In an effort to combat Connecticut’s ongoing opioid overdose crisis, Yale New Haven Health and the Yale School of Medicine have partnered with the state to better facilitate the retrieval of essential patient information.
The collaboration will integrate the hospital’s patient electronic health record system with patients’ prescription histories, which are recorded in the Connecticut Department of Consumer Protection’s Prescription Drug Monitoring Program. According to the medical school’s chair of emergency medicine Gail D’Onofrio, the initiative gives the provider more information about a patient and the safety of prescribing opioids and other controlled substances. These include other co-prescribed medications — such as benzodiazepines like Valium and Xanax — that may contribute to overdose.
“Yale New Haven Hospital is the second medical institution in the state to integrate their electronic health record with the Prescription Drug Monitoring Program, and we expect to see more institutions join them in the future,” said Michelle Seagull, the commissioner of the state Department for Consumer Protection. “This accomplishment allows prescribers to see a patient’s prescription history at the point of care, allowing prescribers to use their time more effectively and spend more time with patients.”
The Prescription Drug Monitoring Program, or PDMP, was a system created in 2013 to collect prescription data for controlled medications. The goal of the program was to help prescribers see a more complete picture of their patients’ medical history in order to make the best health care decisions possible, Seagull said.
In 2015, checking prescription histories using PDMP was made mandatory statewide in order for physicians and prescribers to write a prescription for more than three days. This system, however, led to hassles due to the need for physicians to refer to a separate website, which disrupted their workflow, according to Allen Hsiao, chief medical information officer and professor at the medical school.
Hsiao added that not only was the process of checking PDMP time-consuming, but many physicians would forget the separate login information. As a result, many physicians were reluctant to prescribe any controlled medications. They would either prescribe the medications for a two-day period or choose to refer the patients to their primary care doctors, Hsiao explained.
D’Onofrio noted that these obstacles in the prior system may have left providers at risk of not complying with regulatory requirements and negatively influencing patients’ care. For example, a more long-term prescription may be better for a patient, and referral to another physician may have kept the patient in pain for a longer time, Hsiao said.
“When doctors can get a clearer picture of a patient’s history at the point of care, they’re able to make sure that their patients are getting opioids or other controlled substances when they need them,” said Lora Rae Anderson, the communications director for the Department of Consumer Protection.
The project took about six months, in which a 20-person team worked with the state and with Appriss, the company that produces the program for PDMP.
Now, in the hospital’s electronic health record for each patient, the banner with all basic information — such as name, date of birth and allergies — also has a Narx Score, a composite score giving an overview of their narcotic and controlled medication history.
The Narx Score rises based on the patient’s history of prescriptions and of provider and pharmacy visits. Clicking on the score will then bring the physicians directly to the patient’s record in the PDMP, where they can view complete details, according to Hsiao.
“We’re making it easier for the doctors to do the right thing to take care of patients within their workflow, save them time and help keep our patients safer,” he said.
The information will also help providers identify patients with patterns that suggest an opioid use disorder and then assess and offer treatment engagement when appropriate, according to D’Onofrio. Providers can see if multiple physicians are prescribing opioids for the patient, which may result in risk for overdose.
Hsiao said that the system has been a welcome change for physicians that have started to use the system, noting the need to inform all physicians of the new system.
“The challenge is always communicating improvements to our physicians across our six hospital campuses and hundreds of ambulatory sites, but we are working on educating everybody,” Hsiao said.
According to Anderson, YNHH is the second hospital in the state to implement this integrated system, after the Connecticut Children’s Medical Center achieved a more basic level of integration last spring.
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