Health system approaches to the opioid crisis too often fall short. These efforts may focus on treating opioid misuse and abuse but neglect prevention, target a single specialty (e.g., pain medicine), or be limited within the walls of the hospital.
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Our colleagues from the Pharmacy Executive Forum and Service Line Strategy Advisor developed a framework to overcome the pitfalls of current approaches to the crisis. They recommend providers (1) hardwire cultural change with regard to opioids to achieve organizational buy-in for prescription improvement efforts, (2) formalize organizational support via physician and patient resources to ensure safe opioid prescriptions and consumption, and (3) extend initiatives beyond the hospital to support efforts to reduce opioid use and misuse in the community.
Technology can be used in many areas of an organization's opioid crisis mitigation efforts. It can help improve opioid prescribing practices, reduce opioid diversion, protect patients at risk for addiction and overdose, increase access to treatment, and support public health campaigns. Keep reading to learn some of the ways providers can use IT to act on the above recommendations:
Hardwire cultural change with regard to opioids
Utilize prescription data to generate clinician buy-in for system interventions. Geisinger Health System utilizes a data dashboard to track cross-system opioid prescriptions. This dashboard is visible to all system clinicians and is used to identify providers with a high incidence of opioid prescriptions. The Pharmacy Outcomes team then educates these outliers on pain management alternatives and the data transparency provided by the dashboard helps ensure compliance.
Develop resources for prescribers across opioid episode
Integrate the enterprise EHR system with PDMPs. Prescription drug monitoring programs (PDMPs) are state-run electronic databases that track when controlled prescription drugs are prescribed and dispensed. PDMP data is a powerful tool for providers to prevent opioid abuse and diversion but clinicians often find this data too time-consuming and difficult to access. Organizations that integrate PDMP data into the EHR address this issue by making information on a patient’s controlled substance prescription history available at the point of care.
Enable EPCS. Electronic prescribing of controlled substances (EPCS) ensures prescriptions are securely transmitted from provider to pharmacy without the risk of forgery or alteration and, like EHR-PDMP integration, allows providers to see patients’ medication histories at the point of care. This can help identify patients who may be “doctor shopping” or exhibit other drug abuse-indicating behavior. EPCS is legal in every state as of 2015 but has not been widely adopted. According to March 2018 data from Surescripts, just 24.5% of all U.S. prescribers are EPCS-enabled compared to 92% of pharmacies. This stalled adoption among providers may be due to lack of financial and IT resources needed to comply with the Drug Enforcement Agency’s complex security requirements for EPCS such as identity proofing and two-factor authentication.
Implement appropriate CDS tools. Clinical decision support (CDS) applications can incorporate overdose and addiction risk factors into point of care alerts for providers. Many applications use predictive analytic models and artificial intelligence to determine factors that put patients at risk for an opioid overdose and addiction and subsequently identify high-risk patients. One new CDS tool, Venebio Opioid Advisor, analyzes variables found in a patient’s electronic medical record or other sources, predicts the likelihood of a life-threatening opioid overdose, and provides clinicians with individualized guidance regarding interventions to reduce the patient’s risk.
Engage community in efforts to reduce opioid use and misuse
Leverage videoconferencing to educate community physicians on safe opioid practices and align hospital-based and independent clinician prescribing patterns. UC Davis’s ECHO Pain Management Telementoring program holds online classes for community-based, primary care physicians and provides opportunities for one-on-one telementoring with their pain medicine clinical team. As a result of the program, 70% of participating providers reported a perceived change in their opioid prescribing patterns.
Utilize telepharmacy platforms to extend medication management efforts to small rural or underserved hospitals. Pharmacist review of opioid prescriptions during medication order fulfillment can help ensure these prescriptions are medically appropriate. Health systems with small rural or underserved hospitals can deploy telemedicine programs that facilitate real-time remote pharmacist order fulfillment in facilities that struggle to afford 24-hour pharmacist coverage for this task. A multi-hospital system may have remote pharmacists, located at a larger hospital or working from home, review medication orders for one or multiple small hospitals or outsource the program to a vendor that provides the remote pharmacists and connectivity software.
Share HIPAA-compliant data on opioid overdoses and deaths with local authorities via electronic reporting systems. Data can be used in public outreach campaigns to identify communities and populations that are at greater risk for opioid misuse. This data sharing is most efficiently facilitated by electronic reporting systems such as Arizona’s state-wide Medical Electronic Disease Surveillance Intelligence System (MEDSIS).
The role of IT leaders in tackling the opioid crisis
Health systems must tackle the opioid epidemic with a multi-dimensional approach and tech-enabled solutions are essential to successful strategies. As such, IT leaders have an important role to play in efforts to address the crisis. IT leaders should:
- Ensure your organization complies with state requirements surrounding opioid-related IT solutions. Some states mandate providers utilize EPCS, review PDMPs before writing a prescription, and/or report data on opioid-related incidents to state authorities.
- Engage with the clinical leaders and executives driving your organization’s strategy regarding opioids. Work with these individuals to identify areas for improvement and IT capabilities that can drive these improvements.
- Focus your efforts. Ensure that you have the foundational IT solutions, such as PDMP-EHR integration and EPCS, in place before spending resources on more niche projects.
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