- Volunteer members of the EHR Association (EHRA) have developed a guide to help healthcare organizations apply the 12 recommendations outlined in CDC’s Guideline for Prescribing Opioids for Chronic Pain to EHR implementations.
CDC published its recommendations for opioid prescribing in 2016 to address problems with prescribing, optimize patient safety, and curb the opioid epidemic.
The guide’s recommendations apply to opioid prescribing for chronic pain but exclude prescribing for patients with active cancer, patients in palliative care, and patients with sickle-cell disease. The recommendations apply mostly to physicians, physician assistants, and advanced nurse prescribers of opioids making treatment decisions.
CDC’s twelve recommendations are as follows:
- Opioids are not front line therapy
- Establish goals for pain and function
- Discuss risks and benefits
- Use immediate-release opioids when starting
- Use the lowest effective dose
- Prescribe short durations for acute pain
- Evaluate benefits and harms frequently
- Use strategies to mitigate risks
- Review PDMP data
- Use urine drug testing
- Avoid concurrent opioid and benzodiazepine prescribing
- Offer treatment for opioid use disorder
EHRA created its resource for helping healthcare organizations utilize CDC’s opioid prescribing guide in part because CDC’s recommendations are rarely used in clinical practice. When they are used, the recommendations are often applied inconsistently.
When developing its resource, EHRA’s Opioid Crisis Task Force focused on how clinical practice guidelines can be effectively used within provider EHR systems to promote safer prescribing practices.
“It is clear from conversations we had with medical and public health professionals over the last year that the general availability of content, such as that published by the CDC, is not enough,” said EHRA Opioid Task Force chair Leigh Burchell in an emailed press release.
“It needs to be presented to prescribers, in large hospitals and small physician practices alike, as they make care decisions,” Burchell continued. “This implementation guide will be of value to both technology vendors and provider organizations who are focused on delivering clinical best practices to physicians and other prescribers—at the point of care, within the EHR workflow.”
The implementation guide includes insights from EHRA about how EHR systems can be used to operationalize all 12 CDC recommendations. The guide also includes a menu of proposals for implementing each recommendation.
The implementation of each recommendation included in the CDC guide should be tailored to each provider’s specific organization, protocols, and state laws.
“When the EHRA Opioid Crisis Task Force began its work, we oriented our effort around the premise that powerful information and technology tools like EHRs, PDMPs, EPCS, CDS, and health data exchange hold very real potential to measurably assist in addressing substance misuse,” said Burchell.
“In helping our clients deliver the best and most informed care possible, we must collectively maximize all the tools at our disposal,” Burchell added.
The guide targets a variety of care settings including ambulatory specialty clinics, ambulatory surgery centers, federally qualified health centers, home health agencies, hospitals, hospital outpatient surgery centers, and primary care settings.
“The EHR Association encourages organizations to work with their EHR developers to discuss the implementation approaches and strategies contained in this document and put them into practice as appropriate,” wrote EHRA in its guide.
“While some EHRs may not currently be able to implement every recommendation in this guide, organizations may ask their developers to include desired new capabilities in future updates,” the association added.
EHRA formed its Opioid Crisis Task Force in early 2018 with the aim of researching and providing recommendations on ways EHR technology can help to address issues related to the opioid epidemic.