Interdisciplinary EHR feedback improves opioid prescribing patterns
An interdisciplinary working group, using electronic health record data as feedback, was able to improve compliance with national and state opioid prescribing guidelines at a tertiary academic rheumatology practice, researchers noted.
“The CDC and the majority of state governments have issued guidelines for opioid prescribing for the treatment of chronic non-cancer-associated pain,” Eric J. Wang, MD, assistant professor of anesthesiology and pain medicine at Johns Hopkins Hospital, told Healio Rheumatology. “Many, if not most, health care institutions have adapted these guidelines into objective metrics in the electronic health record, which clinicians are expected to meet. However, it can be difficult for clinicians to remember what all of these metrics are.”
“This makes it difficult for clinicians to have an accurate self-assessment of how well, or how poorly, they are meeting these metrics,” he added. “This also leaves open the possibility for significant practice variations between clinicians, even within the same group.”
To decrease the amount of practice variation and improve compliance with these guidelines, Wang and colleagues at the University of Pennsylvania Division of Rheumatology, at the school’s Department of Biostatistics, Epidemiology and Informatics, created an interdisciplinary Opioid Working Group. According to the researchers, division leadership and providers drafted shared goals at interdisciplinary meetings including rheumatology, pain medicine, nursing and pharmacy practitioners.
Concrete steps included education sessions on opioid prescribing guidelines and sharing data on individual, deidentified prescribing patterns. Further, an “opioid dashboard” page within the electronic medical record allowed providers to review individualized and divisionwide data tracking process measures based on CDC and state guidelines. For this analysis, the researchers compared baseline data from June to August 2017 with monthly data through December 2018.
The investigators reported that only 40% of patients had an active opioid agreement — in compliance with Pennsylvania guidelines and New Jersey state law — at baseline, while 25% had a urine drug screen result within 12 months of their most recent opioid prescription. In addition, 24% of patients at baseline had a concurrent benzodiazepine prescription. However, after 16 months of efforts by the Opioid Working Group, these percentages improved to 88%, 66% and 16%, respectively. During this time, the average number of opioid tablets prescribed per month decreased 18%, from 59,733 to 48,966 (P = .02).
“There is a lot of discussion about how electronic health record systems have become overly cumbersome and is contributing to health care provider burnout,” Wang said. “There is also discussion about how there are now simply too many metrics for clinicians to keep track of, also contributing to the sense that one is always being measured but can never measure up. Many people are disappointed that the electronic health record has seemingly made many things more difficult, rather than easier.”
“Nonetheless, the electronic health record is probably not going to go away,” he added. “Our study shows how the electronic health record can be changed to actually make clinicians’ lives easier, align practice patterns to a common standard and ultimately contribute toward fighting the opioid epidemic.”
Co-author Peter A. Merkel, MD, MPH, chief of rheumatology at the University of Pennsylvania, added that the study highlights the “significant need to apply ever-evolving best practices to the management of chronic pain.”
“This study is important for demonstrating that rheumatologists, and other medical specialists, can utilizing the electronic health record to implement practice changes that will improve care of patients,” he said.
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