There is little debate that the opioid crisis has reached epidemic status. According to the National Institute on Drug Abuse more than 115 people a day die in the United States after overdosing on opioids. The misuse of and addiction to opioids—including prescription pain relievers, heroin, and synthetic opioids such as fentanyl—has a devastating effect on the health of the population but also disrupts and strains the healthcare system as a whole. The current response to address the crisis has been unprecedented, including bipartisan congressional and administration involvement. This can be highlighted by a multitude of bills; at last count there were over 70 opioid-related bills up for consideration, and numerous federal agencies are creating grants and initiatives to respond to the crisis.
The response reaches beyond the government as multiple national stakeholder associations and private parties have also become increasingly involved. Electronic health records (EHRs) and the vendors behind them can also play a role in addressing the opioid crisis. The Electronic Health Record Association (EHRA) is one of the groups that has been actively engaged in searching for information and developing responses to the crisis.
Last month, I had the honor of participating as a panelist at an EHRA congressional meeting focused on the role of health IT in addressing the opioid epidemic. The meeting offered the EHRA Opioid Crisis Task Force an opportunity to share information, offer recommendations, provide feedback on proposed legislation, and provided a forum for discussion with congressional staff who have been working to find ways to combat this issue.
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The meeting included updates on the work of the three subcommittees of the EHRA Opioid Crisis Task Force (Policy, Clinician Impact, and Standards and Technology), as well as a presentation by a representative of the College of Healthcare Information Management Executives (CHIME). For the purpose of the congressional meeting, our panel shared updates from our work to create a landscape of the current state and federal technology efforts being used to fight the opioid epidemic, and gave us a chance to share how we’re identifying gaps and inconsistencies across states. Through our research, we’ve identified some issues and consequences created by inconsistencies, and more importantly, potential changes that could improve the technology tools currently available to support more effective solutions.
Working from the premise that EHRs and related technology are critical components in the fight against opioid abuse, our subcommittee of the EHRA has been focused on two specific pieces of electronic technology that, when integrated with an EHR and the functionality an EHR can bring, delivers clinically advanced tools to the fingertips of clinicians, prescribers, and dispensers. Specifically, this includes Electronic Prescriptions for Controlled Substances (EPCS) and Prescription Drug Monitoring Programs (PDMP). Through the state-by-state analysis, we’ve examined a variety of different characteristics, including state mandates, reporting and query requirements, data sets, accessibility to data, and EHR integration.
What is EPCS?
Electronic Prescriptions for Controlled Substances (EPCS) is a technology solution to help address the problem of prescription drug abuse in the United States by using electronic prescription writing technology known as e-prescribing to electronically create and submit a prescription to a pharmacy. When a patient is seen by a prescriber, the prescriber uses the e-prescribing software from a computer or handheld device to write and send a prescription. The prescription is sent securely and electronically to a pharmacist. There are many benefits to such an approach including: workflow efficiency, increased security, elimination of script loss, theft, transfer or modification. It also provides real time prescriber benefits including drug to drug comparison and drug allergy information.
What is PDMP?
Prescription Drug Monitoring Programs (PDMP) is a drug information repository and monitoring technology implemented at a state level (except for Missouri, where the county of St. Louis operates the PDMP for its area). PDMPs are tools for reducing prescription drug abuse and diversion. PDMPs collect, monitor, and analyze electronically transmitted prescribing and dispensing data submitted by pharmacies and/or dispensing practitioners. Repositories of dispensed medications allow for the identification of patterns in both the types and volume of opioids prescribed, patient trends, information to support clinical decision making tools, and can be used to reduce doctor and pharmacy shopping (a practice of going to multiple doctors for the same illness and being prescribed meds at each and then filling those scripts at different pharmacies).
Preliminary Findings And The Need For Collaboration
As we shared during the congressional meeting, the results of our research are not surprising but still troublesome. For example, a lack of EPCS mandates has resulted in low e-prescribing rates for controlled substances. A lack of standards for PDMP has resulted in 50 different instances of PDMP with incongruity in data sets, inconsistency in reporting requirements, query variations, irregularity in a national data set, and a lack of conformity in EHR integration. These differences create significant complexity in using these systems, but also calls into question the validity of the information and the clinical benefit of the data. In the end, we found that the value of EPCS and PDMP is being hampered by those inconsistencies, lack of standardization, ambiguous guidance, and other issues that impede the effectiveness of potentially life saving tools.
I strongly believe we can not overcome the opioid crisis unless all parties are working together. Compromises to ensure that comprehensive real-time information, with the right levels of security to protect the personal health information that HIPAA offers, must be available in a way that does not obstruct clinician workflow or effectiveness. Governments at all levels need to work with the right stakeholders, both public and private, to ensure that consistency in information is achieved. It will take continued work at all levels of healthcare, social services, and other organizations, to achieve success.
This battle will not be won alone. Studies are showing that there are additional tools and methods to help address this crisis. This includes the use of predictive analytics that take into account social determinants of life, drastically reducing access to illegal non-prescription opioid and opioid derivatives, as well as greater education and involvement by rehabilitation services. The work of the EHRA continues and as I meet with providers across the country I hear more stories of success as we face this epidemic head on. I’ll be bringing you additional thoughts as we continue to collaborate to win this battle.