DrFirst’s Nick Barger explains how the EHR data at the right time can prevent opioids from getting into the wrong hands.
While the debate on how to combat the infiltration and abuse of illegal narcotics in the U.S. languished for decades, something more sinister and formidable was growing. This new threat was not lurking in the shadows; instead, it was right under the noses and prescription pads of physicians— opioids.
The abuse of prescription opioids has now become a national public health crisis, which has been growing since the ‘90s: when physicians were prescribing medications that were thought to be effective for pain management with little risk of addiction. As a result, physicians prescribed opioids with false confidence at a frequency that ultimately proved to be fatal. It turns out opioids are, in fact, addictive and now seemingly pervasive.
According to the National Health Institute (NIH), more than 47,000 Americans died in 2017 as a result of an opioid overdose, including prescription opioids, heroin, and fentanyl: a potent synthetic opiate. Currently, more than 130 Americans die every day from opioid abuse.
The reality of opioid abuse is now well known. However, having the information to effectively treat patients and prevent future opioid abuse is an entirely different challenge—one that Nick Barger said his company DrFirst is facing head-on.
“We have the power to solve this problem,” said Barger, a principal pharmacist at the Rockville, MD-based medication management and e-prescribing solutions provider. “The number of opioid-related deaths is staggering. When you see patients, who are struggling to pay for their healthcare and are on opioids and in pain… sometimes there are more affordable and effective options for them. DrFirst is in a unique position to ensure providers are well-informed at the time of making a prescribing decision.”
The Dawn of Optimized Data
DrFirst has risen to the challenge by developing solutions that allow physicians to access pertinent data from prescription drug monitoring programs (PDMPs) via its electronic prescribing tools, which are directly embedded in the within EHR systems. As a result, prescribers gain access to relevant information in their e-prescribing workflow as well as PDMP data to ensure they are prescribing the appropriate drug. Additionally, the software automatically documents the fact that the doctor checked the registry.
Could something as simple as increased access to prescription data help reduce opioid abuse? According to Barger, such solutions are already showing promise. Last January, DrFirst deployed its solutions to help Nebraska become the first state to require pharmacists and pharmacies to report all dispensed prescriptions to its PDMP and provide that data to physicians.
“The registry requires the reporting of non-controlled substances, as well as controlled substances,” said Barger. “There were some challenges in getting all pharmacies to report all that information because it required some technical changes on the pharmacy side. However, as we look at Nebraska, it is a unique case study; in a relatively short period, providers gained access to the complete medication dispensing records of all their patients. Nowhere else in the country was that possible in such a seamless fashion.”
Barger said the process came with its share of challenges but that there was a great deal of feedback from physicians: “Was there work to do to get there? Absolutely. Was it smooth in terms of the overall landscape? Pretty smooth. It required work for pharmacies, and they did their part. Now we are starting to see benefits because physicians now have all the right information at the right time to make better decisions,” said Barger.
The adoption of state-wide PDMPs will undoubtedly continue to grow, but in the meantime, healthcare providers can start employing solutions to support decision-making for prescription management now. So, what does a successful solution look like? Barger said any effective PDMP solution should provide three essential elements: completeness of data, in-workflow decision support, and analytics.
“A well-informed provider has the best opportunity to have good conversations with their patients around their clinical care, including opioid use,” said Barger. “Providers are now gaining access to tools that allow them to use the PDMP to be well-informed, and have decision support, so they spend less time combing through records outside of their current workflows and spend more face time with the patient and deliver valuable care.”
In terms of how you go about finding a successful PDMP solution, it starts by looking at details of each specific state. In certain states, PDMP funding is available for providers that give them either a low-cost or no-cost in-workflow PDMP solution. There are many resources for finding out the different options available, said Barger.
On the Horizon
With the opioid epidemic at crisis level, all sectors of healthcare are becoming engaged to assist with devising solutions. The pharmaceutical industry is certainly working hand-in-hand with the FDA in managing, maintaining, and developing new strategies for programs. Barger said he sees quite a bit of emerging collaboration when you look at the entire healthcare landscape, including pharmaceutical, health IT, health systems, and individual providers.
At the state level, there has been a direct collaboration with pharmaceutical companies and some state PDMPs. Barger expects that trend to continue and believes that all facets of the healthcare landscape need to play a part in creating solutions. He is especially hopeful that the two-prong approach of in-workflow PDMPs along with EPCS (electronic prescribing of controlled substances) will work to keep providers well informed and limit a patient’s ability to obtain controlled substances for nefarious means.
When asked if he genuinely believes healthcare can help the U.S turn the opioid epidemic around, Barger said: “I am optimistic. Looking forward, the data will show that PDMP and EPCS do have a positive impact on the opioid crisis: a dual-pronged approach that makes it easier for providers to access and use these tools will go a long way. I am hopeful that the increased awareness of the problem and the available tools will also incite change,” he concluded.