The Michigan State Medical Society (MSMS) provided comments on rules presented by the Michigan Department of Health and Human Services (MDHHS) on the reporting of poisoning due to the use of prescription or illicit drugs.
These rules would replace emergency rules addressing the increase in poisonings due to prescription and illicit drug overdoses that are set to expire shortly. Pursuant to the proposed rules, MDHHS will use reported data to identify drugs associated with overdose injury and death, and to guide and evaluate public health response to the opioid epidemic. This will include planning and targeting of resources and interventions to populations and geographies of high need.
This rules set was modeled after rules related to injury reporting and non-medicinal chemical poisoning reporting. The rule makes it possible for MDHHS to require reporting of this information from health care providers and facilities when needed. The reporting request to providers could come in two ways:
- Routine Surveillance Data Request: MDHHS is developing a system to collect information on medicinal and illicit drug poisoning events using existing information feeds. This system will utilize admission/discharge/transfer (ADT) messages from health facilities to identify events with an ICD-10 code related to poisonings and overdoses. This system will be automated, and, as far as we understand at this time, health care professionals and health facilities will not have to enter data, use a list of ICD-10 codes to select cases, or retain data files for future use. MDHHS and the Michigan Health Information Network (MiHIN) are working together to develop the use case for this system now and will be including feedback from MHA and representation from health facilities and health professional organizations (including Medical Examiners) and local public health partners in the requirements development. MDHHS will not be making a request for ongoing submission of routine medicinal and illicit drug poisoning event surveillance data until the forthcoming ADT message system is established, tested, and ready to receive referrals.
- Specific Event Investigation Request: In the case of a suspected outbreak of overdoses or poisoning events, this rule would be used by MDHHS or local public health to obtain information on the circumstances around those specific cases. This information would be used to aid in immediate public health response. MDHHS or local public health would contact the health care provider caring for those overdose cases, as is done currently for communicable disease investigation.
The vast majority of acute medicinal and illicit drug poisoning health care encounters are already represented in existing ADT message data flows. To the extent that these medicinal and illicit drug poisoning events are captured by the ADT messages that health care providers are already submitting, additional messages will not be needed as the new system should automatically capture these existing messages. However, this new system will also include a manual ‘event referral’ screen. If any medicinal and illicit drug poisoning event is inadvertently missed/not captured, or if a health care provider is not actively sending ADT messages, health care providers will be able to log into this system to manually refer these events.
The current emergency and proposed replacement rules require that health professionals and health facilities provide reports when requested. "Health facility" means any facility or agency licensed under article 17 of the public health code, MCL 333.20101 to 333.22260 that provides health care services. The rule mentions a hospital, clinical laboratory, surgical outpatient facility, health maintenance organization, nursing home, home for the aged, county medical care facility, and ambulance operation. Health facility does not include any facility or agency that is prohibited by law under 42 CFR Part 2 from releasing records on substance abuse disorders. Hospice is specifically not listed as a health facility in this rule. Rural health clinics are not covered under the current emergency rule. This gap will be addressed in the permanent rule. "Health professional" means a person licensed under article 15 of the public health code, MCL 333.16101 to 333.18838, in medicine, osteopathic medicine, as a physician's assistant, or nurse practitioner.
The emergency rules were entered under the authority of MCL 24.248. The emergency rules are effective for 180 days. The rule promulgation process on the permanent rules is expected to be completed on or before April 26, 2019. Here is the status on the rules.
Questions regarding the rule making process, MSMS’s comments on the rule, or additional information can be directed to Christin Nohner, MSMS Director, State and Federal Government Relations.