. [Probe] Have these changes led to increased communication between providers about controlled substances prescribing or dispensing best practices?

   3. [Probe] After reviewing a patient’s PDMP report, have you ever felt that a prescriber or pharmacist may not have been acting in the patient`s best interests regarding controlled substances prescribing or dispensing?

      1. [Probe] If so, did you take any actions relating to this behavior?

         1. [Clarifying Information] For example, did you have a conversation with them about their controlled substances (prescribing or dispensing) practices? Did you bring the report to the attention of an outside party?

      2. [Probe] Are you more comfortable taking action in these situations following the implementation of the recent changes to the PDMP?

6. What concerns do you have about the security of PDMP data following the changes to the PDMP?

   1. [Probe] Do you have any concerns about the privacy of your patients?

   2. [Probe] Do you have concerns about the privacy of your clinical decisions or practices?

4. Recommendations for Future Improvements

Finally, we would like to know about your recommendations for additional improvements that could be made to increase the usability of the PDMP system in general and PDMP data specifically.

1. What additional improvements do you think should be made to the PDMP to increase use by prescribers or pharmacist?

   1. [Clarifying Information] For example, better placement within your clinical workflow, more comprehensive or better quality data, easier method of being recognized as a registered user, accessibility to a broader set of clinical users.

2. What improvements would make the PDMP data or reports themselves more user-friendly?

3. Are there any additional comments that you would like to offer regarding what we have discussed today?

Thank you so much for speaking with us today!