ECRI Institute Releases Health IT-Related Recommendations for Safer Opioid Prescribing

Electronic health record (EHR) and health information technology (IT) developers have an important role to play in helping to combat the opioid crisis — an epidemic that has become rampant in the U.S.

ECRI Institute and the HIMSS Electronic Health Record Association (EHRA) released a new guidance for safer opioid prescribing through EHRs, that highlighted strategies based on three high-level recommendations.

Enabling Technologies to Measure and Monitor Prescribing Patterns

According to ECRI Institute and the EHRA, using health IT to measure prescribing metrics can have a positive impact on provider prescribing practices.

More than 260 clinical decision support opioid safety events were reviewed, and 100 percent involved clinical decision support delivered in the EHR as an alert or a reminder. But 41 percent were overridden, and 28 percent did not function as expected.

The institutions suggest that clinicians and healthcare organizations measure and monitor override rates and identify ways to improve opioid-prescribing practices.

Clinicians and healthcare organizations should consider the alert type for opioid prescribing, the reason cited for the override and the clinical appropriateness of the override reason.

These methods will help providers collect the data needed to apply them to metrics and increase awareness about prescribing behaviors.

Metrics that can increase awareness include opioid prescription quantity and duration, the use of prescription drug monitoring program information, individual clinical decision support override rates and the use of morphine milligram equivalents.

Ensuring EHRs Collect Data to Drive Clinical Decision Support

A lot of the information needed to address the opioid epidemic is captured in the EHR. But the system’s ability to implement clinical decision support is limited if the necessary data are unavailable in a standardized and computable format.

And some of the data elements needed are stored outside of the EHR and might not be readily accessible to the user.

ECRI Institute and the EHRA recommend that EHR vendors, along with key stakeholders, facilitate the integration, aggregation and correlation of data elements from within the EHR and the multiple external sources.

This could ensure that EHRs can collect or access data elements needed to drive metrics to monitor and improve quality and to inform decision support.

Feeding the Clinician the Right Data at the Right Time

In order for clinical decision support to be effective, it needs to be delivered as needed. Therefore, it is necessary that the intervention happens at the right time in the workflow to enable safer and more effective opioid prescribing.

Presenting the clinician with the right data at the right time can maximize the benefits of clinical decision support to enable safer opioid prescribing — if the information provided is correct, timely and relevant.

According to ECRI Institute and the EHRA, clinical decision support should be triggered using information from disparate sources to identify opioid-naïve and opioid-exposed patients and to identify their risk factors to the clinician at the appropriate time in the workflow.

If information is presented at the right time, it is less likely that the alert will be overridden.

Currently, most knowledge-based clinical decision support is available all at once and is not tailored to the user or the individual patient.

The information must be actionable and based on criticality using risk scores supported by EHRs that facilitate the integration of medication history, problem list, prescription drug monitoring program data, cumulative morphine milligram equivalents and evidence-based guidelines.

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