EMR alerts aid compliance with state law limiting opioid prescribing

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Penn Medicine outpatient practices in New Jersey successfully implemented electronic medical record best practice alerts to ensure clinicians complied with a state law limiting opioid prescriptions.

Thanks to a “nudge” introduced into the EMR, clinicians at New Jersey ambulatory practices were notified if that limit had been reached. Researchers found that the total amount of opioids dispensed per new opioid prescription decreased significantly compared to prescriptions in Pennsylvania practices, which served as the control group in a study.

“Implementation of a prescribing limit and EMR alert was associated with an approximately 22 percent greater decrease in opioid dose per new prescription in NJ compared with controls in PA,” according to a study published online on Friday in the Journal of General Internal Medicine.

In 2017, New Jersey passed a law that limited new opioid prescriptions to a five-day supply for patients who had not been on opioids for over a year prior. While Pennsylvania currently has a seven-day limit, it doesn’t apply to all care settings, including outpatient clinical practices.

To aid compliance with the New Jersey law, Penn created an EMR best practice alert in the state’s clinical practices notifying prescribers if new opioid prescriptions exceeded the five-day limit. In those instances, prescribers were required to make an active choice to acknowledge the alert before continuing with the original order or adjusting the prescribed quantity to comply with the law.

“Our study provides early evidence that this type of on-the-ground approach from a health system driven by a state law can be an effective strategy to influence prescribing behavior and safely reduce the amount of new opioid prescriptions given to patients with acute pain,” says first author Margaret Lowenstein, MD, a general internist and National Clinician Scholar at the University of Pennsylvania’s Perelman School of Medicine.

“Importantly, we didn’t see any ill effects in the short term, like early refills or an increase in telephone calls or hospital visits, that might suggest inadequate pain control or delayed recoveries in patients,” adds Lowenstein.

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