America’s opioid epidemic shows no sign of letting up. Addiction to legal painkillers and illegal drugs like heroin has resulted in more than 42,000 overdose deaths in 2016, according to Centers for Disease Control and Prevention figures released at the end of March.
Health Data Management, over the past few months, has profiled a number of healthcare organizations that are turning to health information technology to combat the crisis. What follows is a look at four of those initiatives.
Geisinger: Pairing EHR and e-prescribing data
Geisinger, an integrated health system, 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.
The organization developed and initiated several approaches that focus on changing physician patterns to reduce the prescribing of opioids—including creating a dashboard linked to an electronic health record that identifies current practice patterns among Geisinger’s providers, Kravitz testified during an April 12 House Energy and Commerce Committee 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.
But Geisinger didn’t stop there. Among other activities, it 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, and integrating data from a pain app that measures physical activity, patient-reported pain and other metrics into the dashboard and the patients’ medical records.
University of Colorado Anschutz Medical Campus: A new model to predict risk
University of Colorado Anschutz Medical Campus researchers developed a prediction model that leverages electronic health record data to help providers identify hospitalized patients who are at the highest risk of progressing to chronic opioid use after they’re discharged from the hospital.
The research team, which developed the tool using patient data from the Denver Health Medical Center, says the model could be integrated into an EHR and activate an alert when a physician orders opioid medication, informing the doctor of their patient’s risk for developing chronic opioid use.
“The goal was to identify who these patients were to let providers know at the time of care that these patients are at higher risk, so they think twice before they prescribe an opioid or think about other ways to manage their pain in the hospital setting,” says Susan Calcaterra, MD, a fellow in addiction medicine at the CU School of Medicine and lead author of a study published last month in the Journal of General Internal Medicine.
Calcaterra contends that prior to the study by her and her colleagues, no prediction model had been published to identify hospitalized patients at high risk of future chronic opioid therapy (COT)—defined as either receiving a 90-day or greater supply of oral opioids with less than a 30-day gap in supply over a 180-day period, or filling 10 or more opioid prescriptions over the course of a year.
Brigham and Women’s uses digital device to monitor usage
Brigham and Women’s Hospital has turned to digital pills—gelatin capsules containing ingestible sensors and medication—to help track patterns of opioid usage among patients.
The Boston hospital claims to be among the first healthcare organizations to explore the application of this new technology. Specifically, BWH leveraged the etectRx ID-Cap system in a pilot study of 15 patients who received prescriptions to take oxycodone digital pills as needed following treatment in the emergency department for acute fractures.
Patients in the pilot study were directed to use oxycodone—one to two 5-millegram oxycodone digital pills every six to eight hours—as needed for pain. However, to their surprise, Chai and his colleagues found in their study that most patients stopped taking their prescription opioid after only a brief period, even among patients with fractures that required surgical management. The digital tracking system—which uses a radiofrequency emitter—documented that most oxycodone doses were ingested by patients within the first three days after discharge from the ED, and that on average they took only six pills despite being prescribed 21 total capsules.
“The reality is that we’re potentially prescribing too much, as the study showed,” according to Peter Chai, MD, a faculty member in the Division of Medical Toxicology within the BWH Department of Emergency Medicine. “We know that opioids are definitely a source for diversion and non-medical use. So, let’s be smart about prescribing the right amount that controls pain and no more opioids than are needed.” BWH’s clinicians published results of their pilot study in the current issue of Anesthesia & Analgesia.
VA maps opioid-prescribing rates
The Department of Veterans Affairs is posting information on the rate of opioid prescribing, including dispensing rates for each VA facility displayed on an interactive map that shows data over a five-year period.
By publicly releasing this data, the VA says it will “facilitate the sharing of best practices in pain management and opioid prescribing among doctors and medical center directors,” the agency said in a statement.
VA’s Digital Media Engagement team led the effort to develop the interactive map using CARTO, a cloud-based geographic information system and web mapping tool. Working with the agency’s Office of Information Technology, the map and data are hosted on the VA open data portal.
According to VA Secretary David Shulkin, MD, posting information publicly on opioids dispensed from the VA’s pharmacies is a critical component of the agency’s efforts at transparency and to prescribe these pain medications appropriately and safely.
“Many veterans enrolled in the VA healthcare system suffer from high rates of chronic pain, and the prescribing of opioids may be necessary medically,” he said in a statement. “And while VA offers other pain management options to reduce the need for opioids, it is important that we are transparent on how we prescribe opioids, so veterans and the public can see what we are doing in our facilities and the progress we have made over time.”
Bloomberg News contributed to this report.
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