As the healthcare industry explores strategies to combat opioid dependency, it seems that technology could be of increasing value — if used correctly.
Every day, we’re reminded in news headlines and scientific reports that we’re experiencing an opioid crisis in the United States. We’re also reminded that it’s only getting worse.
An estimated two million Americans are addicted to opioids, such as prescription opioid pain relievers or heroin, according to the National Institute on Drug Abuse (NIDA). The NIDA also reports that opioid-related deaths have more than quadrupled since 1999 and that new evidence shows a strengthening relationship between “non-medical” use of opioid analgesics and heroin abuse in the United States.
Fighting back against the opioid crisis has proven difficult for a variety of reasons. Not only do healthcare providers have limited capabilities, but patients aren’t always cooperative when it comes to limiting, or quitting, opioid use. Such is the nature of addiction. Also, the general lack of knowledge regarding addiction, not to mention the patient’s home environment, can also hinder recovery.
As the healthcare industry explores strategies to combat opioid dependency, it seems that technology could be of increasing value — if used correctly. A robust electronic health record (EHR) that is up to date with the right interoperability standards and built with the proper workflows and collaboration tools is the key weapon in the physician’s arsenal on the front lines of the opioid epidemic. The only catch is that physicians must actually use the technology beyond its basic functions, such as data collection.
If fighting the opioid crisis were easy, it’s likely there wouldn’t be a crisis at all. Unfortunately, the challenges facing healthcare professionals as they attempt to find effective solutions are massive and multifaceted. Sometimes, they cannot be controlled, such as the challenge of a patient’s refusal to comply with established protocols, or alternative treatments.
Therefore, the challenges that PCPs and other healthcare providers should address are the challenges that can be controlled — namely those related to communication, and a lack of comprehensive information across the care continuum. While the benefits of care coordination are well-established, PCPs, specialists and other care partners still have trouble getting on the “same page” — or seeing the same picture — when it comes to the patient’s full health. When one care provider doesn’t have sufficient information to make an informed decision, the result can be deadly, such as when a PCP is unaware of a patient’s substance-use issues and prescribes an opioid.
It’s true that mental health information is especially difficult to freely share with PCPs, given recent legislation changes like CFR 42 (Part 2). As a result, behavioral health professionals may be discouraged from sharing data, hindering a patient’s care team from making the optimal care decision. But that doesn’t mean PCPs shouldn’t attempt to coordinate care and share information with their behavioral healthcare partners.
Technology and Policy Solutions
EHRs can bridge many of the communication and information gaps between care providers, thus addressing these challenges in an impactful way.
In fact, EHR systems have proven to be such an effective tool in addressing provider challenges that a growing number of statewide initiatives are giving providers more visibility into a patient’s prescription history. The state of Indiana, for example, recently launched INSPECT, a drug-monitoring platform designed to help fight against opioid abuse. The program allows providers to see a patient’s controlled-substance prescription history more easily within their EHR software.
In hospitals, meanwhile, EHRs are built with increasingly superior notification capabilities that can help physicians and clinicians make better-informed decisions at the point of care. This is especially valuable in hospital emergency departments where opioid-related cases are spiking. In Indiana, for example, opioid overdose visits in the ED have increased by 60 percent over the last five years.
At the ambulatory level, EHRs can also help primary-care providers do a better job of identifying and treating patients who are either at risk for developing substance us disorders, or already suffer from addiction.
But there is a big difference between what a technology system can do and how healthcare providers are actually using it. And there is often a big difference between a robust, certified EHR designed for ambulatory care providers and major hospitals.
The right EHR system for PCPs is equipped with notification technologies that help to flag high-risk patients; it’s loaded best practice modules, or protocols, which can help direct physicians on what actions to take when they encounter such patients. It is inherently interoperable with other organizations’ EHRs, allowing for easier collaboration while decreasing the chances that a physician will miss critical data during their patient encounter.
Arguably the most effective tool in combatting the opioid crisis is an integrated care model that allows PCPs to proactively care for their patient’s mental health by incorporating behavioral health providers into the care team. As such, PCPs need to consider whether their current EHR system can support better collaboration with behavioral health providers and other specialists.
For example, PCPs should ensure their EHR vendors not only understand the important regulations facing behavioral health professionals (e.g. 42 CFR Part 2, which addresses privacy restrictions for substance-abuse patients), but also how to foster collaboration between the two communities in light of those regulatory changes.
In time, these EHR capabilities could be expanded to help providers even more in their fight against opioids.
Recently, researchers at the University of Colorado Anschutz Medical Campus developed a predictive model that leverages EHR data to determine which hospital patients are at a higher risk of becoming chronic opioid users post-discharge. Ideally, this sort of model could be integrated into an EHR and potentially alert healthcare providers to a potential problem before the problem starts.
It’s also the kind of model that should give healthcare providers hope, even as dismal statistics loom.
The worsening opioid crisis means more effort from everyone — providers, patients and their communities — will be required to nudge the needle. And while having the right EHR is just one small part of the fight, it can be the tool that makes an enormous difference as an effective substance abuse solution.