Geisinger CIO says its opioid reduction program is reproducible
Geisinger is curbing patient use of opioids by leveraging health information technology and electronic prescribing, according to CIO John Kravitz, who contends that other healthcare organizations can generate similar results through effectively using their EHRs or clinical order entry systems.
“We developed and initiated several approaches that focus on changing physician practice patterns to reduce the prescribing of opioids—including creating a provider dashboard, which is linked to our electronic health record to identify current practice patterns among our providers,” testified Kravitz before the House Energy and Commerce Committee on Thursday during a hearing on combating the opioid crisis.
Armed with information about prescription patterns in a dashboard linked to their Epic EHR, Geisinger is targeting the “outliers” on its clinical staff and providing them with best practices for pain management, Kravitz told lawmakers. In fact, he said the integrated healthcare services organization has nearly cut in half the number of opioid prescriptions from a monthly average of 60,000 down to 31,000.
Among other activities, Geisinger has adopted the following actions to curb the use of opioids:
- Tracking documentation within the EHR and dashboard that shows providers reviewed the mandated state-run Prescription Drug Monitoring Program if they considered prescribing a controlled substance.
- Documenting findings in the patients’ medical records.
- Integrating data from a pain app that measures physical activity, patient-reported pain and other metrics into the dashboard and the patients’ medical records.
“Although the dashboard may be unique to Geisinger, we believe other health systems and hospitals can generate similar reports on opioid prescribing through their electronic health records or clinical order entry systems,” he added. “The initiatives rolled out by Geisinger are broadly applicable to other healthcare systems across the country, and we encourage others to apply these strategies in their organizations.”
The Danville, Penn.-based health system has implemented a multi-pronged strategy for reducing opioid prescriptions, including electronic prescribing for controlled substances (EPCS), and Kravitz contends it is a major improvement over paper-based prescribing, which can lead to drug diversion, prescription forgery, provider DEA number exposure to the public, as well as doctor shopping to obtain opioids.
“Geisinger started an EPCS program in August 2017, and through February of this year, 74 percent of Geisinger’s controlled medications were e-prescribed, with all 126 of our clinics using e-prescribing,” Kravitz testified.
In addition, he noted that the health system achieved other efficiencies from implementing electronic prescribing of controlled substances that have resulted in $1 million in savings, including:
- A 50 percent reduction the number of patient calls to determine if their paper prescriptions were available, from 660,000 per year to around 330,000 calls.
- Provider time to write an opioid script was reduced from three minutes to write a paper prescription to 30 seconds with the EPCS system.
- Nurses’ time to prepare an opioid script decreased from five minutes to two minutes.
According to Kravitz, Geisinger has implemented best practices for pain management. “This includes a pain management program for surgical patients where we counsel patients and their families to expect some manageable level of pain from minor procedures—and the use of non-addictive alternatives for managing pain,” he said. “In cases where our physicians believe an opioid prescription is in the best interest, they are highly encouraged to order smaller quantities for seven days or less.”
Overall, for healthcare organizations to succeed in reducing the use of opioids like Geisinger, Kravitz concluded that they will need support from their physician leadership. “We are a physician-led organization,” he observed. “This is a process change that has to occur with physicians—it’s not technology, technology is just a tool.”