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Embedding a State-Wide Prescription Drug Monitoring Program into the Electronic Health Record.

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A new electronic health record (EHR) application integrated into workflows improved controlled substance prescription monitoring. This tool increased clinician checks by 57.4%, aiding in significant reductions in opioid prescribing.

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Area of Science:

  • Health Informatics
  • Clinical Decision Support
  • Public Health

Background:

  • Electronic health records (EHRs) present opportunities for integrated clinical decision support.
  • Monitoring controlled substance prescriptions is crucial for patient safety and combating the opioid crisis.
  • Prescriber workflow integration is key for the adoption of new health IT interventions.

Purpose of the Study:

  • To develop and evaluate a novel EHR-integrated application for automated morphine milligram equivalent (MME) calculations and controlled substance prescription monitoring.
  • To assess the impact of the intervention on clinician behavior regarding prescription data checks.
  • To quantify the effect of the intervention on opioid prescribing patterns and healthcare system efficiency.

Main Methods:

  • Development of a FHIR-based application embedded within the EHR system.
  • Automated calculation of MME and highlighting of unsafe thresholds.
  • Presentation of patient's controlled substance medication history directly within the prescriber's workflow.

Main Results:

  • Clinician checks of patient controlled substance prescription data increased by 57.4%.
  • The number of patients whose data was checked increased by 9.2%.
  • Opioid prescriptions written after intervention data review increased from 9% to 14%, while overall controlled substance pills decreased by nearly 11 million over five years.

Conclusions:

  • EHR-integrated applications can significantly enhance the monitoring of controlled substance prescriptions.
  • Automating MME calculations and providing immediate patient data access improves prescriber engagement.
  • This intervention demonstrates a scalable approach to reducing controlled substance utilization and improving healthcare efficiency.