HIMSS EHRA Blog
The COVID-19 crisis started to consume the United States just as it had been turning the corner on the most severe chapter of the opioid crisis. Opioid prescribing rates and drug overdose rates both remain distressingly high, and some patients on opioids are more vulnerable to impacts from COVID-19. At the same time, for patients with severe chronic pain, opioids are clinically indicated, and provide meaningful relief from a life of constant pain that could otherwise be debilitating. For these individuals, prescribers are often challenged with adhering to CDC guidelines and state laws that limit opioid use while effectively treating pain, and this is especially true for patients who have been treated with higher doses of opioids for extended periods of time.
The EHR Association’s Opioid Crisis Task Force has written a white paper to comment on the role that health information technologies, including EHRs, can play in assisting physicians with responsible opioid tapering.
What is Opioid Tapering?
Opioid tapering represents the process of gradually reducing opioid dosages according to a tapering plan, while monitoring for and mitigating side effects and meeting the patient’s pain management needs through non-opioid therapies. When indicated, tapering involves dose reductions of anywhere from 5% to 20% every four weeks. Opioids should not be tapered rapidly or discontinued suddenly due to the risks of significant opioid withdrawal. Opioids may be tapered down until complete discontinuation, or reduced to a safe maintenance level.
How Can Health IT Help Providers with Appropriate Opioid Tapering?
The EHRA white paper notes that each organization should first have an opioid stewardship program firmly in place, and that it makes optimized use of the EHR. EHRA previously developed an EHR implementation guide for existing CDC Guideline for opioid use, suggesting ways to implement all 12 CDC recommendations.
Once a program is established, additional electronic tools can be leveraged to assist providers with opioid tapering, including:
- Morphine Milligram Equivalent (MME) calculations
- Generation of tapering schedules and special instructions attached to medications
- Clinical decision support that promotes non-opioid and non-pharmacologic therapy alternatives
- Specialized physician notes to track tapering progress
- Screening Assessments for withdrawal symptoms
- Evidence-based order sets to manage side effects, and initiate substance use disorder treatment or address other major decompensations if indicated
- Ongoing education for the patient, their family and their caregivers
With the opioid crisis still unresolved and the COVID-19 pandemic making patients more vulnerable to opioid misuse, the need is urgent for the digitization of the opioid tapering plan, and organizations can act now to create, develop, and implement this solution. In the future, there are many exciting new frontiers in EHR development that can advance this process and can help providers to balance safer, evidence based, and equitable use of opioids with patient-centric care plans.