Editorial Note: This blog was also co-authored by Shari Medina, MD, of Harris Healthcare, chair of EHRA’s Patient Safety Work Group who led the Partnership for Health IT Patient Safety’s workgroup on this joint project; and Mark Segal, PhD, FHIMSS, principal, Digital Health Policy Advisors.
The United States is in the midst of an opioid use epidemic. Patients, providers, pharmacists, pharmaceutical companies, and electronic health record (EHR) developers have each been highlighted for their role in responding to the crisis. This blog focuses on the role of health IT in particular, and the safe practices that can be put in place for opioid prescribing.
As conveners of the Partnership for Health IT Patient Safety, a multi-stakeholder collaborative, ECRI Institute sees a very important role for developers of EHRs and other health IT in promoting opioid-related patient safety. Employing health information technology (IT) for early identification of at-risk patients and for safer prescribing can promote more efficient deployment of preventive resources and help reduce the risk of persistent opioid use or abuse.
Fortunately, vendor/developers and other stakeholders are working together to seize this opportunity. For example, the HIMSS Electronic Health Record Association (EHRA) and ECRI Institute’s Partnership for Health IT Patient Safety whitepaper, Safe Practices for Safer Opioid Prescribing: Measures and Clinical Decision Support, highlights areas for targeted actions.
This whitepaper notes that much of the response to the opioid crisis has emphasized individuals with persistent use and abuse disorders. However, to fully address this crisis, we need to reach individuals at risk before the potential for misuse or abuse occurs. Preventing opioid dependence and persistent use must therefore target patient populations that have yet to experience these problems.
A 2018 study estimates that three to ten percent of opioid-naïve patients who are prescribed opioids progress to persistent use or dependence, a very worrisome projection. It is essential to address both opioid-naïve patients and those with previous opioid exposures to reduce the incidence and prevalence of persistent use and dependence.
So, the big question remains, can clinicians and the health IT community use technology and the data available in this technology to help combat the opioid crisis? For example, can we mitigate some opioid concerns using data to assess individual patient risks, evaluate dosages in the context of a patient’s unique clinical situation, and monitor opioid prescribing?
Unfortunately, not all of the relevant data are available and/or computable in the EHR. Wider implementation of structured data using standardized nomenclature, along with efficient use of data already in the EHR, will enable data aggregation and normalization. Equally important, data collection must not significantly increase clinician burden or hinder EHR usability.
The project’s work suggests that two mutually reinforcing approaches can help prevent persistent use of and dependence on opioids.
- Enable better and safer opioid prescribing using clinical decision support (CDS), e-prescribing, and data from Prescription Drug Monitoring Programs (PDMP) in clinician workflow; and
- Use health IT to allow clinicians and healthcare organizations to assess, measure, and monitor opioid prescribing behaviors
The first area of focus, clinical decision support (CDS), has a multifaceted role. Many types of CDS can influence opioid prescribing: alerts, order sets, guidance, documentation forms, data summaries, dashboards, predictive analytics, references, and knowledge resources. To maximize CDS effectiveness, this information must be available at the appropriate time in the clinical workflow—not just at the point of prescribing. Notably, clinicians informed of patient-specific data with tailored resources and recommendations earlier in the process can improve their ability to involve patients in the decision-making process.
For the second area of focus, using health IT to aid physicians in assessing and measuring opioid prescribing, credible measures must be calculated, aggregated, and reported in ways that enhance clinical care and promote safe use of these medications, without increasing clinician burden. In implementing this measurement and feedback approach, it is essential that clinical practices and healthcare organizations have access to measures that meet their own clinical priorities regarding appropriate opioid use.
EHRA and the Partnership proposed three high-level, setting-neutral recommendations to facilitate safer prescribing of opioids for opioid-naïve and opioid-exposed patients:
- Enable technologies to measure and monitor prescribing patterns to allow safer opioid prescribing;
- Ensure that EHRs can collect and access the data elements needed to support measures and drive CDS; and
- Ensure that opioid-prescribing CDS interventions are delivered at the right time in the workflow for both opioid-naïve and opioid-exposed patients.
More work remains to enable EHRs to seamlessly integrate, synthesize and apply relevant opioid-prescribing data from disparate sources. Many such opportunities are acknowledged in a request for information on Health IT and Opioid Use Disorder Prevention and Treatment in the proposed rule on 21st Century Cures Act Implementation recently issued by the Office of the National Coordinator for Health IT.
By acting now, these recommendations and associated implementation strategies and tactics could be placed into solutions and workflows by EHR and CDS content developers in near-term product development and implementation cycles of one to three years, enabling safer prescribing.
Listen to our recent podcast, Health IT Improves Opioid Prescribing, to learn what your organization can do to implement safe practice recommendations on opioid prescribing using CDS and health IT.