- The College of Healthcare Information Management Executives (CHIME) recently recommended federal agencies improve interoperability and EHR integration with prescription drug monitoring programs (PDMPs) to help curb the opioid epidemic.
These recommendations came in response to the Senate Committee on Finance’s request for feedback on policy recommendations to improve access and quality of treatment for opioid use disorder (OUD) and other substance use disorders (SUDs).
First, CHIME recommended CMS leverage the Merit-Based Incentive Payment System (MIPS) improvement activities performance category to incentivize consider adding the following improvement activities to MIPS in 2019:
Next, CHIME suggested CMS and ONC focus on improving interoperability and minimizing administrative burden for clinicians.
“Clinicians still report that Continuity of Care Documents (CCD) are still too bulky and are not easily ingested by a receiving provider’s EHR,” wrote CHIME. “Clinical decision support (CDS) may contain information needed to treat patients with SUDs and OUDs; however, without a way to seamlessly integrate the information into the EHR, clinicians cannot get a holistic picture of a patient’s health.”
CHIME recommended CMS reconsider the idea that sending and receiving CCDs will drive interoperability improvements.
CHIME also recommended the committee advocate for better integration of EHRs with PDMPs.
“Today, oftentimes the information offered to a clinician in a PDMP is presented in a disjointed manner, requiring the prescriber to take additional steps to review past scripts from other healthcare providers,” stated CHIME. “This creates a fragmented picture for clinicians and results in data that is not integrated seamlessly within an EHR.”
The fragmented presentation of information from PDMPs also poses a barrier to interoperability, CHIME said.
“According to the CDC, ‘Clinicians do not consistently use practices intended to decrease the risk for misuse, such as PDMPs, urine drug testing, and opioid treatment agreements,’” wrote CHIME. “This is likely due in part to challenges related to registering for PDMP access and logging into the PDMP (which can interrupt normal clinical workflow if data are not integrated into electronic health record systems).”
In addition to improving EHR integration with PDMPs, CHIME also suggested the committee encourage healthcare providers to use data-driven reports to identify prescribing patterns. These reports would make it easier to note abnormal prescribing patterns that may be indicative of abuse.
“Data collection efforts should be encouraged among healthcare providers to help ascertain who the highest prescribers are and to deduce patterns and abuse concerns,” wrote CHIME.
CHIME also recommended using CDS to offer evidence-based treatment.
“CDS should offer appropriate evidence-based treatment options, which may or may not involve the scripting of an opioid or controlled substance,” wrote CHIME. “Properly developed and used CDS can help those treating patients on opioids and those for whom they are considering prescribing them.”
CHIME emphasized that CDS is one aspect of EHR systems, and suggested EHR technology overall needs to improve to better support opioid and substance abuse treatment.
CHIME also made recommendations about improving health data exchange consent policies, encouraging providers and stakeholders to collaborate and share best practices, and increasing the use of telehealth to support opioid addiction treatment.
Finally, CHIME made recommendations about how to improve data sharing and coordination between Medicare, Medicaid, and state initiatives such as PDMPs. First, CHIME suggested improving patient matching strategies to enable the creation of single, longitudinal patient EHRs. Second, CHIME urged federal agencies to make it easier for clinicians to refer to PDMPs to facilitate seamless data access.
“Unless the barriers at the local level can be overcome, prescribers will continue to have an incomplete picture of a patient,” maintained CHIME. “These obstacles amount to a serious patient safety issue and until corrected will plague prescribers’ ability to treat patients holistically.”