Table 1.

Recommendations to identified problems

Area	Problem	Solution
Access	Separate website, username, password needed to login to PDMP.	Integrate PDMP into EHR for only one login for both.
	Not all state PDMP are integrated into EHR.	Include all states in integrated EHR, or at least neighboring states.
	Patient with multiple names and PDMP profiles.	Create smooth ability to merge accounts to link to a single legal name.
	Access PDMP only at certain times when there is a healthcare encounter.	Access PDMP in EHR anytime, not just when there is an encounter.
Documentation	Not every PDMP access resulted in documentation of the access for a specific prescription.	Require documentation that PDMP was accessed for a given prescription more universally. This includes by pharmacists acting as delegates. Run through this to ensure pharmacists can do this given they have their own NPI.
	It is unclear if a patient has been or should be referred to substance use disorder treatment.	The PDMP could provide information that a patient was referred to treatment and the date.
	An opioid use disorder diagnosis is listed in EHR but not in the PDMP.	Relevant diagnoses should be included in the PDMP.
	Providers in other health systems may not have access to relevant clinical notes related to controlled substance use.	Relevant clinical notes from EHR could be copied into PDMP so other prescribers have access.
Safety alerts	Co-prescribing of opioids and benzodiazepines may not be obvious.	Create robust alerts that acknowledge risk of drug interactions.
Resources	Evidence-based practice (EBP) guidelines and assessment instruments not easily accessible.	Integrate a health system’s evidence based prescribing guidelines and psychometrically sound opioid use disorder assessment instrument into the PDMP. A prompt for EBP could occur when prescribing history indicates multiple prescribers, multiple pharmacy use, high doses of opioids, and/or a combination of opioids and benzodiazepine prescriptions.