How EHR Technology Can Support Best Practices for Opioid Prescribing

By Dan Seltzer and Alan Staples
Co-chairs, Clinician Impact Subgroup, EHRA Opioid Crisis Task Force

screenshot_2018-12-26 ehra cdc opioid guideline implementation guide for ehrs - ehra-cdc-opioid-guideline-implementation-gu[...]The widespread opioid epidemic and its devastating effects flood our news feeds daily. No one is immune, which is why when the Electronic Health Record Association (EHRA) asked for volunteers to join a new Opioid Crisis Task Force, we and many others – including doctors, nurses, and pharmacists – stepped forward to share our experiences and expertise. For the past year, we have been conducting research and providing recommendations on new ways EHR technology can contribute solutions to help solve the complex puzzle of the opioid crisis.

Our most recent contribution is the CDC Opioid Guideline – Implementation Guide for Electronic Health Records.

Initial research and conversations with providers focused on the question, What do providers need from technology to support their efforts in the opioid crisis?  The input we received led us to develop a guide to assist healthcare organizations implement clinical practice guidelines within the EHR to improve opioid stewardship in clinical practice.  

Incorporating Clinical Practice Guidelines into the EHR

Clinical practice guidelines can be designed to yield better patient experience and outcomes, improve safety, and reduce unwarranted variation in care. Yet, despite the wealth of available clinical practice guidelines that are validated, published, and freely available, clinical adoption of guidelines is very slowsome studies show as much as a 17-year lag between research that produces guidelines and the common use in practice of new guidelines.

cdc 12 guidelines image

The CDC Guideline for Prescribing Opioids for Chronic Pain provides 12 recommendations.

We considered many excellent prescribing guidelines, and ultimately chose the Centers for Disease Control and Prevention’s 2016 CDC Guideline for Prescribing Opioids for Chronic Pain as a widely-recognized national standard. The CDC Guideline’s 12 recommendations for prescribing opioids for chronic pain (outside of active cancer, palliative, sickle cell disease and end-of-life care) apply primarily to physician, physician assistant, and advanced practice nurse prescribers of opioids making treatment decisions in the management of chronic pain.

Although the CDC Guideline is often cited by care professionals who treat pain, it is seldom and inconsistently utilized in clinical practice. One reason often cited to explain low adherence to clinical practice guidelines, like the CDC Guideline, is the lack of clinical decision support within a provider’s EHR workflow.

Implementing clinical decision support tools into an EHR can take many forms. Because of the urgency of the opioid crisis, we wanted to make sure that our EHR implementation guide includes “low lift” ways to operationalize each of the guidelines right away.

cdc guideline 6

CDC Guideline #6: Prescribe short durations for acute pain

For example, CDC Guideline #6 recommends short duration prescriptions for acute pain. To aid providers, EHRA’s implementation guide suggests the relatively simple initial step of setting order set defaults for opioid prescriptions at seven days or less with no refills. Additional steps organizations can take to maximize technology include developing reporting tools to monitor prescribing trends, and educating physicians who regularly prescribe longer durations than average.

We encourage healthcare organizations of all sizes to download the CDC Opioid Guideline – Implementation Guide for Electronic Health Records. While all of the suggestions won’t be equally applicable for every provider, the Guide was designed so that everyone can benefit. Reach out to your IT application director or EHR developer to discuss how to incorporate EHRA’s recommendations into your own technology.

EHRA’s Opioid Crisis Task Force Continues Its Work

Members of the Opioid Crisis Task Force began our work in early 2018 knowing that powerful tools like EHRs, PDMPs, EPCS, CDS and health data exchange hold a lot of potential in attacking substance misuse.

octf infographicIf you haven’t yet, take a look at our first deliverable, how individual states are utilizing technology tools, which shows that public policy can sometimes be an impediment to doing the right thing, with wide inconsistencies of PDMP and EPCS rules and regulations among states. The fact that currently, no state or U.S. territory can comprehensively see every place and time a patient has filled opioid prescriptions highlights the need for a consistent, nationwide approach.

An infographic illustrates key initial findings and recommendations, and volunteers are currently identifying components of a minimum data set that could be shared across systems.

EHRA members are invited to join the Opioid Crisis Task Force, and we welcome collaborations and recommendations from other stakeholder groups. Please contact Sarah Willis-Garcia at swillis@ehra.org

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