How Health IT Tools are Working to Reduce the Prescription Opioid Epidemic | Healthcare Informatics Magazine | Health IT | Information Technology Skip to content Skip to navigation

How Health IT Tools are Working to Reduce the Prescription Opioid Epidemic

August 30, 2017
by Heather Landi
| Reprints
Click To View Gallery

U.S. President Donald Trump earlier this month vowed to declare the U.S. opioid crisis a “national emergency,” pledging to commit more funding and attention to the issue. And, while President Trump has yet to officially declare a state of emergency, a move that could help remove barriers and would enable the federal government to devote more funding to address the drug epidemic, healthcare organization leaders have been trying to combat the worsening opioid epidemic for several years now.

According to the Drug Enforcement Administration (DEA), deaths from prescription drug abuse have outpaced those from cocaine and heroin combined in the last 14 years. According to the Centers for Disease Control (CDC), overdose deaths involving prescription opioids have quadrupled since 1999. Further, the CDC reports that, today, nearly half of all U.S. opioid overdose deaths involve a prescription opioid. In 2015, more than 15,000 people died from overdoses involving prescription opioids. What's more, each day, more than 1,000 people are treated in emergency departments for not using prescription opioids as directed.

Many healthcare and health IT organizations have called for increased use of prescription drug monitoring programs (PDMPs) and for federal leaders to ensure that PDMPs are interoperable across state lines, in order to reduce instances of prescription drug and opioid abuse and addiction. Last year, Health IT Now wrote a letter urging the U.S. Food and Drug Administration to leverage health IT tools, in combination with physician education and training, to combat the opioid crisis.

While education and training for healthcare providers is one tool that the FDA has, Health IT Now said that training will be “reinforced and exponentially more effective when that education is paired with comprehensive and real-time data of the patient’s controlled substance prescription history. “In order for those pieces to coordinate, PDMPs need to be interoperable across state lines, real-time and within the workflow of prescribers and dispensers.”

A report from Shatterproof, a national substance use disorder prevention organization, released a report back in March that found that PDMPs can be an effective and valuable tool to help identify and prevent prescription drug misuse. However, in most states, prescriber participation is very low, which compromises the effectiveness of the clinical tool. That report called on state legislatures to require doctors to use state-run databases to track patients’ history of opioid and sedative prescriptions in an effort to address the growing opioid abuse problem in the U.S.

Webinar

Experience New Records for Speed & Scale: High Performance Genomics & Imaging

Through real use cases and live demo, Frank Lee, PhD, Global Industry Leader for Healthcare & Life Sciences, will illustrate the architecture and solution for high performance data and AI...

Health information exchange (HIE) organizations throughout the country also are taking steps to enhance data exchange specifically in the area of prescription information to help providers address opioid misuse and abuse. As an example, the Nebraska Health Information Initiative (NeHII), a statewide HIE, and the Nebraska Department of Health and Human Services, are taking steps to capture state prescription information and deliver it to Nebraska’s enhanced PDMP. According to NeHII, the inclusion of complete prescription data in the PDMP database enhances patient safety and helps combat the abuse of opioids by giving providers and pharmacists a more complete picture of a patient’s medication history, allowing opioid use to be addressed in the overall context of the patient’s care plan while also highlighting diversion or other patterns of abuse.

Beyond PDMPs, many healthcare provider and payer organizations are looking to leverage advanced health IT tools, such as data analytics and predictive modeling, to identify risk factors that can put patients at high risk for a prescription opioid overdose or addiction in order to intervene before an adverse event occurs.

Virginia Premier Health Plan, a managed care insurance organization owned by VCU Health and based in Richmond, Va., plans to implement a newly developed predictive analytics tool that predicts a patient’s likelihood of experiencing an overdose. The tool, called the Venebio Opioid Advisor (VOA), was developed by Venebio, a Richmond-based life sciences consultancy.

The company conducted numerous published opioid studies, with the support of the National Institute on Drug Abuse (NIDA) of the National Institutes of Health (NIH), and, as a result of that research, researchers were able to identify the most common risk factors associated with an opioid overdose and developed predictive algorithms that can predict the likelihood of a patient experiencing an unintentional overdose from a prescription opioid.

Barbara Zedler, M.D., Venebio’s chief medical officer and a lead researcher on several of the studies, says many unintentional overdoses occur not because of excessive dosage, but from other factors like age, concomitant medications and pre-existing health conditions that can increase the risk of certain individuals treated with prescription opioids. The risk-screening tool analyzes these risk factors and predicts a patient’s likelihood of a life-threatening opioid overdose.

“It is tragically ironic that prescription opioid overdose deaths have increased nearly four-fold to almost 50 per day in a time when we have all the data we need to effectively target at-risk patients and address their personal risk factors,” Zedler says “With VOA, we can leverage data that already resides in virtually every electronic medical record (EMR) system and in every payer’s claims data warehouse to identify even hard-to-find patients at risk and help reduce their risk of a prescription opioid overdose.”

Venebio’s tool, VOA, is a clinical decision support tool that quantifies a patient’s likelihood of experiencing a life-threatening overdose from a prescription opioid, determines a personalized risk factor profile for each patient and provides clinicians with individualized guidance regarding interventions to reduce the patient’s risk of overdose. Speaking to the development of the predictive tool, Zedler says, “As a physician, I wanted to be sure [the tool] was very practical, quick to operationalize and could be done right there at the point of care by a physician or other healthcare professional.”

Zedler says Venebio has conducted retrospective validation studies in populations as large as 18 million opioid users and has published four peer-reviewed studies, two of which demonstrate VOA’s ability to predict with 90 percent accuracy the likelihood of a patient experiencing an unintentional overdose from a prescription opioid. Initial adopters of the VOA include health plans and Medicaid-managed care plans in Virginia and New York. The company also is working with an EMR vendor to integrate the tool into its EMR software.

Virginia Premier Health Plan serves about 200,000 members in more than 100 Virginia counties and operates as a Medicaid plan as well as a plan for people are dually eligible for both Medicaid and Medicare. Javier Menendez, vice president, pharmacy operations, Virginia Premier Health Plan, said the organization is currently using analytics tools to identify patients at risk for opioid addiction in order to intervene and connect those patients to needed services. However, he notes that the organization’s current tools are more retrospective, while the VOA offers more sophisticated clinical predictive algorithms.

“For us, it’s all about data integration from a clinical perspective to tie in all the different data claim entry points, like hospital, medical, labs, pharmacy and, through all those, put together our target of finding people at risk for opioid addiction. That may include people that have had previous claims for overdose, or abuse or toxicity. And, in addition to above average utilization or what would be considered high utilization of these controlled substances, we put those two together, and we pretty much know that this person is at high risk for this. And, then we see what we can do to intervene to prevent the addiction, or even to engage to connect the patient to recovery services,” he says.

He continues, “Patient safety is our highest priority, and the risks associated with prescription opioids, at any dose, are substantial. This [VOA] tool will give us an earlier point of intervention to identify those patients that are at risk through some predictive modeling. The Venebio Opioid Advisor offers us the best option available to identify those patients at risk of a prescription opioid overdose and take preventive action before any harm can occur.”

Many physicians already are using predictive screening assessments, where patients are asked about factors in their histories known to be associated with opioid abuse, in an effort to offset addiction risk. However, asking questions has its limitations. Some healthcare IT leaders contend that natural language processing (NLP) technology can be used to find patterns in patient data that point to opioid abuse risk.

NLP is a technology that allows providers to gather and analyze unstructured data, such as free-text notes, and NLP technologies are gaining traction in healthcare as there is an explosive growth of unstructured clinical data available in electronic health records. By leveraging NLP technology text mining, physicians and clinicians may find risk factors for opioid abuse hidden in unstructured data, Elizabeth Marshall, M.D., director of clinical analytics at Linguamatics, a U.K.-based NLP-based text-mining software provider, says.

“With regard to addiction and mental health, it can be difficult for general physicians, such as family practice physicians, especially out there in rural areas, to actually capture information that indicates that a patient is at risk. They are probably asking the right questions, but they might not be asking these questions all within the same visit with the patient. It’s a matter of collecting this information, throughout the timeline of the patient, and if you apply natural language processing and use a predictive model, like the opioid risk tool which has already been validated, you can find information throughout the patient’s timeline that is specific to that risk tool,” Marshall says, referring to the screening tool available at drugabuse.gov that can be used with adult patients in primary care settings to assess risk for opioid abuse or misuse.

“When it comes to technology and NLP and artificial intelligence, I don’t think we should remove the human factor, but it can enhance our capabilities as humans,” she says.

 


The Health IT Summits gather 250+ healthcare leaders in cities across the U.S. to present important new insights, collaborate on ideas, and to have a little fun - Find a Summit Near You!


/article/analytics/how-health-it-tools-are-working-reduce-prescription-opioid-epidemic
/article/analytics/vcu-health-motto-god-we-trust-everyone-else-must-bring-data

VCU Health Motto: ‘In God We Trust; Everyone Else Must Bring Data’

October 19, 2018
by David Raths, Contributing Editor
| Reprints
CMIO Colin Banas, M.D., talks about winning 2018 HIMSS Davies Enterprise Award

VCU Health System in Virginia was recently named a 2018 HIMSS Davies Enterprise Award recipient for leveraging health IT to improve outcomes. Colin Banas, M.D., the health system’s chief medical information officer, said the organization prides itself on using data to improve patient outcomes. “I am reminded of a quote from one of our senior leaders,” he said. “She even puts it at the bottom of her meeting minutes. It says, ‘In God we trust. Everyone else must bring data.’”

HIMSS cited three use cases that demonstrate VCU Health’s commitment to using data and technology to improve outcomes. The first is an Enhanced Recovery after Surgery (ERAS) protocol that improved colorectal surgery outcomes.

As VCU redesigns processes such as this, technology is always one of the last steps.   “When you sit in on these meetings, they are not going to talk about tech solutions for the first two months,” Banas said. “We stress the mantra of people, process and then technology. In a 7-stage flow chart, you don’t see technology until stage six and seven.” Once a team is identified and a standard of care is spelled out, then they turn back to IT and figure out how to hard-wire the changes into the electronic health record.

Because the VCU mascot is a ram, Banas said, the “ninja swat team” that works on process improvement projects is called the RAM Care team. RAM stands for reliable, appropriate and measurable. “We try to remind people that the RAM Care team is not just implementing order sets,” he said. There are five stages of people and processes first and then technology, including decision support and dashboards. “The way to drive variation out of a lot of these care processes is to be data-driven and consensus-driven,” he said. “That is what RAM Care really does – it is all about reducing variation.”

The other efforts HIMSS highlighted involved new tools that streamlined the patient discharge process and automated documentation tools that reduced catheter-associated urinary tract infections (UTIs).

Banas says it is an exciting time to be a CMIO. “We are getting out of the doldrums of regulatory reform and meaningful use, and ICD-10 sucking up all the oxygen, and we are starting to get better tools and better interoperability platforms to start doing innovative things,” he said.  He pointed to SMART on FHIR and open APIs as allowing users to do new things.

VCU Health is a client of Cerner, which has an Ignite API engine. “We have one SMART on FHIR app, Visual DX, and we have just signed the paper to allow the Apple health record beta for VCU Health, so our patients will be able to link their portal data to the native Apple experience,” he said. Cerner is creating its own app store. “Some are free and others have a cost, but it is exciting,” Banas said. “A lot of these people are solving things that have really bugged us and Cerner for quite some time, and they have done it way better. Kudos to Cerner for opening up and allowing other people in this space. They openly acknowledge that some of the things people are developing are in direct competition to core functionality they try to sell to their clients. Competition is good.”

 

 


More From Healthcare Informatics

/article/analytics/how-data-driven-approach-can-bolster-fight-against-opioid-abuse

How a Data-Driven Approach Can Bolster the Fight Against Opioid Abuse

October 12, 2018
by Steve Bennett, Ph.D., Industry Voice
| Reprints

I want to tell you about Andy. Andy’s mom, Pam, is a colleague of mine. Growing up an only child, Andy was a happy kid. He was a straight-A student, loved to play the violin, and spent a year as an exchange student in Europe. Andy had two loving parents. But Andy suffered an injury in college, and needed to have some minor surgery performed to repair his sinuses. Following that surgery, his doctor prescribed opioid pain medication for him, to which he became addicted. Despite several years of effort, Andy was unable to shake the addiction, and tragically lost his life to a heroin overdose two years after his surgery. This was a normal kid with a normal family, like mine, and like yours.

Andy’s story is an important story. The opioid epidemic has led to the deadliest drug overdose crisis in the history of the United States, killing more than 64,000 people in 2016 alone – the last year numbers were available. This is a true national epidemic, and one that continues to get worse. For the first time in nearly 60 years, life expectancy for Americans has dropped for two years in a row due to the opioid epidemic.

The opioid crisis has been so difficult to curtail, in part, because of the inability to integrate data from various stakeholders and systems. With so many players and data sources, today’s information is partial, fragmented, and often not actionable.

While this disconnect applies directly to the opioid epidemic it is a systematic problem that affects the healthcare community at large. Better data and analytics can help develop better treatment protocols for a wide array of medical and public health challenges that affect the general public. For opioids, that could be to develop better pain management programs or for better, more-targeted remediation and rehabilitation for those that become dependent on drugs.

A Data-Driven Healthcare Approach: Making Information Real

Webinar

Experience New Records for Speed & Scale: High Performance Genomics & Imaging

Through real use cases and live demo, Frank Lee, PhD, Global Industry Leader for Healthcare & Life Sciences, will illustrate the architecture and solution for high performance data and AI...

Ample data has been collected on the opioid epidemic, but disparate sources are not communicating with one another. Addressing this disconnect and lack of communication is something that can provide researchers, lawmakers and the public with improved insights.

Data-driven healthcare can help provide this guidance by using available data and analytics to help create programs that can make a tangible difference on population areas that need the most help. By looking at the data, lawmakers, hospital administrators and doctors can begin to make impactful changes throughout the system.

While much can be learned from this data, most of it is not being analyzed in a way that brings true benefits. It has been put in a silo and/or it is not organized in a way that is interoperable with other data systems.

The 21st Century Cures Act, which established the Health Information Technology Advisory Committee, shows the commitment of national leaders to improving healthcare information sharing. Analytics can take this data and turn it into something real. Subsequent visualization of this analyzed data presents the information in a way that can truly tell a story, making sense of data that analysts sometimes miss. Analytics can arrange and organize data in different ways and pick up previously undetected trends or anomalies. This information can be turned into real programs that produce real outcomes for those affected.

The data management and integration process can also help us understand where our knowledge gaps are, revealing flaws in data quality and availability. Organizations may learn that they lack sufficient data in a certain area where they want to learn more, but are currently limited. They can then make changes to data collection efforts or seek out different sources to fill these larger gaps. They can resolve data quality issues across systems and arrive at a consistent, reliable version of the truth.

As organizations get better at assembling and managing the data, automating processes to generate standard reports and file exchanges can ease the burden on analysts. Streamlining the user interfaces for prescription drug monitoring programs and other systems allows analysts and medical informatics staff to spend less time working on the data itself and more time enabling and encouraging the use of predictive modeling and “what-if” scenario capabilities.

Helping to Solve a Problem

The national opioid epidemic is a terrible and complex issue. It is not something that can be solved with just one action, approach or program. It is a layered issue that will require systematic changes to how patients are treated and how the healthcare system operates. Some of the nation’s best continue to work on providing operational solutions to these problems, but as the statistics show, they need more help.

A data-driven approach can be that help. Using data analytics to find better and deeper insights into the root problems of this epidemic can help decision-makers make real change. While opioids are the focus now, there will come a day when a new problem emerges. Having data and analytic solutions in place can prepare these organizations to tackle these future challenges as well.

64,000 people died in 2016 as a result of opioid abuse. But 64,000 is more than a large number – it’s also Andy and his family. With analytics and a data-driven approach, government and healthcare leaders can make better decisions that can help people in need.

Steve Bennett, Ph.D., is the director of SAS' global government practice. He is the former director of the National Biosurveillance Integration Center within the Department of Homeland Security


Related Insights For: Analytics

/article/analytics/doj-approves-cvs-aetna-69b-merger-condition-aetna-divest-part-d-business

DOJ Approves CVS-Aetna $69B Merger, On Condition Aetna Divest Part D Business

October 10, 2018
by Heather Landi, Associate Editor
| Reprints
Click To View Gallery

The Department of Justice (DOJ) has approved a $69 billion merger between mega-pharmacy retailer CVS Health and health insurer Aetna, after Aetna entered into an agreement with the DOJ to divest is Medicare Part D prescription drug plan business.

According to a statement released by the DOJ on Wednesday, the settlement, in which Aetna will sell off its Part D business, was a condition of the merger’s approval and resolves the DOJ’s “competition concerns.”

The deal is the latest in a wave of combinations among healthcare companies, including many pharmacy benefit manager (PBM) and insurer integrations. Last month, the Justice Department approved Cigna’s $67 billion takeover of Express Scripts.

CVS Health announced in early December 2017 its intention to acquire Aetna in a $69 billion-dollar merger, marking the largest ever in the health insurance industry. Woonsocket, R.I.-based CVS operates the nation’s largest retail pharmacy chain, owns a large pharmacy benefit manager called Caremark, and is the nation’s second-largest provider of individual prescription drug plans, with approximately 4.8 million members. CVS earned revenues of approximately $185 billion in 2017. Aetna, headquartered in Hartford, Connecticut, is the nation’s third-largest health-insurance company and fourth-largest individual prescription drug plan insurer, with over two million prescription drug plan members. Aetna earned revenues of approximately $60 billion in 2017.

Following news of the deal back in December, there was speculation that antitrust regulators might not approve the deal. Back in January 2017, a federal judge blocked a merger that would have resulted in Aetna acquiring Louisville, Ky.-based insurer Humana, which at the time was the largest acquisition of its type in the history of health insurance in the U.S., reported at $37 billion. At the time, U.S. District Judge John D. Bates in Washington said that proposed deal would “violate antitrust laws by reducing competition among insurers.” Similarly, a proposed combination of two other health insurers, Anthem and Cigna, was also shot down last year.

Webinar

Experience New Records for Speed & Scale: High Performance Genomics & Imaging

Through real use cases and live demo, Frank Lee, PhD, Global Industry Leader for Healthcare & Life Sciences, will illustrate the architecture and solution for high performance data and AI...

According to the DOJ’s statement issued today on the CVS-Aetna deal, the Justice Department’s Antitrust Division had significant concerns about the anticompetitive effects of the merger with regards to the Medicare Part D businesses. CVS and Aetna are significant competitors in the sale of Medicare Part D prescription drug plans to individuals, together serving 6.8 million members nationwide, according to the DOJ.

In a press release issued today, CVS Health said, “DOJ clearance is a key milestone toward finalizing the transaction, which is also subject to state regulatory approvals, many of which have been granted.” CVS Health's acquisition of Aetna remains on track to close in the early part of Q4 2018, the company said.

“DOJ clearance is an important step toward bringing together the strengths and capabilities of our two companies to improve the consumer health care experience,” CVS Health president and CEO Larry J. Merlo, said in a statement. “We are pleased to have reached an agreement with the DOJ that maintains the strategic benefits and value creation potential of our combination with Aetna. We are now working to complete the remaining state reviews.”

Merlo also said, “CVS Health and Aetna have the opportunity to combine capabilities in technology, data and analytics to develop new ways to engage patients in their total health and wellness. Our focus will be at the local and community level, taking advantage of our thousands of locations and touchpoints throughout the country to intervene with consumers to help predict and prevent potential health problems before they occur. Together, we will help address the challenges our health care system is facing, and we'll be able to offer better care and convenience at a lower cost for patients and payors.”

Following the close of the transaction, Aetna will operate as a standalone business within the CVS Health enterprise and will be led by members of its current management team.

The American Medical Association (AMA), an industry group that has been opposed to the merger, issued a statement saying the agreement that Aetna divest its Part D business doesn't go far enough to protect patients.

"While the AMA welcomes the U.S. Department of Justice (DOJ) requiring Aetna to divest its Medicare Part D drug plan business, we are disappointed that the DOJ did not go further by blocking the CVS-Aetna merger," Barbara L. McAneny, M.D., president, American Medical Association, said in a statement. "The AMA worked tirelessly to oppose this merger and presented a wealth of expert empirical evidence to convince regulators that the merger would harm patients. We now urge the DOJ and state antitrust enforcers to monitor the post-merger effects of the Aetna acquisition by CVS Health on highly concentrated markets in pharmaceutical benefit management services, health insurance, retail pharmacy, and specialty pharmacy."

Agreement with DOJ Resolves “Competition Concerns”

Late last month, Aetna agreed to sell its Part D business to WellCare. According to a Securities and Exchange Commission (SEC) filing from WellCare Health Plans last month, WellCare entered into an asset purchase agreement with Aetna to acquire the company’s entire standalone Medicare Part D prescription drug plan business, which has 2.2 million members. According to the agreement, Aetna will provide administrative services to and retain the financial risk of the Part D business through 2019. In that filing, it states that Aetna is divesting its Part D business as part of CVS Health’s proposed acquisition of Aetna.

“Today’s settlement resolves competition concerns posed by this transaction and preserves competition in the sale of Medicare Part D prescription drug plans for individuals,” Assistant Attorney General Makan Delrahim of the Justice Department’s Antitrust Division, said in a statement. “The divestitures required here allow for the creation of an integrated pharmacy and health benefits company that has the potential to generate benefits by improving the quality and lowering the costs of the healthcare services that American consumers can obtain.”

In its statement, the DOJ referred to WellCare as “an experienced health insurer focused on government-sponsored health plans, including Medicare Part D individual prescription drug plans.”

The Department’s Antitrust Division, along with the offices of five state attorneys general, today filed a civil antitrust lawsuit in the U.S. District Court for the District of Columbia to enjoin the proposed transaction, along with a proposed settlement that, if approved by the court, would fully resolve the Department’s competitive concerns. The participating state attorneys general offices represent California, Florida, Hawaii, Mississippi, and Washington.

In a complaint filed to the U.S. District Court, DOJ attorneys argued that without the divestiture, the combination of CVS, which markets its Medicare Part D individual prescription drug plans under the “SilverScript” brand, and Aetna would cause “anticompetitive effects, including increased prices, inferior customer service, and decreased innovation in sixteen Medicare Part D regions covering twenty-two states.” DOJ attorneys also argued that the loss of competition between CVS and Aetna would result in “lower-quality services and increased costs for consumers, the federal government, and ultimately, taxpayers.”

Under the terms of the proposed settlement, Aetna must divest its individual prescription drug plan business to WellCare and allow WellCare the opportunity to hire key employees who currently operate the business.  Aetna must also assist WellCare in operating the business during the transition and in transferring the affected customers through a process regulated by the Centers for Medicare and Medicaid Services (CMS).

 


See more on Analytics

betebettipobetngsbahis