As physicians, we often don’t see the harm that opioid pain medications can cause to the individual, whether through side effects, dependence, or diversion. Also, we may not always consider the implications on the national scale; prescription drug overdose deaths have increased exponentially from 2013 to 2016. The magnitude of this crisis has led to pain management guidelines from numerous entities, such as the Joint Commission and the CDC. These recommendations provide a solid foundation for opioid stewardship and are now considered to be best practice.
The challenge with pain management guidelines is twofold: first, some physicians are not aware of their existence, and second, other physicians may be aware of the guidelines, but do not prescribe opioids often enough to remember and consider these recommendations. Fortunately, EHRs can help support physicians in adhering to the guidelines and exercising opioid stewardship, by:
Identifying at-risk patients
Assessments embedded in the EHR help clinicians screen for individuals who may be at an increased risk of harm from opioids. For example, patients with uncontrolled anxiety or depression have a greater potential for opioid dependence, while patients with COPD, OSA, or other comorbidities are at increased risk of respiratory depression.
An ideal EHR also gives physicians simple, “in-workflow” access to a PDMP, to further safeguard against harm. During the ordering process, the prescriber can identify patients who may have opioid and other Schedule II medication prescriptions from other physicians.
Identifying other modalities
An EHR may also help physicians identify whether the patient has sought alternative therapies to manage pain symptoms. For example, the physician can determine if a patient with uncontrolled anxiety has undergone behavioral health interventions and may recommend behavioral/cognitive therapy.
Suggesting medications and dosing appropriately
Clinical decision support within the EHR can assist the ordering physician by suggesting shorter-acting, weaker opioids to start, and, if ineffective, gradually increasing the dose and duration that have been recommended.
Monitoring long-term data
Flowsheets enable physicians to monitor patients’ data over the long term. Using these tools, physicians can quickly comprehend the information to spot patterns, manage medications, and oversee factors such as pain symptoms, functional ability, and treatment response. This patient snapshot can be trended over time, and is invaluable to physicians who share patients at practices and clinics.
EHRs are not meant to be passive tools for documentation. They are active tools that include Clinical Decision Support capabilities to help physicians to comply with CDC guidelines and avoid the overuse of opioids. For more information on the invaluable role of the EHR in pain management, I recommend the following:
- Addressing the Opioid Crisis, a Thought Leader podcast with Phil Campbell, CIO and VP, CalvertHealth, and Janet Desroche, AVP, MEDITECH
- “Integrated prescription drug monitoring supports smarter opioid prescribing,” a blog post by Chippewa County War Memorial Hospital.
If you are interested in learning more about how MEDITECH’s Opioid Management Toolkit can help, click the button below to watch a recording of my recent webinar with Dan Seltzer, co-chair of EHRA’s Opioid Crisis Task Force.