Intermountain Healthcare has set an ambitious goal of reducing by 40 percent the number of opioids prescribed at its 22 hospitals and 180 clinics serving Utah and Idaho by the end of 2018. To reach its target, the provider organization will heavily leverage its health information technology infrastructure.
The plan calls for a decrease in the number of opioid tablets prescribed by more than 5 million annually, according to Todd Allen, MD, Intermountain’s acting chief quality officer, who says the organization is the first health system in the country to formally announce such an initiative.
“When you look at the toll that these medicines take in our communities, we need to be aggressive,” says Allen, who notes that Utah—where Intermountain is based—ranks seventh in the nation for drug overdose deaths and has been ranked as high as fourth nationally in past years.
“We’re right up there at the top in terms of the damage that’s being inflicted upon our families and our communities,” he adds. “We knew that we needed to act differently.”
The announcement comes less than two weeks after President Donald Trump declared the opioid crisis to be a national emergency. However, Allen—who is an ER physician—describes the timing as a coincidence and contends that Intermountain was “headed there anyway” even without the presidential action.
Allen says Intermountain is taking a multi-pronged approach, which includes evidence-based best care practices and technology, to the problem of prescription opioids. He reveals that the health system has already trained about 2,500 clinicians on “the intricacies of pain management” with new policies and tools, and that training will be expanded to the organization’s other prescribers in Utah and Idaho.
“We’ll make the training more specific, both to specialties and to the patient populations that physicians and their care teams work with,” adds Allen. “We’ll really leverage the growing capabilities of our information technology infrastructure.”
In particular, Intermountain is adding prompts and default order sets into its Cerner electronic health record system to help reduce the number of tablets prescribed by having these resources built into the clinical workflow.
“We’re nearly at the end of the two and a half year cycle of installing (Cerner) across all of our 22 hospitals and 180 clinics,” says Allen. “One of the foundational principles behind cooperating with Cerner was to preserve the integrity and longevity of our enterprise data warehouse. Intermountain is known over the course of its history for having collected and organized data in a clinically meaningful way.”
The health system also taps into outside data sources. The Utah Division of Occupational and Professional Licensing maintains a Controlled Substance Database (CSD), which collects data on the dispensing of Schedule II-V drugs from all retail, institutional and outpatient hospital pharmacies, and in-state/out-of-state mail order pharmacies. Allen says one of the key features of Intermountain’s Cerner EHR is that it “seamlessly integrates” with the CSD.
Data is critical to the overall opioid reduction effort, according to Allen, who says he’s optimistic about the opportunities to make a difference when it comes to reducing prescriptions—thanks in large part to the evolution and maturity of technology.
“It’s absolutely important for clinicians, physicians to have accurate data that describes their patient population and their particular prescribing habits—and, what the results of those prescribing habits might be,” he observes. “Because we’re an integrated network, we’ve got really good data down to the physician level and clinical condition level about the number of opioid tablets and milligram morphine equivalency that are prescribed on a system, regional, hospital, clinic and provider basis.”
Having access to this kind of quality data will allow Intermountain to track in real time how the health system is progressing toward its goal of slashing prescriptions for opioid tablets by more than 5 million per year, Allen says. “The building blocks are there, but we’re really working on ironing out the whole experience in the Cerner platform,” he adds.
Of particular concern are the majority of opioid tablets that go unused and are left over in a patient’s medicine cabinet, warns Allen, who points to studies showing that two-thirds of all opioids misused and abused come from family members or friends.
“Currently, nationwide, providers tend to write prescriptions for more opioids than patients need, and large quantities of the medications are often left over after the need for pain relief is past,” said Doug Smith, MD, associate medical director at Intermountain Healthcare. “We will follow best practices in prescribing so the medications prescribed more closely match the needs of patients.”
At the same time, Smith emphasized that “patients with acute or chronic pain conditions will still be able to get the medications they need” and “have access to the full range of options to manage pain.”
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