Grappling with the evolving guidelines and regulations surrounding opioid prescribing is a significant challenge for health systems across the country. Over-prescription of opioids, such as morphine, oxycodone and hydrocodone, happens in a variety of ways, according to a report authored by a panel of clinical executives at a leading U.S. health system and described in an article in the Sept. 8, 2017 issue of Health Affairs. As the article states, overtreatment and opioid misuse has “driven an epidemic of opioid addiction and drug overdoses, now the leading cause of accidental death in the United States.”
Addressing the problem of acute and chronic pain management is complicated. Based on various pressures, clinicians have learned to prescribe in a certain manner to alleviate pain. Many caregivers – and patients – came to believe that any level of pain should be addressed through medication. Standards and expectations are changing, but the systems that direct care have not yet caught up and generally are not providing clinicians with the support they need to make this transition.
As best practice guidelines are emerging around opioid prescribing – for example, guidelines emphasizing the importance of assessing patient risk prior to initiating opioids – electronic health records (EHRs) are not yet equipped to guide clinicians or provide decision support during the prescribing process.
MarketWatch recently published an opinion piece by my colleague, Patrick Yoder, detailing five ways that improving use of EHR systems can significantly reduce the endemic overuse of opioids. I encourage you to read this insightful article, “Small changes could reap big rewards in fixing the opioid crisis.” Unfortunately, the care processes and technology we use to support clinicians are often inadvertently driving inappropriate utilization. Tackling these issues first and early, or upstream in the process before serious problems arise, are often just “small changes” and they can drive an enormous improvement in opioid prescribing practices.
Once these issues in your clinical process and EHR systems are addressed, clinicians must understand and improve both general ordering practices and adherence to best practice guidelines. Unfortunately, it has historically been very difficult to have clear insight into clinician ordering habits, and even more difficult to benchmark among clinician peer groups. Physicians are hungry for meaningful feedback about their medication ordering practices for specific types of patients and settings compared to their peers, yet they seldom receive these insights that are essential to address appropriate utilization of opioids.
Frontline clinical teams need support to improve and better control care delivery processes that too often result in the over-prescription of opioid medications. Adapting to rapidly changing guidelines for opioid prescribing requires corresponding updates to health system practices, workflows and related EHR content. LogicStream Health addresses both the proactive and reactive aspects of the challenge by unlocking data from within the EHR so hospital systems can proactively direct hospital staff protocols and reactively identify and address where opioids are overused. In February 2018, we introduced an innovative clinical process module within our software platform to improve and better control opioid prescribing practices.
The software empowers frontline clinical teams to better control their processes and workflows, so they are continuously and reliably aligned with evidence-based guidelines, providing clinicians with a blueprint for appropriate opioid therapy. Clinical teams can fix broken and inefficient clinical processes that are contributing to opioid over-prescription and misuse and sustainably keep them in control over time. Learn more about this recent innovation in software by visiting our Opioid Management page.
One of our customers, an academic medical center, has been using LogicStream Health software to monitor general provider prescribing habits around opioids – who is ordering what, for which groups of patients and where in their EHR workflow they are doing the prescribing. LogicStream Health software has identified problem workflows and EHR build that are driving inappropriate prescribing and gives prescriptive fixes to these problems. Additionally, as new regulations have arisen, LogicStream Health finds gaps in care processes, particularly around assessing risk prior to initiating or continuing opioid use, and provides best practice solutions.
Upstream improvement to the clinical processes guiding opioid prescribing is the best path for health systems and hospitals to address the current epidemic. These processes aren’t the only changes necessary to prevent opioid misuse, but they will certainly make a major dent in the crisis moving forward.
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