Becker's Hospital Review

33 Executive Briefing "These systems can help identify 'doctor shopping' patients or substantiate a history of legitimate opioid use," Dr. Hurwitz said. "Currently I do not have access to the Florida PDMP within my EHR, which makes review of this data extremely cumbersome and time consuming in an already very time-intensive hospitalist workflow." Unfortunately, technical and data standards vary greatly across the 50 PDMPs, which makes it a fragmented source of information. The College of Healthcare Information Management Executives has called for better EHR-PDMP integration, and policy efforts could help simplify the process of connecting PDMP information with prescribers. "Knowledge is power," Dr. Blackman said. "Prescribers should have access, within their workflow, to a patient's history with controlled substances through state PDMP databases, no matter where that patient was seen." Predict risk for addiction and death Using big data and algorithms can help health systems better identify at-risk patients and reveal prescription patterns that most often lead to abuse, overdose and death. Research on this is just beginning and early insights are compelling. Dr. Jernejcic anticipates expanded uses of data at University Hospitals. "For example, tracking suspected opioid overdoses in emergency departments for real-time, communitywide tracking — as well as [using] data to better predict who is at risk for addiction and death from overdose and provide that information to prescribers." When these insights are delivered at the point of care, prescribing patterns can change. "Data can inform prescribers, who might then consider a non-opioid alternative when treating pain," Dr. Hurwitz said. How do we measure success? With a complex issue like opioid misuse, it can be challenging to come up with the right metrics to mark progress. Dr. Blackman cautions against striving for perfection. "We're not realistic if we try to develop a system where physicians never, ever prescribe an inappropriate opioid," he said. "In that situation, there is a substantial chance of undertreating some patients who would genuinely benefit." At University Hospitals, the long-term goal is to lower rates of opioid-related death and addiction, but the coalition recognizes this will take some time to achieve. In the meantime, the organization set concrete short-term goals, initially to reduce opioid prescriptions. From October 2017 through March 2018, University Hospitals has seen a 13 percent drop in opioid prescriptions by family practice physicians and a 21 percent drop by internal medicine physicians. "We measured our progress in terms of pill count and potency," Dr. Jernejcic said. "These metrics are strong, basic surrogates to monitor and address opioid abuse and misuse. However, we soon recognized that this approach would not be enough to make meaningful change." In other words, reducing the overall number of prescriptions could end up withholding opioids from patients who legitimately need them to manage pain. Instead, health systems should focus on delivering the right interventions to the right patient at the right time. As the University Hospitals opioid response matures, the organization is evaluating process metrics and digging into more complex facets of opioid prescribing, such as referral patterns. For example, University Hospitals is measuring if patients who are taking certain levels of MMEs are getting appropriate referrals for pain management and the consults they need from behavioral health. "Process metrics are more difficult to measure than pill counts and MMEs, but they are more sophisticated and precise indicators that we are attacking the opioid problem where it is causing the most damage," Dr. Jernejcic said. Combatting opioid abuse will be a long, complex journey. Harnessing technology can help healthcare systems design more precise interventions to reduce inappropriate prescriptions, and ultimately, the devastating toll opioids are taking on our communities. Learn more about how Allscripts will help fight the opioid abuse in 2018. n Allscripts is an industry leader with a 30+ year history of excellence and commitment to enabling smarter care, delivered with greater precision for healthier patients, populations and communities. Our healthcare information technology solutions advance clinical, financial and operational results. We connect people, places and data across an Open, Connected Community of Health™. We believe connectivity empowers caregivers to make better decisions and deliver better care for healthier populations. Founded in 1986, our primary business was repackaging medication for point-of-care dispensing. In the 1990s, Allscripts started transforming the doctor's office with more comprehensive practice management electronic health record (EHR) solutions. To address fragmented care delivery, Allscripts merged with acute-solution leader Eclipsys in 2010 to create the new Allscripts. In 2013, Allscripts took several significant steps to solidify and advance our population health management solutions, which included the acquisitions of dbMotion, a leading supplier of community health solutions, and Jardogs, the developer of FollowMyHealth, a patient engagement solutions provider. Looking toward the future of health care, Allscripts launched a wholly-owned subsidiary, 2bPrecise, in 2016 to deliver a genomic and precision medicine platform. Today we're a team of more than 7,000 strong, devoted to fulling the needs of providers today and creating the health IT architecture of tomorrow.

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