Who's Measuring Opioid Stewardship?

For the last few years I have led KLAS’ research in the ED market. This has given me the opportunity to hear from ED doctors who are on the front lines of the opioid crisis.

In 2016, an average of 115 people died of opioid overdose each day, and there were 236 million prescriptions for opioids. In contrast, 1992 saw only 112 million opioid prescriptions.

In light of this crisis, provider organizations are working to develop opioid stewardship programs and adopt technology solutions that support their efforts. In a hearing on the opioid crisis before the Senate Health, Education, Labor, and Pensions Committee last month, Chairman Sen. Lamar Alexander (Tenn.) said, “For individual doctors, nurses, and patients, data can mean helping prevent more people from sliding down the slope of addiction.”

But where to start? What tools do providers need? Which vendors do they need to talk to? How does their state fit in?

In our first report on opioid stewardship, we hope to share what organizations are doing, which vendors are best positioned to help them achieve their strategic goals, and what roadblocks (around both technology and state-specific practices) are in their way.

One major challenge we have already seen is the wide variation in practices from state to state in the US. Some states, like Ohio, which has among the highest rate of opioid overdose deaths in the country, have a very open Prescription Drug Monitoring Program (PDMP) that any provider can access for free, and that data can be integrated into providers’ EMRs.

But other states, including our own state of Utah, aren’t so progressive. In Missouri, individual counties have their own databases, which don’t talk to each other. In many states, the ability to share data across state lines exists but isn’t being used.

Here in Utah, the PDMP is in early iterations, and the APIs aren’t as open. Not being able to integrate the database information into the EMR makes finding patient matches and getting the right information more difficult for doctors.

In our research into vendor solutions, we are asking providers how well these solutions help providers do the following:

• Identify and prevent addiction at the point of care
• Monitor and identify problematic prescribing habits
• Monitor and identify possible drug diversion
• Analyze and direct care management efforts to effectively treat patients who may be addicted to opioids

Organizations using best-of-breed solutions tend to have different expectations from those using solutions from enterprise vendors. Best-of-breed customers tend to be looking for one or two main functions that work well. Enterprise customers tend to expect more holistic, wide-reaching technology from their vendors to support for their opioid stewardship strategies. They’re more likely to pull in population health data and coordinate with other types of facilities, like a behavioral health clinic.

Provider organizations are also looking closely at what’s happening internally. Organizations can identify both problematic prescribing habits (such as unintentional overprescribing) that require further provider education and problems with drug diversion.

Measuring actual progress on the opioid crisis can be tricky. Typically, the most measurable outcome in the industry is a reduction in prescriptions for opioids. Some argue this isn’t the best measurement, and that if the number of opioids available from providers decreases without efforts on other fronts (like treatment), the illicit drug trade may increase.

Certainly, a solution will require efforts on multiple fronts. Ideally, the most successful outcome is an overall reduction in opioid overdoses and deaths. The more tools that facilitate prevention up front, the better the downstream effects will be.