Modifying EHR Prescribing Settings Can Improve Prescribing Patterns

Optimizing EHR opioid prescribing default settings can boost prescribing patterns, according to a study published in JMIR Publications. Furthermore, reducing the duration of an opioid prescription and cutting down the quantity of pills could minimize the chance of opioid dependence and overdose.

The opioid epidemic continues to be a significant issue across the United States. According to HHS, over 70,000 people died from a drug overdose in 2019, and over 10.1 million people misused prescription opioids throughout 2019.

Increased chronic opioid use is linked to higher doses and longer opioid therapy durations. To combat the opioid epidemic, clinicians can reduce prescription rates. Health systems can also leverage prescription drug monitoring programs (PDMPs) and computerized provider order entry (CPOE) systems to reduce prescribing rates and simplify the prescribing process.

To reduce opioid quantities and reduce overprescribing, the research team evaluated the default Epic Systems EHR prescription settings at Thomas Jefferson University Hospitals. The health system’s CPOE consists of four opioid prescription entry fields: dose, frequency, duration, and quantity.

Researchers aimed to determine if the opioid prescribing preset modification could change a health system’s prescribing patterns. The research team analyzed a 24-month period before and after the changes. Researchers examined tablet quantity, duration in days, and prescription proportion more significant than 90 morphine milligram equivalents per day for the health system.

The research team modified the EHR in three ways:

• Required duration of treatment for an opioid prescription
• Added a quick button for three-day duration while removing others
• Set the default amount of all oral opioid formulations to ten tablets.

Research revealed a significant reduction in treatment duration, tablet quantity dispensed, and prescription proportion greater than 90 MME per day for all opioid prescriptions. Median postintervention treatment for all opioids dropped from 10 days to 7.5 days.

Oxycodone, which accounted for over 60 percent of the health system prescriptions, encountered reductions in all metrics, while tramadol, codeine, and hydromorphone had declines in at least one metric.

Modifying the default settings is a relatively effective and straightforward way to combat the opioid epidemic, the study authors said. The research team also noted this was the first study to effectively demonstrate overall opioid prescribing reduction for an entire hospital system.

“Our hospitals and ambulatory clinics are located in one of the most lethal counties in one of the most lethal states associated with the opioid epidemic,” wrote the study authors.

“The CDC estimates that the risk of chronic use of opioids is 13.5% after 8 days of treatment and the World Health Organization estimates the annual rate for opioid-dependent individuals overdosing at 45% and death at 0.65%,” the study authors continued. “We reduced our median duration of treatment from 10.5 to 7.5 (6 days for oxycodone), thus potentially bringing more than half of our institutions’ opioid prescriptions below this high-risk threshold.”

The researchers estimated that Thomas Jefferson Hospitals reduced nearly 40,000 opioid tablets from being prescribed per month. This method could lead to roughly 475,200 fewer pills per year. This method could also potentially reduce the tablet number across the country by over two billion, the research team said.

“Our intervention excluded prescriptions for chronic pain, thus these approximations are likely extreme, but even a small percentage of these estimates is a net large and clinically important reduction in opioid tablets,” the study authors wrote.

“Significant reductions in the number of opioid tablets prescribed, durations of treatment, and doses greater than 90 MME/day can play an important role in curbing the epidemic, improving quality of care, and ultimately saving lives.”

Through pre and post-analysis, the research team concluded that modifying the health system’s EHR settings could improve prescribing practice patterns, reduce the number of pills dispensed, cut treatment duration, and lower the number of prescriptions greater than 90 MME per day.

“Reduction in opioid prescribing may aid in curbing the opioid epidemic, thus improving quality of care and potentially saving lives,” the study authors concluded.