Improving Patient Safety and Outcomes Through Electronic Health Record Integration of Opioid Monitoring Guidelines

According to recent reports, 50.2 million people in the United States reported having pain on most days or every day.¹ Over 50% of these patients are treated by their primary care providers rather than specialists, and close to 30% of patients with chronic pain are treated with opioid medication². with the rise of opioid-related deaths, guidelines were published to help providers safely and effectively treat pain, including opioid medication. Despite these recommendations, studies show that approximately half of primary care providers are not appropriately monitoring their patients on opioid medication^3,4.  According to surveyed providers, reasons for this included the time it takes to access information and technical difficulties when trying to do so⁵. One way to address this is to develop better tools within electronic health records (EHR) to assist primary care providers with opioid monitoring. The goal is to reduce barriers to guideline-concordant care and improve patient outcomes.

Purpose/Objectives:

Several agencies produced guidelines in an effort to curb the increasing rate of opioid prescriptions and promote safe prescribing for patients who require it. These guidelines aimed to provide evidence-based recommendations for prescribing opioid pain medication. Despite this, studies show that, on average, only half of the patients receiving opioids from their primary care provider were monitored as recommended by the guidelines^3,4. EHR clinical support tools can influence provider decisions but may increase workload. Providers are more likely to be compliant if the process is easier. The purpose of this paper is to review the results of studies that evaluated the integration of various clinical decision-making tools into the Electronic Health Record to see if this reduces the barriers to guideline-concordant care in order to improve patient safety outcomes.

Method:

This is a literature review of studies that evaluated the integration of various tools into the EHR to determine if the implementation of these tools led to more guideline-concordant care for patients on opioid medication. Search engines utilized included PubMed and Google Scholar.  MeSH terms used were opioid, monitoring, and electronic health record. The initial search yielded a limited number of articles, so the snowball method was utilized.

Results:

Overall, studies are limited and focused on various outcomes, but they did provide some interesting findings that could be used to optimize the use of EHR prompts for opioid monitoring going forward. Tool prompts were implemented to complete overdue risk mitigation tasks, including urine drug screens (UDS), Prescription Monitoring Drug Program (PDMP), naloxone prescriptions, and opioid risk tool (ORT)^3-6 Other methods included “best practice alerts” and provider education in the HER. There was a modest increase in patients completing an ORT, UDS, and receiving naloxone, but the amount varied in each study.

Conclusions: The literature highlights the need for more interventions that are easily accessible to assist clinicians in providing guideline-concordant care. This may include prompts within the EHR, links to clinical decision-making tools, easy access to monitoring programs, and education for providers. Although mixed, results indicate that integrating opioid guideline prompts into the EHR would increase the implementation of opioid monitoring for patients requiring treatment with opioid medication. In future studies, it may be beneficial to see if EHR prompts reminding practitioners of opioid prescribing guidelines produces a further decrease in opioid prescriptions or MME[7]. Therefore, more research is needed to explore other clinical decision-making tools that may aid in promoting guideline-concordant care[8].

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