Ways to reduce opioid misuse through patient monitoring

• While some EHR systems have simplified access to prescription drug monitoring program data, it can still take 6 to 9 minutes to retrieve reports. 
• This complex process is not only time-consuming but also increases the likelihood of manual errors that can result in serious adverse events for patients, physicians and healthcare employers. 
• One way healthcare systems and laboratories can better follow guidelines and reduce opioid misuse and its costs is through clinical decision support.

The cost of opioid misuse could be reduced if more healthcare providers followed state and federal prescribing guidelines. They often skip these required patient-monitoring steps because of the additional time it takes to complete the tasks.

A 2015 Health Affairs study found only 53% of physicians surveyed had checked their state’s prescription drug monitoring program (PDMP), and they checked only 25% of the time before prescribing opioids. Physicians told surveyors that retrieving the information is too time-consuming and difficult.

To retrieve a PDMP report, a healthcare provider must take the following steps:

• Visit the appropriate website
• Find the record for the correct patient
• Read each patient’s prescriptions by brand names or active ingredients, prescriber codes, fill dates and quantities

See related sidebar:  The role prescribing guidelines play in patient-monitoring

While some electronic health record (EHR) systems have simplified access to the PDMP data, the provider must still complete the above steps except for the patient search. With or without EHR access to the PDMP, this process can take between 6  and 9 minutes, not to mention the time it takes providers to process the information.

In addition to retrieving and interpreting the PDMP report, the provider must do the same for an extensive toxicology testing report. Interpreting the report includes reviewing drugs and metabolites found and linking them back to prescriptions that were dispensed to determine if the prescription was still active in the patient’s system when the sample was collected.

Some laboratories provide a summarized interpretation with each test. However, test accuracy is dependent on the laboratory receiving an accurate and complete medication list. The toxicology report does not usually include the PDMP data for comparison, so this review is typically done by the healthcare provider.

This complex process is not only time-consuming but also increases the likelihood of manual errors that can result in serious adverse events for patients, physicians and healthcare employers. A provider might incorrectly interpret toxicology test results as substance misuse or even overlook an active prescription not detected in a test.

With the time involved in retrieving the reports, as well as the mental fatigue and pressure resulting from multiple critical manual processes, it is no wonder a recent study found physician burnout costs the U.S. healthcare system roughly $4.6 billion a year (Han, S., Shanafelt, T. D., Sinsky, C. A., et al., “Estimating the attributable cost of physician burnout in the United States,” Annals of Internal Medicine, May 28, 2019).

The patient-monitoring process

One way healthcare systems and laboratories can better follow guidelines and reduce opioid misuse and its costs is through clinical decision support. Automated clinical decision support integrates laboratory and PDMP data within the EHR. Healthcare providers can have a single point of access that assesses and presents the most crucial clinical information. The automated process can include analytics that fit into the clinical workflow and flag high-risk situations and patients based on comparing PDMP and toxicology testing results.

A process that involves retrieving data from a state PDMP website as well as laboratory data and then completing a manual comparison can be completed more efficiently within an EHR. The EHR can provide a report that includes both PDMP and laboratory data. Using clinical decision support also offers a real-time picture of the following patient information:

• Medications taken versus what has been prescribed
• Drugs taken that were not prescribed
• Prescriptions filled from multiple providers
• Combining prescribed drugs with non-prescribed drug
• Illicit drug use or not taking prescriptions while continuing to refill them

In addition to the use of technology, healthcare providers should have regular discussions with their patients about the effectiveness, as well as risks and benefits of their treatment plans. To address the problem of misuse, providers can also sign controlled substance agreements together with patients at least once per year and educate patients and caregivers on safe opioid use and storage at the time of prescribing and during regular visits.

The overall impact

Opioid misuse is estimated by the CDC to cost the United States nearly $80 billion per year (Florence, C.S., Zhou C., Luo F., Xu L., “The Economic Burden of Prescription Opioid Overdose, Abuse, and Dependence in the United States, 2013,” Medical Care, 2016). A 40% reduction of misuse through increased prescribing guideline adherence by only 20% of providers could reduce the cost of opioid misuse by as much as $6.4 billion per year (LaNeve, R., Cooper, G., Understanding the Opioid Epidemic, Executive War College Conference on Laboratory and Pathology Management, New Orleans, April 30, 2019).

Simplifying the process of retrieving and analyzing PDMP and laboratory reports supports healthcare provider adherence to prescribing guidelines, provides better documentation and administrative reporting and potentially reduces liability for providers and health systems as well.