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September 14, 2016 Readers Write 3 Comments

The Surgeon General’s Rallying Cry Against the Opioid Epidemic Must Also Be a Call to Arms for Healthcare IT
By Thomas Sullivan, MD


In a rare open letter to the nation’s doctors, US Surgeon General Vivek Murthy, MD, MBA sounded a rallying cry to engage their greater participation in the opioid-abuse crisis afflicting our country. Missing from the USSG’s commendable call to arms, though, was mention of the role technology plays in reducing drug diversion and doctor shopping and providing ready access to services to support patients.

Those of us in healthcare IT know that we are critical to this cause. The USSG is talking to our customers, and we know our customers aren’t adopting as quickly as they could the substance abuse-fighting technologies that are widely available to them. This includes a variety of technology solutions such as:

  • E-prescribing technology, particularly EPCS to support the electronic prescribing of controlled substances, which is key to helping providers more efficiently deploy and monitor prescription medicines being prescribed or over-prescribed across a practice.
  • Medication adherence monitoring technology that lets providers gauge in real time, at the point of encounter, a patient’s level of compliance with drug therapy and provide patients with evidence-based support and services for self-management.
  • Clinical decision support that helps doctors avoid adverse drug events and medication errors.
  • State-run prescription drug monitoring programs (PDMPs) designed to help law enforcement track the use of controlled substances and help prescribers identify doctor shoppers and others seeking illicit access to controlled substances.

Specific to the opioid abuse epidemic, the most important next step is for physicians to be able to check PDMPs within their normal workflow. Simply said, the integration and availability of PDMP data within e-medication management solutions — e-prescribing, medication history services, medication adherence tools and the like — will result in the greatest use of PDMP data and the best one-two tech-assisted punch we have in the opioid battle.

Over the past two years, policymakers have begun to take action in using EPCS to address this crisis. This past March, New York State took a major step toward this goal when it began requiring e-prescriptions for all controlled substances as well as all non-controlled substances, frequently referred to as “legend drugs.” Known as I-STOP, the Internet System for Tracking Over-Prescribing act, originally passed in 2012, New York’s experience now serves as a case study for other states that wish to modernize their prescribing infrastructure and address opioid abuse.

Maine as well now will require opioid medications to be prescribed electronically via Drug Enforcement Agency-certified EPCS solutions beginning in July 2017. Several other states including Massachusetts, Missouri and Maryland are also considering or working to pass mandatory EPCS requirements for prescribers.

Unfortunately, neither New York nor Maine PDMP data is currently accessible to health IT vendors for integration into the prescribing workflow of providers.

E-prescribing – the direct digital transfer of patient prescriptions from provider to pharmacy – is broadly recognized as an important tool in helping promote patient safety, convenience, and overall efficiency for all stakeholders in the prescription process. E-prescribing is well understood to assist prescribers by allowing patients and doctors to better guard against medication errors, such as drug-to-drug interactions, reduce common errors inherent in paper-based prescribing — including illegible handwriting, misinterpreted abbreviations, and unclear dosages, — and provide critical decision support tools.

Despite the fact that, nationwide, more than 70 percent of doctors transmit most prescriptions electronically, the vast majority of these prescriptions are only for legend drugs. In comparison, less than 10 percent are using EPCS solutions to e-prescribe controlled substances. However, in New York, the I-STOP legislation has driven adoption of EPCS to over an estimated 70 percent. As such, all indications are that the laws passed in New York and Maine mandating use of EPCS and PDMPs will almost certainly prove helpful in curbing opioid abuse, fraud, and diversion and help prevent possible addiction down the line.

However, full adoption of PDMPs will likely never be achieved until the PDMP information is accessible in the doctor’s technology workflow. Ultimately, the opioid-abuse battle needs to be fought through states enabling their respective PDMP data to flow through doctors’ own workflows, as opposed to requiring that physicians and clinicians go outside their familiar software tool and interact with a separate portal in order to access their respective state PDMP databases.

In the case of New York State, the Medical Society of the State of New York conducted a survey that found a large percentage of prescribers believed that forcing mandatory compliance was placing an undue burden on their practices. No doubt, physicians feel overburdened with IT mandates. Improving integration between PDMPs and electronic health records will alleviate some of these burdens and allow for better compliance.

States must work more closely with the healthcare community to remove obstacles that will allow as close to 100 percent compliance as possible. Every state has the opportunity to learn from New York to smooth implementation and drive adoption to make a meaningful impact on the growing opioid abuse epidemic. Leadership in healthcare IT companies must be more vocal about our role and responsibilities in enabling doctors on the ground.

With the US Surgeon General weighing in, those of us in the healthcare IT community must rise up to make our voices heard. The importance of integrating e-medication management tools and EPCS solutions with PDMP data cannot be overestimated. It is the best path toward helping our customers — the doctors — make the right decision, at the right time, with the right data, on the right platforms.

Thomas Sullivan, MD is chief strategy and privacy officer of DrFirst of Rockville, MD.

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Currently there are "3 comments" on this Article:

  1. “placing an undue burden on their practices” in NYS. Indeed!

    and where is the medical evidence of benefit? and where are the errors being tabulated? and what surveillance is there on these mandated devices?

    I would like to report the adverse events which are ample, but do not know to where.

  2. Dr. Sullivan makes some great points about how technology can play a role in addressing Opioid misuse and abuse. I agree that better integration with state PDMP’s is one of those roles that technology can play. However, since PDMP’s vary so greatly from state-to-state (most radically in Missouri where there is no PDMP), it will be very difficult to drive uniform change through those systems alone since there are both technology and political hurdles to overcome. Then considering implementing prescribing and dispensing procedures at a common healthcare organization that uses the same EHR system that crosses multiple state lines thus requiring multiple integrations with PDMP’s with varying functionality raises that degree of difficulty. That being said, another role technology can play is through case management of patients with chronic non-malignant conditions that require opioid therapy for pain management. Also, through educating patients on the correct use and disposal of drugs used during short-term opioid therapy. Finally, it is important to remember that we do not do a good job of preventing, measuring or treating pain in the US. Finding a way to incorporate technology earlier into the care process to prevent and address pain through multiple strategies is the end goal.

  3. Dr. Sullivan — thank you for this article. It points out the critical nature of workflow integration to prescribers. In my work in the HIE world and with colleagues at Community Care of North Carolina, we have been able to take advantage of fill history during recurring medication reconciliation snapshots with the expert assistance of “network pharmacists” which often includes collaborative work with pharmacy technicians in the emergency room, home health workers in the home, and other transition care workers. The focus is on high risk situations which I strongly believe opioid diversion and addiction represent. There is some very interesting work going on at http://www.healthlinc.org relative to medication planning with a very progressive community mental health center. There are many innovations, one of which is a consent model which informs both consumers, families, and providers to build trust and enhance communication. Keep up the good work. Todd Rowland MD

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