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Opioid crisis: Many stakeholders, common themes, Part 2

Editor’s Note: The recent Modern Healthcare Opioid Crisis Symposium reflected the broad variety of perspectives needed to address this complex problem. Stakeholders included Baltimore’s Mayor, Police Commissioner and Health Commissioner, as well as business leaders, academics, clinicians, national policy experts, a former National Drug Czar, health system leaders and health information technology companies. Dr. David Hurwitz shares his thoughts on the themes that emerged in a two-part blog series. You can read Part 1 here.

Data was frequently discussed as crucial in helping to better understand local opioid prescribing patterns, opioid overdose rates and potentially to predict who may be at increased risk for chronic opioid use.

Baltimore’s Police Commissioner noted the importance of identifying in real-time opioid overdose “hot spots,” areas in which opioid overdose rates and deaths rapidly spike. Once identified, the police department rapidly deploys “boots on the ground” to investigate and determine how best to respond (e.g., shift treatment resources). This information is obtained from local hospitals, and is shared with the police and health departments.

Data also is crucial in helping health systems identify opioid prescribing patterns and address over-prescribing through education, ongoing monitoring and accountability, an approach used successfully to successfully reduce opioid prescribing by primary care physicians at University Hospitals in Cleveland.

Briefly mentioned was the use of machine-learning techniques that analyze large sets of data, which has the potential to help predict individuals who may be more prone to developing opioid-use disorder or chronic use of opioids. One recent study used electronic health record data to create a model that accurately predicted chronic opioid use in 79% of cases. Models such as this could be leveraged at the point of prescribing, providing clinicians with important information to help guide whether opioids are the most appropriate medication for pain relief.

Information sharing across disciplines is critical to a holistic response

Given the complexity of the opioid crisis and variety of stakeholders involved, information sharing is crucial. While state Prescription Drug Monitoring Programs (PDMPs) provide important data to identify individuals who may be “doctor shopping,” it provides a limited snapshot.

Within health systems, review of opioid prescribing data in the electronic health record across multiple prescribing points (e.g., hospital, emergency department, office) can help identify patterns of initiation and ongoing prescribing of opioids among various disciplines.

Data from other sources, such as a health information exchange (HIE) can provide opioid prescribing data from prescribers external to a health system (e.g., other health systems, independent medical practice, outpatient surgery centers, dentists) and add to the overall opioid prescribing picture. Especially important to clinicians is understanding patient context (e.g., reason other providers have prescribed opioids), which may be only available in clinical notes that could be accessed using a HIE.

As noted above, real-time opioid overdose and death data from hospitals provide invaluable information to local law enforcement as well as public health officials, who need to be nimble in their response to the opioid crisis.

Regional data can provide insightful context

Regional initiatives, such as The Northeast Ohio Hospital Opioid Consortium shared by Thomas Zenty, CEO of University Hospitals in Cleveland, highlight the broad base of stakeholders that need to come together to address the opioid crisis.

Regional initiatives could also serve as opportunities to combine data across an entire region (e.g., real-time opioid overdose and death patterns) that could inform efforts to address the crisis.

Overall, the symposium was extremely valuable, particularly hearing from those on the front lines of the opioid crisis, those in local government and law enforcement as well as experts with a national policy perspective. The challenges are immense, but I believe that the opioid crisis can be reversed with broad collaboration between local health systems and providers, government, public health, law enforcement  and with the help of health information technology.

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