What Role Can Health IT Play When an Epidemic Meets a Pandemic?

By David Bucciferro (Foothold Technology), co-chair of the EHRA and the Opioid Task Force, and Renee Han (Epic), Opioid Task Force member

Over the past several years, community service and health professionals have fought hard to gain ground in the battle against the opioid epidemic. From 2017 until 2020, the number of patients receiving buprenorphine, methadone, or naltrexone – common medications for opioid use disorder (MOUD) – consistently increased as more patients at risk for OUD and overdose were identified and treated, according to a report from Epic Research

First-time MOUD, buprenorphine, and naltrexone patients over time. Solid colored capsules show the last observed value. Dashed outline capsules show the predicted value for May 2020. (Source: Epic Research.)

What happens when an epidemic meets a pandemic? 

The COVID-19 pandemic made treatment for those with drug addictions harder to access, while isolation, economic stress, personal loss, and increased rates of depression set the stage for new or increased drug use. The number of patients receiving new prescriptions for OUD medications decreased by more than 30% during the early months of the pandemic as compared to the three years prior. The Centers for Disease Control and Prevention (CDC) has recently estimated that ​​more than 107,000 Americans died of drug overdoses in 2021, up 15% from the previous record set in 2020. In April, the White House released the Biden  Administration’s first national drug control strategy, a plan calling for changes in laws and policies to prioritize harm reduction by engaging drug users in care and treatment.

What role can health IT play in addressing the ongoing opioid crisis?

As regulators and healthcare providers alike work to deliver help to those who need it most, EHR Association members voted this year to elevate the Opioid Crisis Task Force, which was formed in 2018, to a permanent Workgroup. Doing so signifies our ongoing commitment to examine and strengthen the role of EHR developers in supporting OUD identification and care delivery through means such as clinical decision support, improved data sharing among referrals and resources, and increased standardization and integration of opioid use screening tools.

EHRs are the lynchpin for providing workflow-focused health IT strategies to improve physician knowledge and skills for safely managing opioid therapy. For initial acute opioid prescriptions, EHRs can suggest non-opioid treatment options or offer guardrails to help providers prescribe the lowest effective dose. For chronic pain patients requiring longer-term opioid usage, EHRs can help clinicians document and monitor goals and, when safe and appropriate, set an individualized tapering plan to reduce or end the use of opioids with minimal withdrawal symptoms while managing pain with nonpharmacologic therapies and nonopioid medications.

In early 2022, the EHR Association published an Opioid Tapering Implementation Guide for EHRs developed from evidence-based guidelines on opioid tapering from the CDC, U.S. Department of Health and Human Services (HHS), and U.S. Department of Veterans Affairs and Department of Defense (VA/DOD). The guide is designed to enable healthcare organizations to more rapidly implement these best practices using EHR-based clinical decision support (CDS) tools. Additionally, the EHR developer community can use this guide 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.

EHRs can better equip prescribers to leverage patient health data to address the opioid epidemic through access to comprehensive patient information, assessments, and referral resources, but these tools must be efficient in order to work within what are often too-brief patient visits. As more hospitals and health systems connect to state prescription drug monitoring programs (PDMPs) through their EHR systems, prescribers are able to access more complete patient prescription histories. 

While many EHRs currently offer OUD assessments, there is a tremendous opportunity to further streamline and standardize assessments and follow-up into EHR workflows. With a myriad of substance abuse and behavioral health screening tools available, the variations in coding and terminology make what information is being collected more difficult to access and less meaningful to providers. 

Improved utilization of standardized assessments, the ability to connect patients with services when a need is identified, and closed-loop information exchange to confirm that treatment was sought are crucial. Anecdotally, we have heard from our clients that for every 10 patients who are referred to a psychologist, psychiatrist, or substance abuse treatment, just one shows up. By ensuring that referral and attendance information is easily available in the course of a standard visit, we better arm clinicians to identify and treat OUD. 

A 2019 study published in the Journal of Substance Abuse Treatment highlights the need for automated information exchange between emergency departments and community providers of medication for OUD. The study determined that to minimize drop-out in the referral process, that communication needs to be “automated, flexible, and allow multiple channels of referral.” There currently exists a lack of information sharing and coordination across healthcare organizations and nearby community-based organizations (CBOs). Notably, there is a distinct difference in the current capability for information exchange between healthcare organizations – with tens of millions of record exchanges occurring daily – and the rudimentary levels of exchange between care providers and CBOs to which they refer patients. 

The EHR Association consistently advocates for the data standardization needed to support increased interoperability for bidirectional information sharing to inform patient care and help “close the loop” on necessary patient follow-up, and the Congressional funding necessary to enable CBOs to adopt the required IT infrastructure. (See: EHR Association Comments on the White House OSTP Connected Health RFI and EHR Association Feedback on the Congressional SDOH Caucus RFI.)  

What’s Next?

While the opioid epidemic and the COVID-19 pandemic wage on, the Opioid Crisis Workgroup continues working toward its goal of identifying, collaborating, and recommending optimal health IT utilization to reduce overdose deaths through safe prescribing practices and promoting long-term treatment. This is accomplished by publishing resources, reviewing and commenting on public policies, and assessing opportunities for innovative new ways our member companies and their clients can maximize health IT for improved patient outcomes. 
Find additional EHR Association Opioid Crisis Resources here.

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