Directly or indirectly, the scourge of opiate addiction has deeply hurt many families to their core. That includes many members of our own Allscripts family. If we haven’t been personally affected by this modern menace, chances are we know people who have.
The Centers for Disease Control and Prevention reports that prescription opioid use and overdoses have quadrupled since 1999. More than 40 Americans die every day from prescription opioid and opiate overdose alone. And when you factor in drugs from the street, which is often where patients turn when they can no longer obtain or afford their legal prescriptions, that number explodes to more than 115 Americans dying every day. The CDC estimates that the total economic impact of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment and criminal justice involvement.
Our industry knows technology can better support and empower those on the front lines, and help to reverse this frightening trend of overprescription, addiction, overdose and death. We know this to be true from our own experience, and what we are hearing from our clients.
Our goal is to deliver a comprehensive solution by transforming the process from being a task – i.e. check the prescription drug monitoring program – to a true clinical decision support at the point of care. We are working to expand the response to include proactive and ultimately, predictive:
Reactive. The clinician looks at the PDMP; we integrate and streamline the process so the PDMP is seamlessly and automatically triggered for every patient – not just those for whom a controlled substance is being prescribed.
Proactive. The system will:
1) take PDMP data (or at best a basic report) and provide real-time alert scores that can make it easier to discern problems at the point of care,
2) incorporate and make available best practice content
3) leverage electronic prescribing of controlled substances capabilities to help reduce paper prescriptions and related fraudulent use.
Predictive. Organizations reduce the risk of addiction before it takes hold by utilizing advanced data analytic technology for real-time monitoring, triggering alerts scores that make it easier to identify potential problems.
In this way, we will be providing information that enables prescribers to quickly evaluate the situation and act upon it immediately, if necessary.
Additionally, 2bPrecise, one of our significant innovative initiatives, is providing an EHR agnostic, precision medicine and genomic platform. The 2bPrecise platform can analyze drug to gene interaction and apply pharmacogenomics knowhow in order to better discover the most effective regimen for the patient.
The importance of electronic prescribing of controlled substances
Allscripts has a long history as an early advocate of e-prescribing. In 1991, we helped found the National E-prescribing Patient Safety Initiative, and proudly donated our standalone ePrescribe product for free as part of that initiative. Following that tradition and underscoring our commitment to this fight, we want to do what we can to make sure that cost is not a barrier to using these tools. As a result, we are establishing a price point for the entire bundled initiative that is less than EPCS is alone today.
The fact is that when it comes to EPCS, the industry does not have a technology issue, we have a utilization issue. In areas where clinicians widely use EPCS, this solution has already been proven to help save lives by dramatically reducing prescription fraud and abuse.
Technology can deliver the right data to the right place at the right time and empower clinicians and pharmacists to make informed decisions. With EPCS functionality already in place across all of our electronic health records and with more than 90 percent of all pharmacies EPCS-enabled, according to Surescripts 2017 National Report. However, statistics indicate that only 17 percent of clinicians able to prescribe controlled substances are doing so via EPCS. That gap is a problem. We’re making EPCS adoption one of our top priorities at Allscripts, and we continue to discuss the benefits with policymakers.
Interoperability with state PDMPs
The College of Healthcare Information Management Executives, CHIME, has stressed the need for better EHR-PDMP integration, combined with data-driven reports to identify physician prescribing patterns. To that end, many prescribers and dispensers place a high value on the information available to them from the PDMPs, yet they are frequently challenged to access this information given their busy schedules. Recent studies have shown that providers take anywhere from five to eight minutes per patient in the current process of checking the PDMP. Our goal is to eliminate the manual workflow associated with the PDMP check process and implement a solution to avoid the system latencies in existing PDMPs.
In addition to utilization of EPCS and PDMPs, the presentation of content, such as clinical guidelines – based on CDC recommendations, best practices and clinical decision support – will also play an essential role in our overall strategy.
Partnering with plans and pharma to create prescribing guidelines
In 2016, the CDC released its Guideline for Prescribing Opioids for Chronic Pain, which it developed to improve opioid prescribing, provide safer patient care and help reduce opioid use disorder. Technology can help facilitate many of the 12 recommendations contained within the CDC Guideline, including how prescribers select, dose, track and discontinue opioids with patients.
We are actively pursuing partnerships with health plans as well as pharmaceutical companies and third-party content providers to collaborate on evidence-based prescribing guidelines. These guidelines may suggest quantity limits, recommendations for fast-acting versus extended-release medications, protocols for additional and alternative therapies, and expanded educational material and content.
We’ll use the clinical decision support technologies we already have in place to present these assessment tools and guidelines at the time needed within clinical workflows. Leveraging and presenting the information at the right time for the right patient using evidence-based guidelines and clinical tools is an essential component. Our goal is to provide the information to providers so that they can engage in productive conversations with patients, make informed decisions and create optimal treatment plans.
Leveraging EHR and community data to identify prescribing patterns, predict at-risk patients
We have a team of data scientists in Allscripts whose mission is to transform data into insights and actionable information. Their plan is to couple the information that is within the EHR with the data we have in our Clinical Data Warehouse – data that represents millions of patients – and combine it with data that is available through public health mechanisms (such as PDMPs).
That “data lake” can then be used to develop algorithms to identify or even predict at-risk patients, and look at prescription patterns that most often lead to problems with abuse and overdose. Our research on this is still very new, and we are just scratching the surface; it is clear that this is the direction in which we’re headed.
We understand the opioid epidemic cannot be solved overnight, nor is it something any of us can address alone. But we applaud the teamwork and efforts of our entire industry to address this massive problem. We are grateful to our clients and employees who courageously share their personal stories and pain, which both inspire us and provide valuable insights into how we can proactively contribute to the fight. Please join our team at 4:30 p.m. March 6 in the Allscripts Booth 2054 at #HIMSS18 to learn more about how we’re responding to this epidemic.