Becker's Hospital Review

32 Executive Briefing Sponsored by: O pioid misuse and overdoses are rising at an alarming rate. The crisis is due in part to wider use of prescription opioids, despite the risk for addiction and lack of evidence about long-term effectiveness to treat pain. It will require a comprehensive response from many stakeholders to stem the tide of the devastation from opioid abuse. Health IT has a role to play in helping clinicians respond with more precision to this public health crisis. Instead of aiming for the overall reduction of opioid prescriptions, and risk potentially under-treating patients who legitimately need them, technology enables health systems to refine their response and tailor it for their patient populations. Understand prescribing patterns Before designing an intervention, health systems must first understand their own opioid prescribing patterns. They need to analyze data from prescribers to understand frequency, opioid type, quantity, reason for prescribing and other factors. This data can be used to monitor prescribing over time. "We have a client taking a closer look at prescribing data in the emergency department, and it validated what the physicians had been doing for years – prescribing opioids appropriately and in limited quantities," David Hurwitz, MD, general internist, hospitalist and Allscripts Medical Director of Clinical Analytics, said. "In other cases, prescribers may underestimate the frequency of opioid prescribing, and data can be useful to help educate and change prescribing behavior." University Hospitals in Cleveland is committed to combatting the opioid crisis in northeast Ohio. Through multidisciplinary teams and collaboration with the community at large, University Hospitals has armed itself with data from its EHR when designing a response to the crisis. Leading these efforts is Randy Jernejcic, MD, the appointed Vice Chair of Clinical Integration for University Hospitals, Chair of the Opioid Patient Safety Steering Committee at University Hospitals, and 2018 Chair of the Northeast Ohio Hospital Opioid Consortium Executive Committee. "We're pulling data from the EHR, starting with primary care, where the bulk of opioid prescribing occurs at University Hospitals," Dr. Jernejcic said. "The data has helped us understand some of our opioid prescribing patterns and we can now visualize where we want to go. We developed a documentation toolkit to help providers gather more data points and design more precise interventions for our community. " Secure the prescribing process Another early step health systems should take is to implement electronic prescribing of controlled substances. Areas where clinicians regularly use EPCS have seen significantly less prescription fraud and abuse. "Most physicians have stories about altered paper prescriptions. For example, editing a quantity from '3' to '30,'" Michael Blackman, MD, Allscripts Medical Director, Population Health and Analytics, said. "Electronic prescribing of controlled substances can help mitigate some of these risks by ensuring that the pharmacy receives what, and only what, was prescribed." Unfortunately, even though the technology is widely available, it is only required in select states and is not widely adopted. While more than 90 percent of all pharmacies are EPCS-enabled, only 14 percent of controlled substances are prescribed electronically. Provide clinical decision support Evidence-based prescribing guidelines can help clinicians stay current on the most up-to-date research findings. These guidelines can recommend quantity limits, fast-acting versus extended-release medications, protocols for additional and alternative therapies, and expanded educational material and content. University Hospitals has made a commitment to train all prescribers on best practices for opioid prescribing by the end of 2018. Clinical decision support can give prescribers assessment tools at the right place within EHR workflows. Well-placed information helps clinicians to engage in more effective conversations with patients, make informed decisions and create optimal treatment plans. "One of our clients is providing information about MME [morphine milligram equivalents] of prescriptions being written in the emergency department, as higher doses are directly correlated with a higher overdose risk," Dr. Blackman said. "This enables a prescriber to quickly see what they are prescribing in a standardized way." Simplify access to prescription drug monitoring programs PDMPs are state-level databases that collect, monitor and analyze e-prescribing data from pharmacies and prescribers. Integration of state PDMPs into the EHR workflow helps inform prescribers about a patient's prior opioid prescriptions. Review of PDMP data is a requirement in many states prior to prescribing an opioid. How health systems are refining their response to the opioid crisis

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