CDS EHR Integration Aims to Reduce Postoperative Opioid Use

An EHR integration at Baystate Medical Center (BMC) in Massachusetts aims to reduce postoperative use of opioids through interoperable clinical decision support (CDS).

One of the risk factors for continued opioid use is the postoperative prescription of opioids intended to be used only for a brief period, according to an HL7 case study that outlines BMC’s recent CDS project.

Studies have found that minimizing total Opioid Morphine Milligram Equivalents (MMEs) administered post-operatively correlates with reduced length of stay, costs, incidence of respiratory depression, and risk of opioid dependency.

However, calculation of in-hospital opioid use is burdensome, as it requires sorting through a variety of EHR data sources. Also, since opioids come in various forms and potencies, monitoring actual intake is time-consuming.

The medical center worked with health IT vendor Elimu Informatics to develop a SMART on FHIR application that embeds directly into its Cerner EHR to aid clinicians in monitoring patients’ opioid use.

The Sapphire Opioid MME Monitor app allows the care team to view opioid orders and total MMEs administered efficiently. The app also accounts for opiates administered via patches and pumps and calculates total actual administered opioids, including orals, injectables, and transdermals.

The FHIR-enabled EHR integration automatically calculates daily opioid intake in seconds. It provides a graphical timeline of daily 24hr MME, paired with pain scores and hospital events, alongside all ordered opioid and non-opioid analgesics.

The cardiac surgery service and pharmacists at Baystate Medical Center use the MME app during rounds with approximately 25 patients per week.