Giving clinicians the tools for safer opioid prescribing

July 7, 2022 |  Nursing, Physician, EHR, Health IT, Patients


Recent statistics published by the Centers for Disease Control show the grim news that opioid overdose deaths continued to increase this year. 

The 15 percent increase over last year followed a 30-percent spike between 2020 and 2021, when COVID-19 sent so many people into isolation and resulted in more opioid overdoses, particularly from fentanyl. 

Now that clinicians can hold in-person appointments again, they can more effectively determine the patient’s condition and decide the most appropriate response.

And as the CDC considers updating its prescribing guidelines to eliminate suggested prescribing thresholds measured in morphine milligram equivalents (MMEs), organizations will need the ability to set their own dose limits within the EHR to reduce the potential for overprescribing.

Helping prescribers make the right decisions

In our work supporting responsible opioid stewardship, we’ve contributed to ongoing efforts to address opioid addiction and misuse from the clinical side, including the Electronic Health Record Association’s Opioid Crisis Taskforce and ECRI Institute’s 2019 Measures and Clinical Decision Support for Safer Opioid Prescribing: Recommendations and Implementation Strategies.

These recommendations — aimed at improving how technology supports responsible prescribing — fall under three main categories: 

  • How technology can measure and monitor prescribing patterns
  • How EHRs can collect the information that drives clinical decision support (CDS)
  • How CDS can alert prescribers to the need for interventions

At MEDITECH, we’ve further refined our solutions to meet these goals, including an opioid risk tool that generates an assessment score as the physician enters a patient’s drug and alcohol history prior to prescribing any opioids for chronic pain.

With that data, prescribers can quickly determine the appropriate course of treatment for each patient.

We’ve also deployed opioid toolkits and Business and Clinical Analytics dashboards so health systems can review and respond to trends on the clinic floor and in the wider community. Additionally we’ve built functionality within Expanse so organizations can set their own opioid prescribing guidelines for providers to follow.

Patient safety is the priority

Over the last few years, all 50 states have established Prescription Drug Monitoring Programs (PDMPs) — including an increase of almost 20 states since 2018. That means prescribers can make more informed decisions about what to give their patients.

PDMPs help prevent prescription “shoppers”, who attempt to get multiple doctors to administer or prescribe opioids. They also identify prescribing trends that hospitals and health systems can use to address potential problems.

From what we’ve observed with MEDITECH customers who utilize our opioid toolkit and direct connection to Prescription Drug Monitoring Program (PDMPs) within the Expanse workflow, prescribers are more likely to recommend safer courses of treatment, such as non-opioid options or lower starting dosages.

This is one example of how our approach to building solutions is aligned with the Institute of Medicine’s (IOM) STEEEP principles: Safe, Timely, Effective, Efficient, Equitable, and Patient-centered care.

Making prescribing history and guidelines available at the point of care is a step toward achieving these goals, proving how EHRs can help providers and patients make the most effective and safest treatment decisions.

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Written by Bryan Bagdasian, MD, MMM, Primary Care and Hospitalist Medicine, Steward Health Care, and Dan Seltzer, Senior Analyst, Professional Services Division, MEDITECH

Bryan Bagdasian MD, MMM joined MEDITECH in July 2013 as a physician informaticist specializing in standard content and clinical decision support. Dr. Bagdasian supports the implementation of MEDITECH's Expanse platform through our READY and CLPP programs. He is also an advocate for EHR safety and serves on MEDITECH's Patient Safety Review Board. With more than 25 years of clinical experience, Dr. Bagdasian was among the select physicians named to Castle Connolly's 2017 Top Doctors list. His professional memberships include the American Association for Physician Leadership, American Medical Association, Massachusetts Medical Society, Society for Perioperative Assessment and Quality Improvement, and American Telemedicine Association.

Dan Seltzer is a senior analyst in the Professional Services Division responsible for operationalizing clinical guidelines driving our toolkits. He helped spearhead the EHR Association (EHRA) research to create the CDC Opioid Guideline Implementation Guide for Electronic Health Records, as well as the EHRA Opioid Tapering White Paper. Dan is also the lead author of MEDITECH’s Sepsis Management and Opioid Stewardship Toolkits.