Readers Write: The Opioid Crisis: Fix the Process, Fix the Problem

The Opioid Crisis: Fix the Process, Fix the Problem
By Brita Hansen, MD

Brita Hansen, MD is chief medical officer of LogicStream Health of Minneapolis, MN.

As the nation continues to grapple with the overprescribing and misuse of opioids, reaching a solution often feels far out of reach. According to the US Department of Health and Human Services, more than 11 million individuals have been documented as having misused prescription opioids, resulting in an alarming 116 opioid-related deaths daily.

Despite this growing epidemic, provider organizations are uniquely positioned to address a key issue contributing to improper prescribing practices – inefficient clinical processes. Outdated and obsolete clinical processes built into electronic health records (EHRs) can be significant factors driving inappropriate drug utilization and impaired patient safety and quality care.

While the opioid crisis has no single origin point, one contributing factor can be traced back to the early-2000s when the Joint Commission implemented its revised pain management standards in response to the under-treatment of pain that was reported throughout the industry. In turn, many healthcare organizations interpreted these standards as a mandate and began to adopt clinical processes that aggressively treated patients’ acute and chronic pain. This also contributed to the then-growing trend of patients and caregivers equating pain management with medication use, which led to a demand that helped drive the increase in opioid prescriptions, and subsequently, opioid-related abuse and overdoses.

Despite evolving patient expectations and the emergence of new best practices for opioid prescribing, EHRs still lack the ability to appropriately guide clinicians and provide effective decision support during the prescribing process. Further, healthcare organizations also face the challenge of ensuring that clinicians understand and adhere to both general opioid ordering practices and best-practice guidelines. Gaining insight into these clinician’s ordering habits has been a continuous issue, and while clinicians express interest in reviewing and improving their ordering practices, this information is difficult and time-consuming to gather.

In addition to fixing and controlling processes and improving clinician adherence, provider organizations must ensure content in EHRs are continuously and reliably aligned with evidence-based guidelines to enable sustainable opioid therapy. For instance, recently developed treatments limit patients’ exposure to opioids, and instead, provide them with powerful yet non-addictive drugs such as corticosteroid injections for rapid pain relief and local anesthetics used during surgery or physical therapy sessions.

Facing the pressures to curb the country’s misuse of prescription opioids and adhere with rapidly changing prescribing guidelines, many healthcare organizations are increasingly leveraging health IT to encourage and improve the use of evidence-based best practices at the point of care. However, these tools are only as effective as the upstream clinical processes governing them, processes that are too often overlooked in the overall improvement strategy.

The data and trends contained within EHRs provide the key insights needed to optimize, measure, and manage the clinical processes related to opioid prescribing. With this critical information, frontline care teams can target and eliminate obsolete opioid protocols and order sets, thereby helping to improve, standardize, and better control processes and decrease the variability in how opioids are prescribed.

By identifying inefficiencies in workflows and the EHR build that often drive inappropriate prescribing practices, care teams can eliminate these issues. With the right tools, they can also continuously monitor the clinical processes guiding opioid prescribing and ensure they are aligned with current clinical evidence, regulatory requirements, and internal workflow needs. It’s equally imperative to continuously monitor clinician interaction with and adoption of the clinical processes that have been implemented, as various barriers inevitably lead to low compliance with set prescribing standards and protocols among some clinicians. Regular monitoring of opioid ordering enables clinical leaders to identify outliers, address barriers, and deploy appropriate interventions as needed.

To truly address the current opioid epidemic, provider organizations must fix the process to fix the problem, which begins with maintaining upstream improvements to clinical processes guiding opioid prescribing. While these steps may be one part of the nation’s opioid strategy, they remain key to providing healthcare organizations with the proactive support needed to combat the crisis.