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By Scott LaNeve

June 18, 2020

A recent look at clinical decision support systems (CDSS) in online journal npj Digital Medicine found these benefits for patients, clinicians and administrators:

  • Patient safety: A common use for CDSS is to reduce medication errors. For example, a CDSS might check for drug-drug interactions or send an alert when a prescribed dose exceeds the recommended amount.
  • Clinical management: CDSS can improve adherence to clinical guidelines, for example. 
  • Administrative functions: CDSS can make it easier for doctors to choose the right diagnosis codes or complete documentation.

Given the benefits, one can see why healthcare organizations have turned to various types of CDSS to help safely manage opioid prescribing. The potential patient safety impact is the prevention of addiction or overdose. Opioid prescriptions come with numerous federal, state, and professional guidelines that must be followed, leading to clinical management challenges. These challenges even lead to primary care physicians turning away patients who are on chronic opioid therapy. Opioid prescribing also comes with numerous administrative requirements, such as risk assessments, patient agreements, morphine milligram equivalent (MME) calculations, and prescription drug monitoring program (PDMP) checks.

But CDSS are not a perfect solution. The npj Digital Medicine article also identified several CDSS pitfalls, including alert fatigue and data/content maintenance. Medication lists, in particular, were a noted issue: “Medication and problem lists can be problematic, if not updated or used appropriately. At one site, the medication list might be a list of dispensations, which means patients may or may not be taking them (and thus must still be asked in person). Other medication lists are generated from CPOE orders only, thus still requiring manual confirmation that patients are taking the medication.1

Opioid prescribing is prone to these CDSS pitfalls. For example, a study published in the Annals of Emergency Medicine about opioid CDSS concluded, “To prevent one adverse drug event, providers dealt with more than 123 unnecessary alerts. It is essential to refine clinical decision support alerting systems to eliminate inconsequential alerts to prevent alert fatigue and maintain patient safety.”2   Clinicians participating in the OPTI study to improve opioid safety didn’t  use the available CDSS because of technical difficulties accessing and navigating the system and belief that the system was based on outdated initiatives and guidelines.3

hc1 has addressed these issues by focusing on what we do best—transforming lab data into personalized insights—and by partnering with Appriss® Health, the leading provider of PDMP services for the United States, to build hc1 Opioid Advisor®

The American Society of Interventional Pain Physicians (ASIPP) recommends that opioid prescribers use a combination of urine drug tests and PDMP checks to monitor their patients for adherence, abuse, and noncompliance.4  Patient monitoring is exactly where hc1 Opioid Advisor offers clinical decision-making support. 

hc1 Opioid Advisor does a complete drug consistency analysis by comparing drug test results against the list of all tracked medications dispensed to the patient, as reported to state PDMPs. Prescribers no longer need to maintain medication lists or spend time manually comparing drug test results to prescribed medications, parent drugs, and metabolites, looking for inconsistencies. Prescribers can instead focus on the patient communication and engagement that is crucial to ensuring that patients adhere to their pain management programs.

Visit www.hc1.com to learn more about Opioid Advisor and request a demo

References and Resources

  1. Sutton, R.T., et al. (2020 February 6). An overview of clinical decision support systems: benefits, risks, and strategies for success. npj Digital Medicine. 3, 17 (2020). https://doi.org/10.1038/s41746-020-0221-y
  2. Genco, Emma K. MS, et al. (06 November 2015). Clinically Inconsequential Alerts: The Characteristics of Opioid Drug Alerts and Their Utility in Preventing Adverse Drug Events in the Emergency Department. Annals of Emergency Medicine. https://doi.org/10.1016/j.annemergmed.2015.09.020
  3. Seal Karen H. MD, MPH, et al. (2019 February 1). Optimizing pain treatment interventions (OPTI): A pilot randomized controlled trial of collaborative care to improve chronic pain management and opioid safety-Rationale, methods, and lessons learned. Contemporary Clinical Trials. 2019;77:76‐85. https://doi.org/10.1016/j.cct.2018.12.006
  4. Navani, Annu MD, et al. (2017). Responsible, Safe, and Effective Prescription of Opioids for Chronic Non-Cancer Pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines. Pain Physician Opioid Guidelines Special Issue Vol 20 issue 2S. https://www.painphysicianjournal.com/linkout?issn=&vol=20&page=S3#
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