Palmetto Health is using analytics to access controlled substance data in real time from a state-run Prescription Drug Monitoring Program, which records a patient’s opioid prescribing history, to identify usage patterns and those patients that are at potential risk for misuse or abuse.
Called NarxCare from analytics vendor Appriss, the substance use disorder platform automatically integrates with Palmetto’s Cerner electronic health record system analyzing PDMP and EHR data to assess and manage patient risk factors.
Last year, South Carolina had the ninth highest rate of opioid prescriptions in the nation, with nearly five million opioid prescriptions filled in the state. And, since 2011, more than 3,000 South Carolinians have died from prescription opioid overdoses.
As the largest and most comprehensive integrated healthcare system in the South Carolina Midlands region, Palmetto—like other provider organizations around the country—is working to better manage and prevent substance use disorders, particularly addiction to opioids.
“It is a crisis in the United States, and it’s not going to get better if we don’t focus on it and put some real solutions into place,” says Tripp Jennings, MD, chief value and informatics officer at Palmetto Health. “For every single patient that we care for and pull up in the EHR, NarxCare automatically pulls from the PDMP and presents a score based on the number of active prescriptions and prescription patterns over a period of time.”
In addition to computing patient scores (000-999) based on a complex proprietary algorithm, factoring in numbers of prescribers, morphine milligram equivalents, pharmacies and overlapping prescriptions, NarxCare also provides an interactive visualization of usage patterns that help identify potential risk factors for overuse or abuse of narcotics, sedatives and stimulants, enabling clinicians to intervene early at the point of care.
While nearly every state has implemented PDMPs, not all states require providers to access these databases before writing a prescription. However, according to Jennings, South Carolina—with a few exclusions—has a “mandatory look-up” requiring physicians to consult the state-run database before writing prescriptions to make more informed prescribing decisions for controlled substances. “That is so effective,” he comments.
Nonetheless, Jennings points out that “before our state did a major revamp of our PDMP, we had very bad use rates because it was difficult to log in with a user name and password—it wasn’t that the providers didn’t want to go get the information, it was just a challenge.” That’s no longer an issue, he says.
Because NarxCare is integrated with Palmetto’s Cerner EHR and the PDMP, there’s no need for an extra log in or to re-enter patient data. Perhaps more importantly, the tool is readily available to clinicians as part of their daily clinical workflow.
“When you open up a patient’s chart, it automatically queries the PDMP and presents that information to you,” adds Jennings. “That has been huge from a time-saving standpoint and also takes it from being a task to being true clinical decision support to help make decisions.”
Further, NarxCare enables Palmetto staff to add critical patient data to the platform such as history of overdose, specific medication restrictions, caregiver support or other relevant clinical or social information, as well as display automatically generated clinical alerts triggered by customizable algorithms based on PDMP and non-PDMP data.
“As a clinician, you have a better idea of how to proceed with the ongoing care and prescribing decisions that you’re about to make,” says William Stadler, Cerner’s director and solution executive of behavioral health.
Cerner contends it has the first EHR system to integrate NarxCare (formerly called NARxCHECK) nationwide.
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