Considerations for Integrating the CDC Opioid Prescribing CDS Tools

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While the CDS tools are pre-built software, health systems can customize the tools once integrated into their EHR system. Options include selecting all 12 of the 2016 CDC Guideline recommendations or selecting a limited number. Follow the checklist below to support your health system’s use of the CDS tools.

Technology Tip

Consider setting default reminders in your EHR system. Examples include:

  • Prompting clinicians to schedule a follow-up with a patient in 2 weeks when they authorize a new opioid prescription.
  • Urging clinicians to ask patients to re-sign their controlled substance agreement after a predetermined period of time.
  • Reminding clinicians to order urine drug testing every 6 months.
  • Encouraging clinicians to prescribe naloxone to all patients with an opioid prescription ≥50 morphine milligram equivalents (MME) and/or are receiving long-term opioid therapy.

“We achieved our biggest victories when we put the default prompts into our EHR system.”

Ezekiel Fink, M.D., Medical Director of Pain, Houston Methodist
  1. Understand the problem. Rather than going to the solution first, understand the problem you are trying to solve and determine which 2016 CDC Guideline recommendations will help you achieve that solution. For example:
      • Are clinicians writing too many prescriptions for high-dosage opioids? Consider integrating 2016 CDC Guideline Recommendation 5 (“When opioids are started, clinicians should prescribe the lowest effective dosage …”).
      • Is the problem that clinicians are forgetting to prescribe naloxone to patients? Consider integrating 2016 CDC Guideline Recommendation 8 (“Clinicians should incorporate into the management plan strategies to mitigate risk, including considering offering naloxone when factors that increase risk for opioid overdose … are present”).

    Once you determine the problem, you can customize the CDS tools to focus on those recommendations needed to achieve the desired outcome. It is important to implement the recommendations selectively to know which ones will yield the best clinical results.

  1. Test the tools in the clinical setting. Once you select the CDS tools and appropriate solutions, test the tools in the clinical setting. Encourage clinicians and others in the continuum of care to provide feedback to ensure the tools are providing the decision support needed.
    • Consider coordinating with the clinical settings and staff who will utilize these tools, such as primary care physicians, nurses, and pharmacists.
  1. Determine the infrastructure needs to support the tools. To support the intended clinical practice changes, determine whether your health system has the necessary infrastructure, such as technology and team members, to support these tools. To ensure each tool is successful, be sure your infrastructure can support the ongoing integration and data management of the tool.
    • For technology, does your health system have the information technology support to troubleshoot software issues?
    • For team members, consider who will print out the treatment agreement for clinicians and patients to discuss and sign. Who will scan the agreement into the system? Who will train that person to ensure they upload the agreement into the right place? Who will help collect the urine samples for routine urine drug testing?

    The launch of these tools is only a preliminary event. For example, Houston Methodist saw a need for continued resources related to these tools for them to be successful.

Training Tip

Consider engaging clinical leadership early in the integration process.

Yale New Haven Health leveraged its opioid stewardship and clinical leadership channels for communication. Its clinicians were able to hear the clinical reasoning for these tools directly from leadership.

“Clinicians are most interested in hearing about the logic, workflow integration, and ease of use of the CDS intervention. The alert design is self-explanatory based on the feedback we got from our clinical leadership during the project feedback sessions.”

Nitu Kashyap, M.D., Associate Chief Medical Information Officer, Yale New Haven Health
  1. Provide regular trainings. While clinicians and other team members are getting acclimated to the tools, consider providing regular training workshops and education opportunities, sending weekly emails and reminders, and assigning a team member to provide e-consults for clinicians who may need additional support. Create a learning page or dashboard within the EHR that contains training information, education, and resources.
    • Consider using grand rounds for clinician education.
      1. For example, Stormont Vail Health System held three primary care grand rounds to educate providers. Topics included urine drug screening in chronic pain management, street drugs, and treating substance sse disorders in primary care.
  1. Refine as needed and be patient. Once these tools are integrated into your health system, continue to refine based on feedback to ensure these tools are providing the support needed to help clinicians with safer opioid prescribing. Utilization of these tools may be a long-term project. Flexibility is key to successful integration into the clinical workflow.
    • Consider creating a committee to regularly review the data and implement new changes as needed.
      1. For example, Houston Methodist created an Outpatient System Pain Committee consisting of primary care doctors and other senior leaders. The committee is actively involved in reviewing the data, implementing changes to the tool, and providing training.

“With careful consideration at each step, it can result in a user-friendly process with high provider engagement and safer prescribing practices for the community.”

Brandy Ficek, M.D., Medical Director, Palliative Medicine and Supportive Care, Stormont Vail Health
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