Opioid prescription protocols. Now in Epic.

The numbers are staggering.

More than 115 − people who die every day in the U.S. from opioid overdose. About 80 percent – heroin users who began with prescribed opioids. Roughly 25 percent – chronic pain patients misusing their opioid prescriptions.

The National Institute on Drug Abuse has put the data pieces together, and the result is ghastly. This didn’t happen overnight. It started a couple decades ago, with providers prescribing opioids for pain, temporary and chronic.

Since then, research has shown people are more likely to continue taking opioids if their first time taking them is longer than a three-day regimen.

Partnering for solutions.

This is one reason Houston Methodist teamed up with the Centers for Disease Control and Prevention, Epic, Yale University, the University of Utah and the Carolinas HealthCare System to devise an electronic solution to find a way out of this quagmire. To save lives.

In fact, Houston Methodist is first in the nation to institute all 12 CDC recommendations for prescribing opioids for chronic pain, with direct integration to the state prescription drug monitoring program, all within Epic.

“The CDC invited us to help design a platform within Epic, to guide physicians in safer, more effective pain management,” said Houston Methodist Executive Vice President and Chief Medical Officer Robert Phillips, MD, PhD.

“This model isn’t just for our Epic EHR,” he said. “We want to be able to provide a working model for EHRs nationwide.”

How it works.

“Improving access to prescription drug monitoring databases can reduce medication misuse and overdose,” Phillips said. If physicians spot signs of possible opioid abuse, they can intervene as needed.

“Before this pilot launched, if physicians wanted to see what other opioids a patient had taken, they had to stop what they were doing in Epic and log in to the statewide prescription monitoring database,” he said.

A tailored report displays patient information from the Texas Prescription Monitoring Program (PMP), a statewide electronic database that tracks controlled substance prescriptions.

Last fall, Texas Gov. Greg Abbott signed into law the new program that supersedes the prior Texas Prescription Drug Monitoring Program.

Appropriate pain management. Proper safeguards.

The new PMP strengthened prior program requirements for controlled substances prescription monitoring, reducing the reporting window from seven days to one business day. Pharmacists must access the PMP before filling prescriptions for narcotics, stimulants, sedatives or other controlled substances.

“We want to effectively deliver proper pain management with proper safeguards,” said HM System Medical Pain Management Director Dr. Ezekiel Fink. “We’re seeking to design fail-safe mechanisms within Epic that direct physicians in appropriate opioid prescribing.”

The new Epic analytics provide visibility into patients’ overdose risk scores, in addition to other red flags in patients’ medical records. Tools integrated in Epic make this possible by:

  • Tracking patients’ urine toxicology screen results
  • Identifying patients with addiction risk
  • Providing patient population benchmarking with an opioid registry
  • In Epic, opioid prescriptions default to a three-day prescription.

“With this system, if physicians decide on the five-day prescription, they’re making an informed decision,” Fink said.

Better visibility. Better medicine.

Epic analytics are helping physicians monitor patients’ opioid abuse risk. They’re also helping clinicians prescribe the lowest effective dosages. All of this can be accomplished with one click, without having to leave Epic.