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Interoperability is a buzzword in the healthcare IT (HIT) world that essentially means computer systems talking with one another—but could it also hold the key to helping providers stem the tide of opioid-related overdoses?
A nationwide health information exchange (HIE), matching patients to their data, across networks and interactions with providers, offers the promise of meaningfully impacting population health management, bringing treatment to remote or isolated patients, and streamlining the entire delivery of care.
In this post, we’ll focus on how electronic health records (EHR) have made a difference for those communities hardest hit by the opioid epidemic, and how this technology can be configured to meet any community’s population health management needs.
Opioids are pain-relieving substances that act on the nervous system or specific receptors in the brain. There are a wide variety of opioids, including prescription medications, heroin, and synthetic opioids such as fentanyl.
Beginning in the late 1990s, synthetic opioids became widely prescribed throughout the United States to manage chronic and acute pain. While it was initially believed that patients were not at significant risk of abusing synthetic opioids, these medications soon proved highly addictive and extremely dangerous. According to the CDC (Center for Disease Control), of the 91,799 drug overdoses that claimed American lives in 2020, nearly 75 percent can be attributed to opioids. Of those deaths, 82 percent involved synthetic opioids.
In response to this growing epidemic, the federal government passed the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act in June of 2018. Recently, the CDC and the Department of Justice's Bureau of Justice Assistance also incentivized states with grants to fight opioid abuse by participating in RxCheck, a federally supported open-source data-sharing hub.
To support these data-sharing and prevention programs, many states and healthcare systems have established partnerships with privately held healthcare technology and EHR (electronic health record) vendors as part of a growing movement toward leveraging interoperability to combat the opioid crisis.
EHR-supported processes like EPCS (electronic prescribing of controlled substances) allow clinicians to digitally submit prescriptions for these types of medications, increasing security, preventing fraud, and providing greater opportunities to hold providers accountable.
Conversely, some states have demonstrated early success in improving clinical reconciliation and decision support for facilities through privately managed and state-funded interoperability initiatives, which frequently involve state-run Prescription Drug Monitoring Programs (PDMPs).
While many states and private organizations have effectively used these processes to prevent the abuse of opioids, the road to nationwide interoperability remains rocky.
In 2018, the College of Healthcare Information Management Executives (CHIME) outlined various data interoperability barriers to solving opioid issues to the Senate Committee on Finance.
While PDMPs are a targeted solution that has given providers a competitive advantage on a state-by-state basis, the lack of a secure, standardized process for managing prescriptions across state lines is problematic. Patient data and medication access rules vary by state. In many cases, providers who do not practice locally can see but not share or save medication histories that may identify habitual abusers.
Although privately held HIEs that integrate PDMPs have been shown to generate good results at the state level, to get the most out of what is already established, and to make marked progress in controlling opioid abuse across state lines, further collaboration and standardization are necessary.
CHIME notes that thanks to the widespread adoption of EHRs after the passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act, much of the groundwork for leveraging healthcare data technology systems is already in place.
Interoperability can be a powerful weapon in the fight against the opioid epidemic if EHR vendors, hospitals, and the government can cooperate to standardize connections between patient data systems.
MEDHOST’s interoperability platform offers solutions that facilitate improved care coordination, data availability to patients and third-party applications, reporting to public health agencies, and HIEs at state and federal levels, while complying with necessary legislative requirements.
Learn how we’ve come to be a trusted IT solutions and services provider for healthcare facilities for over 35 years. Email us at inquiries@medhost.com or call 1.800.383.6278.
Opioid analgesics are FDA-approved prescription medications that can provide pain control for moderate to severe pain when appropriately prescribed; however, inappropriate prescribing can lead to opioid abuse, diversion, and deadly overdoses.1
According to the Centers for Disease Control and Prevention (CDC), the number of drug overdose deaths was four times higher in 2018 than in 1999 despite a recent decrease and, of those 67,367 deaths in 2018, nearly 70 percent involved an opioid and 14 percent involved prescription opioids. As stated by the CDC, “the best ways to prevent opioid overdose deaths are to improve opioid prescribing, reduce exposure to opioids, prevent misuse, and treat opioid use disorder.”2
Benefits of Electronic Prescribing of Controlled Substances
Electronic prescribing of controlled substances (EPCS) allows physicians to transmit controlled substance prescriptions securely to their patient’s pharmacy. The use of EPCS reduces prescription fraud and diversion by removing the risk of prescription forgery and alterations. It also decreases prescribing errors that are often caused by illegible handwriting and use of unapproved abbreviations. And, because the electronic prescription data flows into state prescription drug monitoring program (PDMP) databases, EPCS can help provide physicians with insight into a patient’s controlled substance prescription history, thus helping to identify “doctor shopping” behaviors and opioid overuse.3
Current Usage and Future Requirements
EPCS is now legal in all fifty states, yet it is not widely adopted. Less than 60 percent of all United States prescribers are currently EPCS-enabled, despite having 96 percent of US retail pharmacies capable of receiving electronic controlled substance prescriptions.4 However, individual state and federal regulations will soon change that.
The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, passed by Congress in 2018 to help combat the opioid crisis, requires EPCS for all controlled substances prescriptions covered under a Medicare Part D prescription drug plan or Medicare Advantage Prescription Drug (MA-PD) Plan, beginning January 1, 2021.5 Recently, Centers for Medicare & Medicaid Services (CMS) announced that they will delay enforcement until January 1, 2022.6 Despite the delay in enforcement, many states are continuing to pass their own EPCS-required mandates to help address the opioid crisis. Twelve states have already required the use of EPCS prior to December 31, 2020 and an additional 15 states will begin requiring EPCS this year.7
How Your Facility Can Make an Impact in Your Community
MEDHOST EPCS solution is DEA-compliant, Surescripts-certified, and is available in both MEDHOST Emergency Department Information System (EDIS) and MEDHOST Enterprise Electronic Health Records (EHR). To learn more about how MEDHOST can help your facility reduce opioid prescription fraud, improve patient safety, enhance physician workflow, and meet EPCS state and federal requirements, please reach out to us at inquiries@medhost.com or call 1.800.383.6278.
References:
1Preuss, C.V., Kalava, A., & King, K.C. (2020). Prescription of Controlled Substances: Benefits and Risks. StatPearls [Internet]. Retrieved from here.
2Centers for Disease Control and Prevention (CDC). (2020, March 19). Opioid Overdose. Retrieved from https://www.cdc.gov/drugoverdose/index.html
3The Office of the National Coordinator for Health Information Technology (ONC). (2019, December 18). Health IT Playbook: Opioid Epidemic & Health IT. Retrieved from https://www.healthit.gov/playbook/opioid-epidemic-and-health-it/
4Surescripts. (2020, December). Electronic Prescribing for Controlled Substances. Retrieved from https://surescripts.com/
5Center for Medicare & Medicaid Services. (2020). Medicare Program: Electronic Prescribing of Controlled Substances; Request for Information (RFI). Federal Register 85:150 p. 47151-47157. Codified at 42 CFR §423. Retrieved from https://www.govinfo.gov/content/pkg/FR-2020-08-04/pdf/2020-16897.pdf
6Center for Medicare & Medicaid Services. (2020). Medicare Program; CY 2021 Payment Policies Under the Physician Fee Scheduled and Other Changes to Part B Payment Policies; Medicare Shared Savings Program Requirements; Medicaid Promoting Interoperability Program Requirements for Eligible Professionals; Quality Payment Program; Coverage of Opioid Use Disorder Services Furnished by Opioid Treatment Programs; Medicare Enrollment of Opioid Treatment Programs; Electronic Prescribing for Controlled Substances for a Covered Part D Drug; Payment for Office/ Outpatient Evaluation and Management Services; Hospital IQR Program; Establish New Code Categories; Medicare Diabetes Prevention Program (MDPP) Expanded Model Emergency Policy; Coding and Payment for Virtual Check-in Services Interim Final Rule Policy; Coding and Payment for Personal Protective Equipment (PPE) Interim Final Rule Policy; Regulatory Revisions in Response to the Public Health Emergency (PHE) for COVID–19; and Finalization of Certain Provisions from the March 31st, May 8th and September 2nd Interim Final Rules in Response to the PHE for COVID–19. Federal Register 85:248 p. 84472-85377. Codified at 42 CFR §400, 410, 414, 415, 423, 424, and 425. Retrieved from https://www.govinfo.gov/content/pkg/FR-2020-12-28/pdf/2020-26815.pdf
7Imprivata. (n.d). Federal and State Regulations. Retrieved from https://www.imprivata.com/federal-and-state-regulations. Accessed January 3, 2021.
