The opioid epidemic has been one of the most daunting challenges to face the healthcare industry. As deaths have continued to mount, organizations have invested significant resources — and formed partnerships — to try to wrap their arms around what the CDC has termed a “multi-layered problem.”
And for a few years, they were making progress by implementing programs to monitor and reduce the prescribing of opioids.
Then, the Covid-19 pandemic hit, resulting in diminished access to treatment, social isolation, and a more potent drug supply – a “recipe for death,” according to a Washington Post article. Indeed, more than 100,000 Americans died from drug overdoses in 2021, marking a 15 percent increase from the previous year. To date, the epidemic has claimed more than 1 million lives.
“These are powerful drugs, and people can’t develop a tolerance to them,” said Scott Weiner, MD, Emergency Physician at Brigham & Women’s Hospital. “It’s scary.”
During a panel at the ViVE22 event, which took place in Miami Beach, Fla. in March, Weiner and four other experts — Sean Kelly, MD, CMO at Well Health and an Emergency Physician, Beth Israel Deaconess Medical Center; Patty Lavely, Chief Information & Digital Officer at Health Care District of Palm Beach County; Matt Sullivan, MD, CMIO at Atrium Health; and Greg Polston, MD, Pain Management Specialist at UC San Diego Health — shared perspectives on how their organizations are addressing the problem, and the critical role technology can play.
Because of the scope of the problem, however, it’s critical that leaders take a pragmatic approach, noted Sullivan. “We’re not going to solve the nation’s drug crises, and that’s hard,” he said. “But we can take a look at the amount of prescription medications that we’re delivering across an institution and make sure we highlight the problems.”
For Atrium Health, along with many other organizations, there’s no shortage of data. The challenge lies in sorting through it and figuring out how to surface information in a way that is free of bias and easy for providers to access. “Once we show what we can deliver, we can work with operational leaders to determine what action should be taken,” he added.
It’s a goal CHIME has been working toward since its Opioid Task Force was founded in early 2018, according to Lavely. “We need better analytics to identify patients accurately and consistently that are at risk or have opioid use disorder.” One of its core objectives was to develop a framework for organizations “to build IT-based supports for launching and maintaining system-wide initiatives” such as e-prescribing of controlled substances and prescription drug monitoring programs (PDMDs) to reduce usage.
So far it has worked, she said, citing results from the 2021 Digital Health Most Wired survey indicating that 100 percent of organizations have adopted e-prescribing, and 90 percent are connected to the state’s PDMP. “We’re successfully utilizing order sets to reduce the amount of prescribed and offer non-opioid options.”
Of those respondents, however, just 68 percent reported having single sign-on capability and are able to “preserve patient context between the EHR and PDMP,” which is a critical factor in reducing opioid use. “The lack of interoperability with the right data sources plays a significant role in this challenge,” Lavely added. “We really need better integration with the health system.”
Another weapon organizations are leveraging in the fight against opioid use are risk assessments, which have garnered mixed reviews. “A lot of the risk scores are based on patterns of concurrent opioids,” and can identify whether patients have used multiple providers or pharmacies.” And while that is certainly helpful, “it doesn’t take into consideration all of the other factors that play into reasons for addiction,” noted Weiner, who is also director of the Brigham Comprehensive Opioid Response and Education Program. “It’s an incomplete view of the data.”
Lavely agreed, cautioning that risk scores “don’t tell the whole story” of what a patient is experiencing.
The other potential issue is that risk scores place a heavy burden on clinicians to decide how to proceed if a patient is deemed high risk. “Does that mean we don’t prescribe opioids for someone who is in severe pain?” he asked. “What do we do as clinicians?”
This, the panelists noted, is where IT can play a key role. Below are some of the suggestions that were offered during the conversation:
- Insert flags. There are times in which even high-risk individuals can be prescribed medication to help manage pain; however, there needs to be a specified endpoint, noted Polston. “That’s where IT might be able to add an alert that says, ‘wait a second — you’re refilling this prescription. Are you sure you want to do that?’” Another area in which providers could use a prompt is to determine when it’s appropriate to prescribe Narcan, said Weiner. “When we create best practices advisories that show someone has had an overdose in the past, we can add a popup that says, ‘make sure they have Narcan.’” Not only can this help reduce harm, but it can also start to chip away at the stigma that exists. “People are going to use drugs; it’s a fact of life,” he added. “Our job is to keep them alive.”
- Embrace text messaging. Given the acceleration of digital health — and rising consumer expectations when it comes to communication — enabling electronic dialogues has become increasingly important, said Sullivan. “It’s a way to connect with patients and gently remind them that they can come to the clinic, or ask if they need more Narcan.” It’s may not be the preferred platform for everyone, but even if just a few patients participate, it’s worth the effort. “We’re in the business of saving lives, even if it’s just one or two at a time.”
- Pivot quickly. With a situation as fluid as the opioid epidemic, changes are often made to treatment recommendations. Therefore, it’s critical that order sets are updated as quickly as possible, said Weiner. “We need changes to happen quickly.” And although he acknowledged that there are myriad competing priorities for CIOs, “this is still happening. It’s an epidemic. And by making adjustments, you have the power to help patients.”
- Consult the playbook. Lavely strongly recommended visiting CHIME’s Opioid Action Center, which offers best practices for creating an opioid stewardship committee, dashboards, and order sets, as well as links to case studies and news updates.
Finally, Weiner urged leaders to acknowledge the enormous potential their teams have to make a difference. “You have tremendous power because you hold the keys to the EHR, which affects every aspect of patient care in the clinical environment,” he said. “Don’t underestimate that.”