A Window into Opioid Management

From the data gathered as part of CHIME’s “Healthcare’s Most Wired” program, our recent Opioid Management report is essentially a white paper on the state of opioid prevention in the most technologically advanced ambulatory organizations in the country. While this white paper does not represent the country as a whole, it does represent what 137 of the best organizations are doing right now to combat opioid use disorder (OUD).

The Challenge of PDMPs

One of the most important tools in combating opioid use disorder is the prescription drug monitoring program (PDMP). This is essentially a state-run database that monitors controlled substances. It documents when and to who controlled substances are prescribed, when the prescription is filled, what the cost it is filled for, what the dose is, and which doctor prescribed the medication.

What doctors are supposed to do when they want to prescribe a controlled substance is to log on to the PDMP and search the patient to see whether he or she has already gotten the prescription. This information could appear in several ways. Maybe a patient is just doctor shopping, or maybe that person filled a prescription for a 30-day supply from the urgent care facility down the street 2 days ago and is now in this doctor's office looking for another 30-day supply. The PDMP basically identifies those people that shouldn't be getting the opiates because they already have enough.

Now, logging into the PDMP database takes several minutes every time a doctor wants to do a search. That is a bigger deal to some than others. For example, if a provider is on a state border or in a smaller state that is surrounded by other smaller states, the search gets complex. Washington DC has a PDMP, Maryland has a PDMP, Virginia has a PDMP, and Delaware has a PDMP. A doctor that is close to these other states is supposed to search all of those different PDMPs. However, this expectation is not realistic because it would take far too much time for one doctor to search all of the PDMPs to find out whether one patient can get an opiate or not.

The Potential of EMR Vendors

EMR vendors can help solve this time-consuming process by linking their solutions to each of the PDMP vendors nearby. Once they integrate with those PDMP vendors, they have the capability to put a PDMP search within the workflow itself. At that point, the EMR essentially does all the work. Doctors only need to do one search based on their patient and the opiate that they are prescribing. The EMR then searches the PDMPs and comes back to the provider workflow with a flag if the patient has already gone through a different doctor to get the same prescription in a recent time frame.

The second chart in the report shows the percentage of organizations where the ePrescribing module in the EMR is connected to the PDMP database. That is really the most important thing that we've found in doing this opioid research because, when the EMR has that PDMP integration, it makes the process so much easier.

Provider Perspective 

Opioid management is a huge deal within the market, and there's definite provider interest, but there aren't a lot of best-of-breed, opioid-focused solutions or vendors that are addressing this issue. Unfortunately, EMR vendors still seem to see this as an ancillary area because buying decisions aren't made on whether an EMR has OUD functionality or not.

The last chart in the report is based on Arch Collaborative data. Nearly 12,000 physicians responded to the statement: “the EMR enables me to identify and prevent opioid misuse and addiction.” What is really interesting is that, nationwide, you have only a little more than a third of these providers that say that the EMR is actually doing something that really helps.

In my opinion, that percentage should be much, much higher. For the most part, the EMR is really not living up to its potential to help doctors prevent opioid misuse. EMR vendors are currently putting forth the effort to make things simpler and as effective as they need to be. From these findings, many EMR vendors could be doing more to step up to the plate.

To find out more about the state of opioid management solutions, I recommend reading the whitepaper.




     Photo credit: Adobe Stock, irissca