Implementing Electronic Health Record Default Settings to Reduce Opioid Overprescribing: A Pilot Study

Area of Science:

• Health Informatics
• Pharmacology
• Public Health

Background:

• Opioid overprescribing remains a significant public health concern.
• Electronic health records (EHRs) offer opportunities for clinical decision support.
• Default prescription quantities in EHRs can influence prescribing behavior.

Purpose of the Study:

• To pilot test the effectiveness, feasibility, and acceptability of a 15-pill quantity default in EHRs for new Schedule II opioid prescriptions.
• To assess the impact of EHR defaults on opioid prescribing quantities.

Main Methods:

• A mixed-methods pilot study was conducted in two health systems.
• Pre-post analysis of 6,390 opioid prescriptions from 448 prescribers.
• Focus groups and interviews with prescribers and administrators.

Main Results:

• The proportion of 15-pill opioid prescriptions increased significantly at one site (15.9% to 37.2%, P < 0.001).
• The default increased prescriptions among high-prescribing departments and most prescriber frequencies.
• Implementation faced limited challenges, though EHR vendor variation existed; most prescribers were unaware of the default.

Conclusions:

• Changing EHR default settings can increase the number of prescriptions at the default level.
• This low-cost intervention may impact opioid overprescribing.
• Careful selection of default settings is crucial to prevent unintended consequences.