Back in 2015, CalvertHealth Medical Center in Prince Frederick, Maryland, was ranked as the No. 1 prescriber of morphine milligram equivalents in southern Maryland.

THE PROBLEM

Maryland sits in the top five states for opioid-related overdose deaths. For the sake of the community and the people in it, CalvertHealth knew that drastic changes needed to be made.

Family members of staff inside the hospital were being impacted by substance abuse disorder. At CalvertHealth, staff saw it as a call to action to move forward and make a real change in preventing the opioid epidemic from spreading any further within Calvert County.

“Compounding the issue was the fact that we weren’t the only ones managing pain and prescribing opioids within the county,” said Phil Campbell, CIO and vice president of information services at CalvertHealth Medical Center.

“We had to consider community physicians, dentists and eventually the community itself. It became obvious very quickly that we needed to take a proactive approach in attacking this crisis because we were not going to move the needle if we just tried to contain it within our hospital.”

CalvertHealth needed to consider how it would track prescriptions between prescribers and hospitals. Is its staff prescribing to recommended CDC guidelines? What kind of decision support do providers need? A natural planning process fell into place from what staff saw as the requirements to solve the problem.

PROPOSAL

The Chesapeake Regional Information System for our Patients (CRISP) is a regional health information exchange that serves Maryland and the District of Columbia. It essentially shares information between all the hospitals in the state and individual community providers, and sign-up is free. It allows CalvertHealth to share information about encounters statewide.

“That part was absolutely critical, because now, when we see a patient, we can check if they have been ‘doctor shopping’ for opioids at other locations within the last week, two weeks, day, even that morning,” Campbell explained.

"Within the EHR we set up decision support to ensure physicians were being held accountable for searching [the HIE], and confirming that what they were prescribing was the best choice for the presented symptoms."

Phil Campbell, CalvertHealth Medical Center

Meditech’s electronic health record system enables CalvertHealth to apply best practices across its organization in the form of standard order sets that include alternatives to opioids or decision support that provides warning flags for providers ordering controlled substances to ensure they really want to do that.

Meditech also offers reporting capabilities to monitor those prescriptions and ensure that any prescriptions matched up with the ICD codes that were assigned to the diagnosis.

MARKETPLACE

There are many vendors with electronic health records systems on the health IT market today, including Allscripts, Cerner, eClinicalWorks, Epic, Greenway Health, HCS, Meditech and NextGen Healthcare.

MEETING THE CHALLENGE

CalvertHealth determined there was no way to fight the opioid battle without leveraging technology and making the workflow as seamless for providers as possible. Meditech implemented a single-sign-on button in the EHR that links directly to CRISP in order for physicians to have easy access to the patient’s medical history that exists outside of CalvertHealth.

“Within the EHR, we set up decision support to ensure physicians were being held accountable for searching CRISP and confirming that what they were prescribing was the best choice for the presented symptoms,” Campbell noted.

“Creating those discharge protocols within the EHR serves as a reminder for busy physicians and clinicians. Having that decision support means that we keep the focus of those physicians on the appropriate prescription of opioids.”

Within the EHR, staff narrowed the selection of opioids in emergency department order sets by eliminating Dilaudid. Staff also tailored pain management order selections by chief complaint in each associated chief complaint order set and updated the nonfatal overdose chief complaint order sets to include follow-up opioid use disorder or substance use disorder therapy recommendations.

“Finally, on the back-end, using the reporting capabilities of the EHR, we can monitor those prescriptions, make sure they match with the assigned ICD codes, and pull daily reports, and use that data to move things forward,” Campbell said. “That is a critical step.”

RESULTS

Today, CalvertHealth no longer uses Dilaudid as a first-line medication, and keeps only one or two doses in its dispensing cabinets.

“With the clinical decision support built into the EHR, clinicians have been able to move away from unnecessary opioid prescribing,” Campbell reported. “With the measures we have taken, we have seen a 94% reduction in Dilaudid use and a 46% decrease in use of other opioids.”

ADVICE FOR OTHERS

Campbell advises peers who wish to follow a similar path that they first must begin with the admission of whether or not they believe they have an opioid problem in their area.

“Recognizing the problem, understanding the depth and breadth of the problem, understanding the true scope of what’s required to combat that problem, is absolutely critical at the executive level,” he cautioned. “If you do not have solid executive commitment and a deep belief in doing this program well, it’s going to fail.”

He added that technology alone will not solve the issues.

“It also is about engagement and education with your patients and community,” he said. “We recommend developing a tri-fold for the patients and family to say, ‘This is what opioids are and this is what they do.’ They do have an appropriate role in pain management and treatment of certain conditions. However, they do not always have an appropriate role, and the use of those very powerful narcotics should be time-limited and appropriate to the condition, and offering alternatives.”

Sharing that with the community, he concluded, really helps them begin to understand that there are things they can do both at home and that they will experience in the emergency department that will avoid introducing opioid substance abuse disorder while still managing their pain.

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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