- Healthcare providers are primarily relying on their electronic health record vendors to help them identify problematic opioid prescribing patterns and reduce the unnecessary use of potent, dangerous painkillers, a new KLAS survey reveals.
Seventy-six percent of digitally advanced organizations consider their EHR vendors responsible for providing insights into opioid stewardship, the perception study said.
In sharp contrast, only 22 percent of these providers will first look directly to their state-level prescription drug monitoring program (PDMP) databases for help.
With more than 100 overdose deaths every day as of 2016, clinicians expect their EHR tools to be able to interface with PDMP databases and offer opioid-specific clinical decision support (CDS) capabilities without extra effort on the part of the user.
Ninety-two percent of the hospitals and ambulatory clinics participating in the poll expect an API directly to their local PDMP database, while 76 percent are looking for CDS tools.
A quarter of respondents are interested in population health management and care management functions specifically geared towards substance use disorder (SUD) to better coordinate care for patients with complex socioeconomic and clinical needs.
“Most respondents expect their EMR vendor(s) to take a leadership role in helping them with their opioid stewardship strategies, and expectations are increasing as healthcare organizations further develop their strategies,” the report said.
“Overall, nearly 60 percent of those respondents who could name a vendor that they feel is best poised to help organizations address the issues of opioid stewardship named their EMR vendor as the primary resource they are looking to for help.”
However, these high expectations are not necessarily being met, KLAS said. Only 34 percent of organizations agree that their EHRs enable physicians to identify and prevent opioid misuse and addiction – just five percent “strongly” agreed with the statement.
Providers are somewhat optimistic that EHR vendors will improve their capabilities soon.
One-third of respondents said they are highly confident that their EHR vendors will provide enhanced opioid management toolkits within 12 months, and another 36 percent expressed moderate confidence in their technology partners.
For the remaining organizations, however, poor communication may be stoking uncertainty about new features coming down the pike.
One director of pharmacy said, “I haven’t heard from [our EMR vendor] about anything they are developing to help with our opioid stewardship strategy. . . . I don’t think that [our vendor] is working on any solutions or tools of their own.”
“This lack of communication between EMR vendors and provider organizations could explain why one-third of organizations have little to no confidence that their EMR vendor will deliver on new opioid-related functionality in the next 12 months,” KLAS said.
While users are generally demanding more from their EHR developers, a few well-known brand names are already receiving adequate marks in provider satisfaction.
Epic Systems scored particularly highly for its ability to identify potential addiction at the point of care, monitor and flag problematic prescribing habits, and offer support for care management efforts.
Epic also received the highest marks for user confidence that more tools are on the way. Eighty-four percent of Epic users are either moderately or highly confident that the company will meet their opioid stewardship expectations within the next 12 months.
In comparison, 63 percent of Cerner users, half of MEDITECH users, and just a third of Allscripts users felt the same – however, the pool of surveyed users for each of these vendors was significantly smaller than the Epic customer sample.
Organizations that are less digitally savvy are also less likely to pin primary responsibility on their EHR vendors, the survey found.
“After EMR vendors, Appriss Health and state PDMPs/HIEs are the second and third most mentioned vendors or technologies, being mentioned by over 40 percent of interviewed organizations,” said KLAS.
“It is difficult to separate the two groups since Appriss Health currently supplies the technology for nearly all state PDMPs. Organizations with less developed opioid stewardship programs are more likely to directly depend on these technologies for their opioid stewardship than organizations with more advanced programs.”
Perhaps surprisingly, e-prescribing networks such as Surescripts have fallen well short of providers’ desires, continued the study. Only 9 percent of respondents use Surescripts to identify and prevent addiction at the point of care, and a mere 3 percent rely on the network for highlighting problematic prescribing patterns.
“’The Surescripts tool would be an ideal system to notify us about drug misuse,’ said a CMIO. ‘I don’t know whether that vendor is working on something.’ These customers feel that Surescripts’ place within the prescription workflow gives the vendor the ability to have excellent insight into potential opioid misuse and help identify the patients most at risk, but the vendor ‘could do more’ and has under-delivered on providers’ expectations,” observed KLAS.
Despite frustrations with their technology partners, many providers understand that opioid addiction and substance use disorders are extremely difficult to predict, identify, and manage.
“Drug diversion is actually tricky to catch,” acknowledged one CMIO.
Another executive said that the underlying data analytics and population health management ecosystem needs to see improvement before vendors will be able to present meaningful data to users at the point of care.
“There needs to be a good registry for patients addicted to opioids. We have registries for common diseases, like hypertension or diabetes, but opioid addiction is not monitored in the way it should be,” the participant stated. “Population health platforms really don’t have opioid addicts as a true population. A good place to start would be if care management programs could identify patients who are at risk.”
“Ultimately, we need something that can track patients across the continuum of care. We need to be able to identify these patients, but our solutions are not quite there yet. These patients need to be identified and plugged into some sort of program so that they can be tracked and monitored. Care management platforms would be the best place to tackle that.”
As the opioid epidemic continues to rage across the country, EHR vendors may need to accelerate their population health management capabilities in order to equip users with the tools they need to get ahead of this public health crisis.