administering an large amount of opioids

The Arch Collaborative Summit - Opioid Use

Opioid abuse has been sweeping across the nation. Many people have family members or friends who are struggling or have struggled with opioid abuse. Many see it as an illness and believe that we should treat it as such: with compassion, counseling, and a watchful eye.

Attendees of the Arch Collaborative Summit gathered in a panel to learn how to leverage the EHR in solving the opioid epidemic. The panel comprised Laura Polito of Sansum Clinic, Rob Schreiner of WellStar Health System, and Dr. David Rich from WVU Medicine. Each panel member discussed challenges and innovations related to opioid use for providers to consider.

Sansum Clinic

“Even in California,” said Laura Polito as she started her presentation, “we didn’t realize how much of an issue we had.” Many problems start in the ambulatory setting or the ED. The driving forces behind making changes in the Sansum Clinic were building their EHR around measures and the new laws that had been put in place in California. 

The clinic now has several alerts that tell prescribers to check CURES, California's prescription drug monitoring program (PDMP). The problem is that the prescribers must still log out of the clinic’s system and log in to CURES. Another of Laura’s concerns is how to get their system to tell them when a patient has certain risks, such as overdosing several months before or being on a particular medication.

WellStar Health System

“Embedding access to the PDMP is a big clinician satisfier,” Rob Schreiner began. “Embedding the link inside the ambulatory clinical system generated 80% of the goodwill we got.” WellStar has also been extracting information from the EHR and feeding it back to the clinicians. They use specialty-specific reports of practice pattern use of opioids, and then they distribute those to individuals.

“We don’t profess to know the right rates, but we expect our clinicians to have peer-to-peer conversations equipped with practice patterns.” WellStar’s motto is to not tell doctors what to do but to tell them what they have done. Their focus is continual, local improvement. “We don’t concern ourselves with national comparisons,” Rob said.

WellStar is also working on enhanced recovery after surgery. Most of their total-hip-replacement patients go home on the first day without opioids. Their EMR standardizes their program and enables all the care providers to be on the same page.

WVU Medicine

“Sometimes, there is a recency bias,” said Dr. David Rich in a modest attempt to explain his organization’s high scores. “About a month before we completed the KLAS survey, we rolled out NarxCare, which really has been a time saver for our providers. So sometimes providers remember only what we did last.” WVU Medicine is querying multiple states’ PDMPs, and their ED tracking board flags and reports at-risk patients.

West Virginia borders five states, which is important to remember when looking at opioid abuse and doctor shopping. Currently, there are some limitations to NarxCare. The first is that WVU Medicine gets tables from only two of the bordering states. The second is that only physicians can log in; nurses can’t. “We are getting half of the information we could be getting,” said Dr. Rich. “That is an opportunity for us.”

WVU also uses Collective EDie from Collective Medical Technologies. The tool collects information from previous visits and presents flags on a tracking board so that potential security threats can be documented.

“A lot of what we are doing with opioids involves awareness,” Dr. Rich said. “We have to be thinking about whether patients are getting products from other places. The tool is great for raising that awareness.”

Governance was definitely a theme at the conference. WVU Medicine has a task force that looks at the laws as they change. Dr. Rich mentioned that he had received an email about a policy change just the previous night. His organization’s task force looks at pain assessments and standards of care to see how they can move things along and change practices. “The battle is tough, but we are glad to be part of the solution.” 

Managing State Differences

Dr. Rich pointed out that different states have different opinions on what could or should be shared. “This is a national crisis,” he said. “We have the infrastructure. We have a real opportunity to share information and make care better. It is not enough to have one conversation.”

Education requirements can also be different in each state; for instance, states disagree on who is authorized to do counseling. Certain tools can help providers stay compliant with their education requirements.

Sansum Clinic does have education requirements with every prescription and is required to provide education on NARCAN. They built an alert for the NARCAN prescription based on California law, but there are no rules in California about who does education.

WVU Medicine is using functionality that automatically populates after-visit summaries. “But sometimes those summaries don’t even make it to the parking lot,” said Dr. Rich. There is a tool that goes through those checks, but the providers have to remember to use it. 

Enacting Change

All the panel members, including some people in the audience, mentioned problems with their states’ regulations that are making efficiency hard. 

“I know my congresswoman and spoke to her the other day,” said Rob. “I know my state representatives. I go down to the capitol not infrequently.” Rob’s take was to be actively involved and sponsor bills. “The opioid illness is on us,” he said, urging healthcare organizations to spend their money and open their checkbooks to enact change. “Having to pay for change is part of our job.”

It was widely agreed among the panel members and audience members that convincing the people in Washington requires marketing and advertising skills, not science. In other words, storytelling works, and policy in Washington is driven one story at a time.

There was energy in the room, and it was obvious to me that everyone was sharing similar experiences. All healthcare organizations are largely facing the same barriers, challenges, and frustrations with opioids. So please—share your stories and help drive the change that needs to happen.





     Photo cred: Shutterstock, Pop Paul-Catalin