Wednesday, January 02, 2019
Health IT Is In The Front Line To Try And Stem The Opioid Crisis in The US – Relevant Here Too!
This appeared last week:
Published December 26 2018, 7:49am EST
Providers have begun to harness technology to improve their management of opioids and avoid misuse.
It’s not a moment too soon. The Centers for Disease Control and Prevention’s most recent reports, released in November, confirm that the opioid crisis is worsening. The number of drug overdose deaths in the United states in 2017 was 9.6 percent higher than in 2016. The rate of drug overdose deaths involving natural and semisynthetic opioids like oxycodone and hydrocodone has risen steadily since 1999. The rate of drug overdose deaths involving synthetic opioids such as fentanyl, which individuals frequently turn to when they can no longer obtain prescribed opioids, increased 45 percent between 2016 and 2017.
One of the key components to reversing these trends is to keep people from becoming addicted in the first place, says Jim Turnbull, CIO of University of Utah Health and Co-chair of the College of Healthcare Information Management Executives (CHIME) Opioid Task Force. Providers are uniquely positioned to address this problem because they are the ones prescribing the drugs.
“We want to make sure we’re not contributing to addiction. We don’t want to be the source of people getting addicted,” Turnbull adds.
CHIME’s Opioid Task Force was launched in early 2018 to leverage the knowledge and expertise of its members to find and share IT-based solutions to the opioid crisis. It is compiling examples of data-driven initiatives and raising funds for its Health IT Action Center, a web-based repository for healthcare organizations seeking resources. The Task Force has also partially completed a playbook for CIOs, says Turnbull.
However, using technology to combat the crisis is still relatively new. A KLAS report on opioid management published this past September found that most provider organizations relied mainly on their EHR vendor to help them with opioid stewardship.
Some enterprising providers are taking a more hands-on approach and directly applying health IT to address opioid prescribing in their organizations. Many of these initiatives are homegrown, using an entity’s own data, and are so recent that their effects have yet to be determined. But even those projects in their infancy look promising.
“We realized we needed to see how data and IT plays into this. We’re using data as a platform to make cultural change,” says Alexander Garza, MD, chief quality officer at St. Louis based SSM Health.
Mining the EHR
Danville, Pa.-based Geisinger Health System is one of the first provider organizations to spearhead the use of data to assess its opioid prescribing habits. Pennsylvania has one of the highest death rates from opioid overdoses in the nation, according to the CDC.
“About three to four years ago, we realized that we were prescribing more opioids than we should. So we started using analytics to see how much was being prescribed and compare prescribers to others in the network,” says Geisinger’s Senior Vice President and CIO John Kravitz.
The health system created a provider dashboard linked to its EHR, using Tableau’s platform, to display the volume of opioid prescribing. The dashboard identified prescribing patterns among the providers and flagged several “heavy” prescribers. Geisinger then used the information to focus on these prescribing outliers and instill best practices in prescribing overall.
Opioid prescriptions have declined from 60,000 per month across the system to 22,000 a month, and the number continues to drop. “No one wants to be on the high end of opioid prescribing. The doctors are very aware of the numbers in the dashboard,” says Kravitz.
The dashboard was implemented in tandem with Geisinger’s redesign of its surgical program to reduce opioid use and improve the patient experience, which includes presurgical consults alerting patients to the pain levels they’ll have and the provision of alternative pain medications. That pilot program, launched in June 2017 and called ProvenRecovery, drove an 18 percent decrease in opioid usage across the organization, says Kravitz.
On November 15, Geisinger announced that the program will be rolled out across 42 surgical procedures impacting approximately 15,000 surgery cases a year, with the goal of reaching 100 surgical specialties by the end of 2019.
“We’ve started closing the spigot on getting new people addicted. It will be instrumental to have treatment programs to help [those already addicted] to help them get out of it,” says Kravitz.
SSM Health is taking a similar approach, extracting the data from its EHR and creating a heat map colored coded by diagnosis and dose to flag outlier opioid prescribers. “The heat method was used to develop a performance improvement tool. It will become part of a dashboard going forward,” says Garza. SSM is now working on how best to share the results with prescribers.
Kravitz recommends that other providers dive into this data.
“This is not rocket science. We all have the capability to produce a dashboard, pull the data and see what providers are ordering and how big a problem you have. When we saw our volume, our eyes were wide open. We had no idea,” he says.
Many more ideas are found here:
This is really a useful summary of a range of sensible idea. Well worth a read of the full article.
Posted by Dr David G More MB PhD at Wednesday, January 02, 2019