Opioids

Who is Responsible for Solving the Opioid Epidemic?

If we’re to have any chance of solving the opioid crisis, we’ll need the buy-in from an array of key stakeholders. Everyone from the doctors prescribing medication to the state programs and legislators working to combat opioid deaths. Considering that each of the 50 states have different strategies and requirements surrounding opioid control it becomes a complicated problem very quickly.

While there’s a lot of variation in what regulatory requirements states set up, I’ve always found it best in situations like this to focus on the similarities. Several states require electronic prescribing of controlled substances (ePCS), which puts extra protections in place to prevent possible prescription fraud. In some states, providers have begun implementing tools that analyze prescribing data and churn out actionable insights. But the most common regulatory requirement is to check the state prescription drug monitoring program (PDMP).

A PDMP is a state-run and -funded electronic database for prescriptions of controlled substances. The PDMP can be a valuable tool for identifying possible opioid abuse at the point of care. But while PDMPs have been around for several years, there are still some big problems to be solved.

For example, providers are often slow to adoption because the PDMP information isn’t readily available in their workflow. Additionally, they often lack tools to analyze the PDMP medication history in a meaningful way, or they don’t find value in checking the PDMP (i.e. they feel they already know their patients well enough).

As mentioned in our last post about opioid stewardship, the ability to share PDMP data across state lines remains in its infancy. While some states have formally agreed to share, and the supporting technology exists, we’re still in the early stages of cross-state PDMP support. Often doctors still elect to simply call other states and request a patient’s information directly.

Other problems to solve around PDMPs include issues with patient matching (often there’s no way to be sure that the John Smith in the PDMP is the same John Smith in front of you and in your EMR), a lack of helpful analytics, a clunky and time-consuming workflow, and no EMR integration.

On this last front, EMR vendors have an opportunity to work with the states. Every state is different, so providers need the expertise of their vendors to help set up seamless connections with the state PMDP. Several vendors have proven out the model of EMR-PDMP integration, but it is not yet an industry standard.

Regardless of how connections are set up, both the states and the EMR vendors have to be willing to come to the table. States have to be open to working with the vendors, but vendors also have to build out what’s needed and be somewhat flexible.

One more group is noticeably absent from the opioid stewardship discussion: population health vendors. While population health vendors are already deep in the weeds of analytics and care interventions, provider efforts around the opioid epidemic are largely separate from population health efforts. Most opioid interventions and analysis happen on an individual patient basis.

I have heard about some one-off cases where customers have asked their vendors for help in this area, and vendors have consented and built out solutions. But no population health vendors are offering a solution across their customer base; these are one-off cases. Nobody has a unified approach.

There are also CRM vendors who have done the same type of work for individual customers. For example, HC1 has partnered with Appriss Health (a PDMP vendor) to look at opioid use across various regions and analyze where treatment centers or outreach programs would have the greatest impact.

In the future, we hope to see more vendors with something to offer get involved in opioid stewardship. With recent pushes for EMR interoperability and value-based care, many vendors have the technology base to make a big impact.

We recently kicked off research for our inaugural perception report on opioid stewardship strategies and what vendors can help. We’re also looking forward to exploring the possibility of other topics focused on combating the opioid crisis, such as best practices for state PDMPs, the role of your EMR, and vendor performance.

If you’re interested in participating in our research, contact me at jackson.tate@KLASresearch.com. We’re excited to share the knowledge and insights we’ve gathered to help providers, vendors, and government bodies combat the opioid crisis.