Overall strategy responding to the opioid crisis (in addition to PDMP integration)
Facing the complex, global opioid crisis, Cerner Corporation has a holistic strategy to support patients, practitioners and health systems in the mission to prevent and manage opioid use disorder. Though the industry has previously emphasized reducing opioid over-prescribing and access to prescription drug monitoring programs (PDMP) as keys to managing the opioid crisis, Cerner coach health systems on balancing the Three Pillars of Opioid Management:
- Opioid Safety – Tenaciously identify and mitigate risks of opioid use while utilizing evidence-based opioid prescribing practices
- Pain Management – Maintain excellence in pain management, support chronic pain populations with proactive connection with the right providers and services to manage their underlying disorders, and address variance in pain management
- Opioid Use Disorder – Tenaciously maximize patient engagement at every state in the Cascade of Care for opioid use disorder, and support care teams and providers with the training and resources they need to be successful in helping individuals manage their opioid use disorder
Achieving excellence in opioid management requires a strategic approach each of the Three Pillars with a focus on how the people, processes, and technologies support each other in a common mission. Though much focus has been given in the industry on “don’t do” clinical decision support, such as alerts to prevent prescribing of opioids beyond a certain number of days’ supply, Cerner Corporation is working with health systems and their providers to use technology to truly support clinical decision making.
For example, the Cerner Opioid Toolkit includes a collection of CDS to help providers identify person-specific risks prior to prescribing an opioid. It even includes analytical tools that go beyond prescribing rates to determine where opioid treatment agreements and proactive naloxone education can be used more effectively to mitigate patient risk. The opioid crisis is obviously complex, and while many providers feel a sense of duty to help, most are in want of resources that can help. A very simple place to start is to help providers know where a patient can go for treatment of their substance use disorder.
SAMHSA offers a free online treatment locator; which Cerner has integrated into EHR workflow using Cerner MPages technology so that providers can see up-to-date locations of different types of providers based on the patient’s preferred zip code for service.
Cerner Corporation – PDMP Strategy Survey
Though these provide a few examples of specific technologies supporting providers, it is important for health systems to not “throw the kitchen sink” at the problem of opioid misuse. No two states or health systems experience the opioid use disorder epidemic the same way. There are disparities in access to care for populations, differences in the prevalence of fentanyl in illicit sources of opioids, state strategies and community engagement. In 2018, Cerner created the Opioid Management Value Advisory to work in partnership with its clients, taking a data-driven, value-based approach to the opioid crisis. The methodology yields a sustainable process of continuous improvement in both preventing and managing opioid-related harm.
Overall approach to PDMP integration
- Point to point, hub and spoke
- No different than any other EHR – current options are limited. Cerner is connected to Appriss who connects to PMPi. Cerner currently support connecting to both WA and IL PDMPs which is a point to point connection.
- Where in workflow?
- General workflow integration. Workflows in Cerner can are configured Linearly and can be contextual to Role, Venue, and specialty. PDMP integration can be placed/ ordered right before or after the home medication list is reviewed and reconciled.
- EPCS
Other – for example: all encounters vs EPCS only
- Practitioner access to prescription drug monitoring programs is ideally part of EHR workflows to bolster utilization of the PDMP. When left to tediously access the PDMP via a state web portal, many a practitioner has confessed that they “look the patient up in the PDMP only if they look like a junkie”. This leads to under-identification of individuals engaging in opioid misuse since, for example, individuals with a substance use disorder may not have an appearance or demeanor that matches the practitioner’s conception and may, in fact, appear and be a high-functioning individual. The utility of PDMPs to the practitioner and the patient are improved by including PDMP access easily within common EHR workflows for providers who prescribe or manage opioid medicines.At a minimum, providers of primary care, pain medicine and emergency medicine should have access to PDMP data accessible prior to medication order entry and/or in relation to their medication reconciliation workflow. State law(s) and opioid prescribing guidelines should be consulted for additional guidance.
Plans and progress in interoperability with state PDMP’s
State-specific successes and challenges
- Cerner is working to connect all state and territory PDMP to allow for integration of the PDMP report inside clinical and prescriber workflows. Cerner was the first to connect EHRT to the Appriss API and first to have a Provider organization realize the benefits of workflow integration. Due to connection to Appriss, Cerner supports most states that support Appriss integration. Cerner also currently supports workflow integration of 2 states that do not support Appriss – WA and IL. Currently Cerner is working to connect to CA and other states that do not support Appriss integration. This has been a challenge due to lack of standards (API specifications and content format that is delivered.
Interoperability with Appriss.
- Formal agreement?
- Yes, Cerner Resales Appriss connectivity however recognizes no margin.
- NarxCare resale?
- Yes, same as above.
- Alternate risk model and analytics availability? Describe.
- Native development and/or 3rd party eg PastRx
- The component that launches the Appriss report is native Cerner Developed and supported. Appriss delivers HTML which is not modified merely launched in a window for clinical user to review.
- Direct link to PDMP?
- Connected to Appriss API. Also connect to WA API offered by OneHealthPort and IL via API supported by Logicoy
- Data import from PDMP? Describe.
- No, data from Appriss API is HTML and not delivered in discrete format like XCPDP. Report level saving is also not offered. Very few states allow saving of report so have not invested in capability although newer Appriss spec can deliver an alternative format that is more conducive to saving to EHRT.
Interoperability with alternate PDMP solutions
- Custom integration with state portal(s)
- WA through OneHealthPort.
- RxCheck/PDMP Assist
- No
- Logicoy –
- Yes, in IL
- HIE as link to Appriss or others.
- Other
Client case studies – include 2-3 representative client examples
- Atrium Health reduced prescribing rates for opioids and benzodiazepines after the implementation of EHR-based clinical decision support to identify person-specific risks of use.
- Cook County
- Intermountain Health Care reduced opioid prescribing rates by about 40% (compared to 2016 rate) through a combined effort of provider collaboration, implementing an opioid stewardship committee, and EHR-based clinical decision support.
Optional: Economic model in provision of these services to the provider client