I’ve been a member of the College of Healthcare Information Management Executives (CHIME) for 23 years, most of that time as CIO of Huntington Hospital in Huntington, New York. When I was invited to join CHIME’s Opioid Task Force, I knew I had to accept, believing strongly that CHIME is uniquely positioned to advocate for meaningful change in how healthcare organizations address the national emergency of opioid addiction. In short, I joined hoping to improve patient safety and make a difference in people’s lives.
What I didn’t expect was how emotional and personal the experience would become.
The task force held its kickoff meeting on January 24-25 in Washington, D.C., where I learned that Ed Kopetsky, CIO of Lucille Packard Children’s Hospital Stanford in Palo Alto, California, lost his son Tim to an opioid overdose last May. Hurting badly and wanting to do something to fight the opioid epidemic, Kopetsky joined with Jim Turnbull, CIO of the University of Utah Health, and Russ Branzell, president and CEO of CHIME, to form the CHIME Opioid Task Force.
Currently, the task force has 22 members, including both healthcare and IT vendor executives. What is striking about this group is how many of its members have lost either children or other family members to opioid addiction. Thankfully, I am not one of these people, but I feel their losses deeply.
At the kickoff meeting, we met with federal and state lobbyists and Congressional staff members. What struck all of us from CHIME was how little the federal government is really doing about the opioid crisis. While some money has been made available to fight opioid addiction through the Substance Abuse and Mental Health Services Administration (SAMHSA), Washington has basically left the states responsible for dealing with the epidemic.
Neither the Centers for Disease Control and Prevention (CDC) nor the Food & Drug Administration (FDA) is involved in this national emergency. The CDC has always been actively involved in any national epidemic, issuing guidelines for hospitals to follow when patients present with an epidemic-related condition. Although the CDC has prescribing guidelines for opioids, they have issued no guidance to healthcare facilities on what to do when a patient presents with substance abuse disorder or an overdose. In my view, this is unprecedented and unacceptable for an epidemic that cost 62,497 lives in 2016.
There is much that individual states can do, but each state is taking a different approach, and we clearly need national coordination. For instance, only some states require that their Prescription Drug Monitoring Programs (PDMPs) share information about controlled drug prescriptions with other states. As a result, when an addict can’t get an opioid prescription from a local doctor, it’s easy to go to nearby states where doctors can’t see their prescription history.
Electronic prescribing of controlled substances (EPCS) helps reduce opioid diversion and abuse because addicts can’t steal prescription pads or claim they’ve lost paper prescriptions. However, only a small percentage of physicians use EPCS, partly because only a handful of states mandate it. That’s an area where the CHIME Opioid Task Force plans to take a stand in the near future.
Right now, 40 states require physicians to review a patient’s prescribing history in their PDMP registry before they prescribe controlled substances. However, I’ve talked to physicians who don’t want to spend the four or five minutes per prescription that it takes to leave their EHRs and log onto their state’s PDMP website. They view it as a hassle, and I’m sure they’re not alone. And obviously, when doctors don’t see prescription histories, addicts can fall through the cracks.
The solution is to feed the PDMP data right into the e-prescribing process so doctors don’t have to disrupt their workflow. Thirteen states allow health IT vendors to access their PDMP databases and link them to EHRs and e-prescribing software so that physicians can pull up the data as part of the prescribing process. Ironically, however, New York is not one of those states, despite having the strongest EPCS mandate and being among the first states to mandate PDMP checking with I-STOP, the Internet System for Stopping Overprescribing. The CHIME Opioid Task Force may take up this issue and encourage more states to get on board.
Healthcare organizations have a special responsibility to respond to the opioid crisis. Aside from the fact that they employ the bulk of prescribers, they also have a history of promoting opioids. Back in the 1990s, the Centers for Medicare and Medicaid Services (CMS) made pain the “fifth vital sign” by creating a category for pain management in its Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction surveys. As a result, hospitals made it a goal that no patient leaves feeling pain, and that they get sufficient pain medication to keep pain at bay. That practice boosted the use of prescription opioids, which lies at the root of our current epidemic. So, since we helped create this problem, it is incumbent upon us to lead the fight against opioid abuse.
However, we can’t let the pendulum swing too far in the opposite direction. Today, some doctors are so afraid of prescribing pain meds, that they don’t prescribe pain medications at all. This attitude may have unintended consequences, such as the disturbing trend we’re seeing in New York, where opioid prescribing has dropped significantly but heroin overdoses are up. When addicts couldn’t get prescription opioids, they turned to street drugs and bought heroin instead, which is often cheaper and more readily available than opioids.
Another consequence is that some doctors are not prescribing pain meds to patients who really need them, such as terminal cancer patients. The pain these people feel should be alleviated to give them some quality of life in the time left to them. The rules governing opioid prescriptions should be made flexible in these cases, and doctors should be better educated about the line between appropriate and inappropriate prescribing of opioids.