September marks National Recovery Month — a time to recognize those who have been affected by substance use or mental health issues, including those who have been impacted by the opioid crisis. The Centers for Disease Control and Prevention (CDC) estimates that 128 people die every day from opioid-related drug overdoses. This year marks an especially challenging time due to the impact of the COVID-19 crisis on opioid overdose rates, in addition to the ongoing overprescribing of opioids — resulting in an increased vulnerability for patients.
Traditionally, EHRs haven’t been widely used to aid with opioid stewardship. As a Professional Services Senior Analyst at MEDITECH, I help develop clinical toolkits and assist our customers with implementing new processes at their organizations. Prior to creating our Opioid Stewardship EHR Excellence Toolkit, I served on an opioid task force established by the Electronic Health Record Association (EHRA) — an organization that brings leaders from our EHR developer community together to collaborate on solving industry challenges — to evaluate the CDC’s Guideline for Prescribing Opioids for Chronic Pain.
The task force provided commentary on the 12 recommendations outlined in the CDC’s guide and recommended ways EHRs can help with addressing the opioid crisis. This led to the creation of the EHRA’s CDC Opioid Guideline Implementation Guide for Electronic Health Records. The first recommendation directed healthcare organizations to avoid using opioids as a first line of therapy. When an opioid treatment was prescribed, providers were expected to use the lowest effective dose and to review the Prescription Drug Monitoring Program (PDMP) data.
The EHRA encouraged healthcare organizations to establish an opioid stewardship program. Implementing clinical practice guidelines yielded better patient experiences and outcomes, improved safety, and reduced unwarranted variation, improving overall opioid prescription management. Leveraging the tracking and standardization features available within an EHR proved to be a highly effective tool for achieving these goals.
The EHRA Opioid Tapering White Paper — recently highlighted by Healthcare IT News — explains the role tapering opioid doses plays in easing patients who are already taking high doses of opioids off their prescriptions. When recommended, tapering involves dose reductions of 5% to 20% every four weeks. Patients who have their opioid prescriptions suddenly discontinued or tapered too drastically can experience harm as a result of serious withdrawal symptoms. This can include exacerbation of pain, psychological distress, and in severe cases, suicide. Managing an opioid taper schedule at just the right speed, individualized to each patient, can help improve outcomes and avoid harm.
Based on evidence provided by the CDC, the recommendations outlined within the white paper suggest implementing the following using an EHR:
- Establish order sets that include pain management alternatives to opioids as well as side effect management and narcan for accidental overdoses
- Use a Milligram Morphine Equivalent (MME) calculator to determine the relative strength of prescribed opioids and aim to keep or reduce the dosage to less than 50 MMEs per day
- Integrate a PDMP overlay available on demand within the clinical workflow.
See how MEDITECH’s Opioid Stewardship Toolkit helps providers reduce opioid-related harm.