The United States is facing an alarming rate of opioid and heroin overdoses. The recent death of Prince highlighted yet again a tragic event that is occurring 78 times everyday in the United States according to the Center for Disease Control (CDC). With more deaths from overdoses occurring annually than motor vehicle collisions, President Obama’s administration recently asked Congress for more than $1 billion to fight the opioid epidemic. Fortunately for Obama the issue has garnered strong bipartisan support and what remains is how to responsibly allocate this funding toward a variety of strategies aimed at prevention, treatment and harm reduction.
As emergency physicians we offer an idea that could help: optimize use of state prescription drug monitoring programs (PDMPs). PDMPs are currently utilized in nearly all states and offer one strategy for addressing the opioid overuse epidemic. A study from 2010 that studied the effectiveness of PDMPs measured a 41% change in prescribing behavior that resulted in fewer or no opioid medications being given by emergency physicians that reviewed the PDMP [1]. Moreover, the state of Virginia reported a decrease in the number of “doctor shoppers” after a PDMP was implemented in their state [2].
Some policy initiates have attempted to mandate use. For example, Connecticut began to mandate that clinicians who wish to prescribe more than three days of opioids check the Connecticut PDMP prior to doing so. Despite this additional safeguard, the majority of patients discharged from the emergency department are given short acting opioids with less than a three-day supply [3]. While this mandate serves as an important first step, a more unifying solution is required that would be less burdensome so that the provider could fully benefit from the value of the PDMP.
Connecticut and other states should focus their policy and funding efforts on integrating the PDMP into hospital electronic health records (EHRs) that securely store patient information. Most states PDMPs require access through a separate web portal outside the hospitals EHR that requires repeat authorization, is time consuming, and often lacks any pertinent patient information. Clinicians often find this process inefficient, overly burdensome and resort to using the hospitals EHR for clues related to overprescribing. Since most hospitals do not share their EHRs with outside hospitals what results are “doctor shoppers” that go undetected.
The scope of this integration inefficiency is best understood in the state of Indiana where they successfully integrated their EHR and PDMP systems. In Indiana, 58% of prescribers reduced their number of prescriptions and quantity of pills after the integration occurred [4].
This solution is not a panacea but could be a part of a multi-pronged effort developed to fight this problem. It’s about time we start using the technology that already works and exists to fight this epidemic.
Joshua W. Elder, an emergency physician, is a clinical scholar at Yale University. Gail D’Onofrio is a Professor and the Chair of the Department of Emergency Medicine at the Yale University School of Medicine.
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One key reason for failure of new EHR implementation is failure to bring over all historical medical records to the new system. EHR vendors should make it clear to hospitals that they do not convert over all data to new systems. Hospitals by now must be aware that they need to engage professional Data management companies who can help transition all the historical clinical and clinical data into the new EHR or archive them. When a nurse is forced to lookup two different systems to get a one year old lab report of a patient, I am sure they are not a happy customer! Check more for successful EHR implementation on
http://www.triyam.com/data-conversion.html
What if the same PDMP were used by the liquor stores and drug stores before you bought wine or cigarettes or bought bungee cords for base jumping? There is a whiff of too much top-down government in these otherwise helpful databases. You don’t want to invert the power structure in the US where the people are supposed to be the bosses. I hope that some of these PDMPs are voter approved. Anyway, a fine article. What we need is a drug like catnip for humans: euphoria for an evening without side effects. A runner’s high must be owing to chemistry..,,what else? Simulate this with a pill…. like a safe khat.