By Daniel Seltzer, Co-chair of the EHRA Opioid Crisis Task Force

Care disruptions due to the COVID-19 pandemic and other ongoing events have put long-term opioid therapy (LTOT) patients at increased risk for opioid-related harm and heightened the urgency around addressing the opioid crisis. This has, in turn, presented a significant opportunity to leverage technology to improve certain care processes around opioid therapy, starting with digitizing the tapering plan and incorporating existing clinical practice guidelines into clinical decision support (CDS) tools. 

These are areas that have been researched extensively by EHRA’s Opioid Crisis Task Force, which was formed in 2018 to explore and recommend ways EHR technology can help solve the complex opioid crisis puzzle. This research culminated in the newly released Opioid Tapering Implementation Guide for Electronic Health Records, a set of clinical practice guidelines that can be operationalized to improve opioid stewardship and opioid tapering in clinical practice. 

EHRA’s goal with this Opioid Tapering Guide is to enable an organization’s health IT team to implement tapering best practices more rapidly using EHR-based CDS tools. The EHR developer community can also use it to steer the future development of new or updated products and services that can help hospitals, physician practices and other care environments implement these and other best practices. 

In developing the guide, the Task Force leveraged evidence-based guidelines on opioid tapering published by several organizations and agencies with subject matter expertise, including clinical recommendations from the United States CDC, VA/DOD, and HHS. These referenced guidelines include tapering plans for pain lasting longer than three months or past the normal tissue healing time frame, outside of active cancer treatment and palliative or end-of-life care. 

Ultimately, the guide can assist organizations of all sizes accelerate the design and implement CDS for clinicians who treat pain. Those with separate IT departments could review and incorporate this guidance into their workflow as appropriate. Smaller organizations without dedicated internal IT departments could work with their EHR developer or IT consultant to incorporate this guidance into their protocol.

As guidelines are implemented, it’s crucial to keep in mind aspects of substance use disorder (SUD) that are unique to the population served. It’s also important to note that not all recommendations will be equally applicable to every clinical environment.

Finally, each guideline referenced in the guide impacts a variety of medical services, particularly as they relate to the management of chronic pain. Implementing changes from these guidelines, as well as maintaining new policies and procedures with effective governance, may affect clinical practices, workflow, and EHR content. As such, we recommend including clinical and IT leaders from all applicable services and departments, including behavioral health and psychology; clinical pharmacy; emergency medicine; orthopaedics; pain management; and primary care and family practice.

We encourage organizations of all sizes to act now to leverage their investment in health IT and the EHR to create, develop, and implement these guidelines. In the future, new frontiers in EHR development can advance this process and help providers effectively balance safer, evidence-based, and equitable use of opioids with patient-centric care plans.  

The Opioid Tapering Implementation Guide for Electronic Health Records can be accessed here.