Since the emergence of COVID-19, fatal drug overdoses have surged by 29% in the U.S. In Ohio, fatal opioid overdoses are at the highest rate in 10 years, with over 11 deaths every day in 2020.
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Headed by Brendan Patterson, MD, Department Chair of Orthopaedic Surgery, Cleveland Clinic’s Enterprise Pain Management Committee comprises a multidisciplinary team of clinical leaders that oversees strategies to curb the opioid epidemic. Leveraging our electronic health record is critical to the success and implementation of those strategies, says committee member and Associate Chief Medical Information Officer Eric Boose, MD.
Here are five ways Cleveland Clinic uses Epic’s electronic health record system to combat the opioid crisis.
Highlighting risk when prescribing
Cleveland Clinic continuously customizes enterprise workflows and clinical decision support tools to better highlight patient risk of developing opioid addiction. Cleveland Clinic physicians also try to prescribe opioid alternatives when available. This approach ensures clinicians in all relevant specialties are mindful of addiction risks when prescribing for pain.
- Integrate Prescription Drug Monitoring Program (PDMP) reports and NarxCare scores into patient charts. As one of the first adopters of this practice, Cleveland Clinic realized the benefits early on. This kind of integration reduces clicks and allows clinicians to quickly identify high-risk patients. It also ensures clinicians are viewing the most current and accurate information by pulling directly from state databases in real-time.
- Remove all saved Preference Lists that contain opioid orders. In Epic, Preference Lists are searchable groups of common clinical content (diagnoses, levels of service and orders) that clinicians can use as a workflow shortcut. By removing all saved Preference Lists with opioid orders, clinicians are now prevented from automatically prescribing large quantities of opioids simply because that was the saved dose. Instead, clinicians are required to prescribe intentionally, reviewing all relevant alerts and refill protocols directly displaying within individual orders.
- Update medication orders to increase visibility around risk and related fields. Adding prescribing duration fields, morphine equivalent daily dosage (MEDD) calculations and refill protocol checklists directly within medication orders ensures clinicians are fully aware of prescribing guidelines and regulations when prescribing opioids. Additionally, setting up BestPractice Advisory alerts to display when opioid orders meet certain criteria, reminds clinicians to take care prescribing in high-risk situations, e.g., when MEDD exceeds checkpoints, inpatients are opioid naïve or naloxone has not been co-prescribed.
- Automate clear communications and instructions regarding risk and responsible use for providers to present to patients when opioids are prescribed. Patients who are prescribed opioids for long-term chronic pain management must sign an annual Opioid Treatment Agreement, which contains directions on how to take opioid medications responsibly. Enabling this document to be quickly accessed and signed electronically within the patient chart helps patients and providers stay compliant. Similarly, setting Opioid Safety and Disposal Instructions to print on After Visit Summaries (AVS) ensures patients are informed of how to handle their medications responsibly whenever they are prescribed opioids during a visit.
- Introduce reporting and data visualization tools to help providers quickly manage and monitor their entire patient population. The Opioid Management dashboard enables clinicians to assess their opioid prescribing practices and identify any gaps or areas for improvement (e.g., Opioid Agreement compliance, PDMP review rate, naloxone prescribing rate, etc.). Clinicians can also utilize Epic’s self-reporting tool, SlicerDicer, which includes an opioid outpatient prescription data model. Clinicians can run a wide variety of reports with this model, including their co-prescribing rate for opioids and anxiolytics.
Combatting the opioid crisis on top of COVID-19 can be overwhelming. Leveraging electronic health records functionalities, such as displaying alerts for high-risk patients and disabling ordering shortcuts, can help clinicians prescribe opioids safely and with minimal additional effort.