Health IT shows potential in fighting opioid addiction
Organizations such as EHRA and CHIME are working on ways to let technology better enable clinicians in sharing information and improving treatment.
Even as the COVID-19 pandemic grabbed much of the healthcare system’s capacity and the nation’s attention over the past two years, organizations have continued to deal with a rising undercurrent of opioid abuse.
While opioids haven’t received the press during the pandemic, the toll remains high — and grew higher, during the pandemic.
The Centers for Disease Control and Prevention’s Dashboard on Nonfatal Overdose Data shows a 19 percent increase in nonfatal opioid drug overdoses in the U.S. from January to February – with 20 states reporting “a significant increase.” Overdose rates since then have declined slightly from February through April. The CDC reports that overdose deaths from opioids increased to 75,673 in the 12 months ending in April 2021, up from 56,064 in the year-ago period.
This isn’t a new concern for healthcare technology experts, who realized several years ago that electronic health records systems could have a potential impact in this battle. In 2018, the Electronic Health Record Association (EHRA) and the College of Healthcare Information Management Executives (CHIME) each formed an Opioid Crisis Task Force to explore ways that health IT could help reduce opioid abuse and overdose deaths.
Difficulties tracking data
The EHRA’s Opioid Crisis Task Force came from the realization that it was difficult for providers to effectively use current mechanisms to track opioid use because the systems and oversight in each state vary so much, says David Bucciferro, vice chair of EHRA and senior advisor to Foothold Technology.
Some had hoped that opioid overuse issues could be managed through the use of the prescription drug monitoring programs (PDMP), which use an electronic database to track controlled substance prescriptions in states. As envisioned, PDMPs were expected to give health authorities timely information about prescribing and patient behaviors, enabling more effective responses.
In 2018, Congress passed the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, to encourage wider use of Electronic Prescribing for Controlled Substances (EPCS). The legislation mandated that all Medicare Part D providers electronically prescribe controlled substances by 2021, which is now delayed to 2023. It is not clear how such a system would work and if it would only apply to Medicare beneficiaries, who are a small percentage of opioid abusers.
But because each state is regulated by different types of agencies and each has their own laws for regulating the exchange of controlled substance information, they have been hesitant to exchange this critical information across state lines, Bucciferro says. This made it difficult for clinicians to spot “doc shoppers” – patients who go to numerous physicians in hopes of getting prescriptions for opioids.
“I don't think people realized how big the issue was around not sharing information across states, or the difficulty in not having a standard set of information,” he says. “As you can imagine, when you have different standards within each state, a number of things happen. One is that it's very complex for developers to be able to ensure that their software is able to incorporate a lot of the requirements of the state. So in some cases, you might have 50 different versions of the PDMP program and various versions of electronic prescribing, depending on if it's the state only – or locality and the state.”
With the advent of e-prescribing, states started to get their systems in place for the PDMP and EPCS programs, but they still didn't share information with other states, according to Bucciferro. This is beginning to change, but there are still challenges due to varying state laws on data exchange.
Bucciferro says the EHRA Opioid Crisis Task Force uses every opportunity it gets to talk to legislators about the need for more standardization in the rules that allow information on opioid use to be exchanged nationwide. The task force recognizes that, in the end, change like this takes government authority through the reporting process.
CHIME’s Opioid Task Force
EHRA isn’t alone in the IT community, battling the opioid crisis. In 2018, CHIME formed a task force to harness the knowledge and expertise of CHIME members and its CHIME Foundation partners to turn the tide on opioid addiction and deaths, according to CHIME CEO Russell Branzell.
“Within months, we were sharing best practices through free and open webinars. Our task force members produced a playbook for other IT leaders to use to develop opioid initiatives in their healthcare organizations,” Branzell writes in a CHIME blog. “They raised their voices in Washington, working with CHIME’s policy team and policy steering committee to help shape opioid-related laws and regulations that better protect patients.”
“This group of volunteers fights every day to reduce the number opioids prescribed by providers, to find ways to help those who struggle with opioid addiction,” Branzell says.
Among other initiatives, the CHIME effort has produced a task force playbook to assist organization in efforts to engage IT with opioid initiatives.
EHRA creates opioid tapering guide
As part of the EHRA effort, its Opioid Crisis Task Force published its first formal offering in January, Its Opioid Tapering Implementation Guide for Electronic Health Records, aims to help physicians taper their patients safety off of opioids, offering recommendations specific to a patient’s age, weight and other data. The guide provides guidance to the EHR community to develop decision support tools to help clinicians accurately manage patient weaning.
EHRA’s tapering guidelines are critical in the effort to eliminate abuse of opioids, Bucciferro says. “Part of the problem with the opioid crisis has been there was really no guidance around how to get someone off opioids,” he says.
The guide provides a way to ease patients off of opioids by giving them smaller and smaller doses, based on clinical science specific to that patient, according to Bucciferro. Putting this tapering information into a clinician’s hands as part of their workflow in the EHR has been a big part of the task force’s efforts — helping physicians to be gatekeepers, Bucciferro says.
Bucciferro says the task force’s next plans include examining the potential use of artificial intelligence to combat the opioid crisis. The group wants to see if machine learning can be used, garnering intelligence from the information that is gathered within an EHR and with other health technology. He believes that machine learning could enable clinicians to identify people at risk of opioid addiction. The goal is to recognize patients who would be susceptible to addictions to other spiking addictive agents, which now include fentanyl, heroin and opioid-like drugs sold on the black market.
SDOH’s role
EHRA would like to see the federal government create policies that address social determinants of health (SDOH) issues, which often pose barriers to opioid abuse prevention, screening, testing, care, and recovery--and to promote access to treatment.
Leigh Burchell, co-chair of the Opioid Crisis Task Force and vice president of policy and government affairs at Altera Digital Health (formerly Allscripts) says the group believes an investment needs to be made in expanding the digital infrastructure outside traditional healthcare environments to include behavioral health organizations and community-based organizations, because they play a critical role in helping patients.
“While there are huge volumes of helpful data that are accessible within the hospital or the physician practice, that same data would be more useful if it were able to be efficiently received electronically and comprehensively by inpatient rehab centers, for example, and if the next phase in a patient’s treatment could be reported back, with consent, to the patient’s other providers to close the loop,” Burchell says.