From 1999 to 2016, more than 12,000 North Carolinians died from opioid-related overdoses, the North Carolina Department of Health and Human Services reports.
With more than 900 care locations and more than 14 million patient encounters annually, Atrium Health of North Carolina observes the devastating impact of the opioid crisis in its communities daily and felt compelled to respond to the challenge of treating opioid use disorder.
In 2017, Atrium Health created a taskforce to reimagine tools and resources that would help support safe prescribing of opioids—including stakeholders from medication safety, musculoskeletal, behavioral health, addiction and emergency medicine. In conjunction with this taskforce, researchers created the Prescription Reporting with Immediate Medication Utilization Mapping (PRIMUM) tool to offer real-time decision support at the point of care. This first-of-its-kind EHR alert proactively recognizes patients who may be at risk for misuse of the drug.
PRIMUM relies on clinical risk factors that are documented in the EHR in order to deliver automatic information to the clinical team. The prescriber selects the controlled substance, and the EHR then searches the patient’s chart for defined risk factors for opioid use disorder. In order to limit bias, the assessment and alerting focus on objective risk characteristics instead of subjective or anecdotal ones. PRIMUM notifies prescribers when patients are deemed potentially at risk based on the following criteria identified in the EHR:
- Current or past prescribed medications that can cause overdose when combined with opioids
- History of substance abuse
- History of drug overdose
- Previously testing positive for illicit substances
- History of early prescription refills
- High-range dose of narcotics prescribed
Additionally, PRIMUM is linked to state databases for controlled substances, allowing prescribers to view and manage pain contracts in a clinically consistent way. It also sends a notification reminding the clinical team to prescribe Naloxone, an opioid reversal drug, when patients are in high-risk situations for opioid use disorder.
Due to the new prescribing alerts in the workflow, more than 1,100 opioid and controlled substance prescriptions were prevented each month for patients with documented risk factors for prescription drug misuse and abuse. In the first three years, the platform has identified risk factors in 25% of patients—preventing more than 43,000 high-risk prescriptions for controlled substances system-wide.
Atrium Health has collaborated with the Centers for Disease Control and Prevention through a series of grants to help define risk factors for opioid use disorder, develop guidelines for best practice prescribing patterns, and understand how to operationalize those guidelines across the healthcare system.
HIMSS Davies Award of Excellence
The HIMSS Davies Award of Excellence recognizes the thoughtful application of health information and technology to substantially improve clinical care delivery, patient outcomes and population health. The Davies Awards program promotes HIMSS’s vision of better health through information and technology by recognizing and sharing use cases, model practices and lessons learned on how to effectively leverage information and technology to improve outcomes.
“Atrium Health has thoughtfully applied a variety of information and technology solutions to reduce the number of high-risk opioid prescriptions across their enterprise,” said Jonathan French, CPHIMS, SHIMSS, senior director of quality and value-based care at HIMSS. “Perhaps more importantly, these solutions become the foundation for identifying at-risk patients and driving them to care interventions to get on the road to recovery. For their thoughtful application of information and technology to improve the health of patients across North Carolina, HIMSS is proud to recognize Atrium Health with the Davies Award of Excellence."
“Solving today’s most pressing healthcare issues will require collaboration and divergent thinking,” said Eugene A. Woods, president and CEO of Atrium Health. “This is exactly why we’re so proud of this opioid alert platform and especially this recognition by HIMSS. This is just the start of incredible positive change, and in partnership with others, we can continue to bring health, hope and healing to this growing epidemic.”
Atrium Health will be recognized during the 2020 HIMSS Global Health Conference & Exhibition, which takes place March 9–13 in Orlando, Florida.
Read more stories from 2019 Davies Award winners:
- Hawai‘i Pacific Health Utilizes Virtual Solutions for Success
- Heritage Living Center Tackles Quality Measure Challenges
- Mackenzie Health Improves COPD Care Coordination
- St. Stephen’s Hospital: From EMR Implementation to Digital Integration
- Truman Medical Centers Reduces Patient Falls Through Remote Patient Monitoring