An Honest Broker System for Secure Linkage of Opioid-related Clinical, Prescription, and Outcomes Data

Integrating patient-reported outcomes and clinical data with external sources such as Prescription Drug Monitoring Programs (PDMPs) enables comprehensive evaluation of opioid prescribing and outcomes. The authors describe the implementation of a secure, honest broker system by the Overdose Prevention Engagement Network to link state-wide registry data with Michigan's PDMP. A trusted intermediary facilitated linkage via a process approved by the institutional review board. Merged data were encrypted and coded without personal identifiers before being released to investigators, ensuring patient privacy and compliance with the Health Insurance Portability and Accountability Act. The linkage process excluded only 0.7 to 2.0% of patient records, demonstrating high performance. Since implementation, 11 peer-reviewed publications have used the linked datasets to advance opioid stewardship research. This novel, privacy-preserving framework provides a scalable and replicable model for diverse cross-system data integration while maintaining patient confidentiality.