(Bloomberg Businessweek) -- It happens all the time at one of Palmetto Health’s five emergency rooms in Columbia, S.C., says emergency medicine physician Tripp Jennings. A patient comes in complaining of pain somewhere, and the attending physician types his name into a computer database and discovers he’s already been prescribed opioids—a lot of them. On further questioning, the patient cops to struggling with addiction. So instead of opioids, the patient gets a different kind of medication, or in some cases is sent to drug counseling.
Jennings, who’s also the health-care network’s technology chief, says that’s been the routine since late 2015, when Palmetto started using database software made by Appriss Inc. The developer bases its analysis of patient behavior on prescription records from 40 state governments (plus the District of Columbia and Guam), which it’s quietly secured access to over the past few years. “There’s probably not a day that goes by in our emergency department where this doesn’t occur,” says Jennings, who’s personally dealt with three such cases in the past six months. “Before that, you really had to have suspicion of overuse or drug-seeking behavior.”
Appriss, a 600-employee company in Louisville, is working to mitigate a U.S. opioid crisis blamed for more than 20,000 fatal overdoses a year—33,000 when heroin-related deaths are included—and $79 billion in annual response costs and lost productivity. President Trump said on Aug. 10 that opioid addiction represents a national emergency. While privacy advocates worry about misuse of data as sensitive as a person’s prescription history, states are pushing to link the information ever more quickly to simplify diagnoses for doctors, who hand out 259 million opioid prescriptions each year and often have little time to question patients.
The company’s software accounted for 84 percent of U.S. doctors’ 130 million opioid-related queries to state prescription-drug-monitoring programs last year, according to data collected by the American Medical Association. That includes sharing data across state lines. “Our vision was that we want every opiate record looked at every time a doctor considers a prescription and every time a pharmacist dispenses,” says Chief Executive Officer Mike Davis. “We want everybody to see everybody’s data. We built it to do that.”
Appriss is filling a gap left by Washington. No federal agency synthesizes data from America’s 51 monitoring programs, which so far have been left to state-level governments (D.C., Guam, and every state except Missouri). In Missouri, privacy concerns are a central tenet of resistance to even a state-level program. “This is a mandatory, involuntary database,” John Lilly, a family doctor from Springfield, Mo., who’s testified to lawmakers against drug monitoring, says of Appriss’s software. “When you have so many people that could have access to it—hundreds of thousands—someone is going to go fishing.”
Davis says states dictate how Appriss is allowed to use their data, and the company works with oversight committees to establish security protocols. “There are really complex issues that you are dealing with,” he says. “That’s all being discussed, and it will be driven by legislation and policy.”
The son of a General Electric executive, Davis co-founded Appriss in 1994 after getting his bachelor’s in data processing from the University of Louisville. He’d been watching news reports of a local woman murdered by an abusive ex-boyfriend she didn’t know had gotten out of jail. That set him to work on software that would alert victims of violent crimes when their assailants were being paroled. Eventually he also began developing databases to track large sales of the cold medicines that can be used to make meth.
Appriss turned its attention to opioids in 2011 and by 2013 was testing that system in five states. “Everything we did up to this point positioned us to tackle this big national problem,” Davis says. After Insight Venture Partners bought 85 percent of the company in 2014, Davis used the infusion of private equity money to acquire his two leading competitors. Neither Davis nor Insight Managing Director Deven Parekh would disclose the company’s revenue or other funding, except to say that it’s profitable. Public data from contracts in Michigan, Ohio, and Massachusetts show those states paying $1 million to $1.5 million a year for Appriss services.
Ohio, whose prescribers led the U.S. last year in queries to drug databases, uses Appriss to help spot emerging abuse trends, says state pharmacy board spokesman Cameron McNamee. Since buying the software last year, Michigan has suspended the licenses of 20 doctors the database showed were overprescribing, says Kim Gaedeke, director of that state’s bureau of professional licensing. Queries rose 66 percent last year in states that use Appriss, compared with a 24 percent increase in the nine states using homegrown systems, the AMA’s data show.
It probably won’t reassure privacy advocates that Davis says he’d like to combine Appriss’s siloed prescription information with data on hospital treatments for ODs and heroin use. He’s hoping to identify people at risk of addiction before they’re ever prescribed an opioid. “We’re spending millions of dollars, on a factor of 10 more than any state could spend, to move this technology to the next level,” he says. “We’ve got lots of road map planned.”
To contact the author of this story: Jeff Green in Southfield at jgreen16@bloomberg.net.
To contact the editor responsible for this story: Jeff Muskus at jmuskus@bloomberg.net.
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