BSMH Opiate Response
To improve and measure opioid prescribing behavior, we implemented provider facing EMR changes. In addition, we developed an opioid analytics platform built on a tabular cube that permits evaluation of opioid prescribing behavior at the order, provider, department, specialty, market and enterprise levels. The EHR changes include 1) Fully configured medication preference list that in the display text include the Morphine Equivalent Daily Dose (MEDD) and day supply; 2) in-line dynamic calculation of MEDD; 3) hard stop alert requiring diagnosis association with all opioid orders; 4) order validation alerts if MEDD or day supply limits exceeded ; 5) Direct HER integration through single sign on with prescription drug monitoring program (APPRISS) ; 6) Configuration change to require for all opioid orders to use discrete sig (rather than free text); 7) alert for opioid prescribing to minors resulting in the printing of a consent form; 8) actionable alert with alternatives for concomitant benzodiazepines and opioids. We present and graph trends over time and drill and identify outlying behavior. The metrics of greatest clinical and public health impact and the corresponding results (reductions) between July 2017 and July 2018 are: 1) Total Opioid orders 41,331 to 36,160 [13% reduction]; 2) Rate opioid orders to all medication orders 8.6% to 6.7% [22% reduction]; 3) Rate MEDD >30 to acute opioid orders 14.7% to 9.6% [35% reduction]; 4) Rate MEDD >80 to opioid orders 3.5% to 3.0% [14% reduction]; 5)Rate supply >7 days to acute opioid orders 23.5% to 13.3% [43% reduction] 6)Total morphine equivalents prescribed per patient 59.0 to 45.2 [23% reduction].
1. Understand the role of iatrogenic opioid prescribing as the impetus of the opioid epidemic
2. Demonstrate the role of analytics in identification and correction of outlying opioid prescribing
3. Demonstrate Electronic Health Record build and configurations to reduce inappropriate opioid ordering and to evaluate and treat opioid use disorders
Start Date: 10/08/2019
Event Type: *Hidden , Archived , College LIVE
Mark Binstock, MD MPH, Chief Medical Information Officer, Bon Secours Mercy Health