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Christopher Jason

Only 22 percent of prescribers located within a high opioid prescribing area had PDMP EHR integration that allowed efficient prescribing oversight.

Hospitals located in areas with high rates of opioid prescribing were less likely to have prescription drug monitoring programs (PDMPs) integrated into the EHR, which limits the impact of PDMPs in these vital areas of the country, according to research published in JAMA Network Open.

A PDMP that is implemented into the EHR can decrease the strenuous process of checking the PDMP, which as a result, can reduce the cognitive workload and clinician burden.

However, EHR-integrated PDMPs are not particularly widespread.

PDMPs are state-run electronic databases that create a record for the patient so that healthcare providers can access the PDMP to understand a patient’s full prescription drug history.

A PDMP aims to enhance prescribing rates, mitigate the risk of opioid abuse or fraud, and target treatment to at-risk patients.

With opioid overdose rates quadrupling between 1999 and 2015, the opioid epidemic has shown no signs of stopping. However, an easy to use PDMP could help clinicians slow down the epidemic.

While study authors noted increased awareness surrounding PDMP usability, there have been limited studies about PDMP adoption and EHR integration.

Additionally, hospitals located in counties with high opioid prescribing rates may benefit more from PDMP EHR integration, due to the providers being in contact with more people who are prescribed opioids.

Researchers evaluated the number of hospitals located in counties with high opioid prescribing rates, compared to other hospitals closer to the mean opioid prescribing rate, and the level of PDMP EHR integration at those hospitals.

Researchers analyzed data from over 3,500 hospitals that took the American Hospital Association Annual Survey and IT Supplement for 2018. Using this data, researchers wanted to answer three PDMP-related questions: the ability to e-prescribe, the ability to conduct a PDMP query within the EHR, and PDMP EHR integration.

Along with those three questions, researchers gauged hospital data, such as size, rurality, region, system membership, and teaching status to identify whether or not each hospital was located in a high opioid prescribing county based on 2017 prescribing rates.

Of the 3512 hospitals, 639 were located within a county with a high opioid prescribing rate.

However, the 2,873 hospitals in other counties were more likely to be able to e-prescribe than the hospitals located within a high opioid prescribing county. Only 57.3 percent of those high prescribing hospitals could e-prescribe, compared to 65.2 percent of other hospitals.

Only 10.8 percent of hospitals located within counties with high prescribing rates had PDMP EHR integration, compared to 15.1 percent of other hospitals.

Finally, while EHR-based PDMP queries were lower across the board, only 22.1 percent of hospitals with high prescribing rates had that capability, compared to 30.3 percent of other hospitals.

While over half of hospitals with both high and normal prescribing rates had the ability to e-prescribe, the majority of hospitals were unable to integrate PDMP data into the EHR, and thus were unable to query from within the EHR. If a PDMP is not implemented directly into the workflow, it is not unusual for a query to take up to seven minutes to process, putting a major strain on clinician workflow.

Hospitals located in counties that needed these capabilities the most, were unable to fully maximize the benefits of an EHR-integrated PDMP.

“Physicians and policy makers are actively considering new strategies to manage the opioid epidemic,” concluded the study authors.

“Focusing efforts on hospitals in areas with high rates of opioid prescribing to build PDMP integration into their EHR may be associated with improved PDMP effectiveness and reduced prescriber administrative burden.”