Opioid use disorder and opioid-related overdoses continue to devastate communities and families across the U.S. In Massachusetts last year, the severity of the crisis prompted policymakers to enact legislation to set limits on opioid prescriptions and to establish services to identify high-risk individuals.
To support this legislation and develop additional best practices, Partners HealthCare created the Opioid Steering Committee, which includes representatives from the Brigham Comprehensive Opioid Response and Education (B-CORE) program at Brigham Health.
A major component of this initiative has been the development of new functionality in Partners eCare to help providers document a patient’s history with opioids, educate patients about potential risks associated with opioid use and evaluate a patient’s risk factors for developing a substance use disorder. Brigham Health providers can use these tools to easily view opioid-related patient information, remain aware of compliance requirements and document patient conversations regarding the appropriate use of prescription opioids.
Safe opioid-prescribing practices are fundamental to mitigating opioid abuse in our community, said Scott Weiner, MD, MPH, of the Department of Emergency Medicine and director of B-CORE.
“This crisis is affecting the entire country, and Massachusetts is definitely no exception,” Weiner said. “As a group, we spent a lot of time thinking about how we can make opioid prescribing more uniform and evidence-based across the institution. We found that there are a lot of ways that Epic can help us achieve this.”
Brigham Health has adopted the Massachusetts Health & Hospital Association’s guidelines for opioid management in a hospital setting, developed by the association’s Substance Use Disorder Prevention and Treatment Task Force. In addition, B-CORE has developed prescribing guidelines for treating acute and chronic pain.
Clinical Opioid Medication Management Agreements
At the Brigham, patients being prescribed clinical opioids for more than three months – defined as chronic users – and their providers are expected to sign the Opioid Medication Management Agreement, a consent form developed for standard use across Partners. The Opioid Medication Management Agreement is designed to make patients aware of the goals, benefits and risks of opioid prescriptions.
Documentation in eCare
Sound documentation gives Partners providers visibility into the use of opioids among our patients, in order to promote safer, more effective use of these medications.
Opioid Documentation Activity (SmartForm) – The Opioid Documentation Activity will form the basis of a Partners-wide opioid registry – a central, one-stop location where information regarding a patient’s chronic opioid therapy can be documented. The opioid registry will be populated only if information is entered by the provider. This Opioid Documentation Activity is available across many applications and care settings. The information will be saved and available for future review and update.
Opioid Documentation SmartPhrases – Two SmartPhrases have been created for providers to incorporate into their documentation when prescribing an opioid medication. The first documents that the provider has written an opioid prescription, checked the state’s prescription monitoring program, known as MassPAT, and informed the patient about the option to fill the prescription at a lesser quantity. The second, for use in the Patient Instructions section of the After Visit Summary, documents that the provider has discussed with the patient the potential risks of an opioid prescription and the option to partially fill the prescription.
Partial-Fill SmartPhrases – These SmartPhrases can be used to document in eCare and on printed prescriptions that the patient may request a partially filled prescription. They can also be used to note that non-opioid alternatives were considered but deemed inappropriate or inadequate. These SmartPhrases enable providers to comply with the state opioid-prescribing law.
Substance Use Disorder Evaluation (SUDE) Workflow – This workflow allows mental health providers and social workers to more easily document their consults related to a patient’s risk factors for opioid addiction.
Information about the benefits, risks and safe use of clinical opioids is fundamental to preventing opioid abuse and is automatically provided to any patient prescribed opioids. The Prescription Opioid Handout is included in the After Visit Summary for patients who have just been prescribed an opioid.
Click here for more information on how to use these tools within eCare and to learn more about the Partners Opioid Steering Committee.
Providers with questions about Epic opioid prescription functionality should reach out to Scott Weiner, MD, MPH, at firstname.lastname@example.org.
In addition, the Partners Employee Assistance Program is available to aid any staff undergoing personal or professional challenges.