Editor’s Note: Throughout the next week, in our annual Top Ten Tech Trends package, we will share with you, our readers, stories on how we gauge the U.S. healthcare system’s forward evolution into the future.
Opioid abuse and addiction continues to be a national crisis, but it is being felt at a very local level. Patient care organizations across the country are seeing the impact of the opioid crisis on the health of their patient populations.
From 1999-2016, more than 350,000 people died from an overdose involving any opioid, including prescription and illicit opioids, according to data from the U.S. Centers for Disease Control and Prevention (CDC). Overdose deaths from opioids, including prescription opioids and heroin, have increased by more than five times since 1999. More than 40 percent of all U.S. opioid overdose deaths in 2016 involved a prescription opioid, with more than 46 people dying every day from overdoses involving prescription opioids, according
to CDC data.
Many industry leaders say technology can help address two key challenges of the opioid epidemic: drug diversion, including the illegal use of prescription opioids, and clinical appropriateness, including effective uses of opioids for patients with legitimate needs. Technology tools such as e-prescribing, prescription drug monitoring programs (PDMPs), and clinical data exchange, all aid healthcare professionals, by informing their care decisions with more actionable intelligence at the point of care.
Surescripts, the Arlington, Va.-based operator of a nationwide electronic network for prescription-related data and information, has been at the forefront of this area as its platform connects electronic health record (EHR) vendors, pharmacy benefit managers, pharmacies and clinicians, as well as health plans and long-term and post-acute care organizations. In 2017, 13.7 billion secure health transactions took place via the Surescripts network—a 26-percent increase from 2016—including 1.74 billion e-prescriptions. What’s more, the network connected 1.47 million healthcare professionals—13 percent more than in 2016—with secure patient data for 233 million Americans, or 71 percent of the population. Also, in 2017, more than 1.46 billion medication history transactions were made available to providers at the point of care.
There is a burgeoning health IT solutions market targeting opioid use disorder and addiction, with many of these solutions leveraging data and analytics to help providers see prescription drug usage patterns.
Jackson Tate, a research manager with Orem, Utah-based KLAS Research, who has been researching this technology market for an upcoming KLAS report, notes that there is significant innovation occurring, but this health IT sector is still in nascent stages. “There are certain technologies that we’re seeing pop up and become more popular that help doctors and care managers engage with their patients who are at high risk for opioid dependency or currently have an opioid use disorder. We still classify this market, as a whole, as being in early stages, with a few vendors that are out there in the field.”
The Louisville, Ky.-based Appriss Health is a leader in the field of PDMP analytics and tools, as its platform, PMP Aware, is now live in 30 states and provides access to mandatory pharmacy reporting. Appriss Health’s PMP Gateway platform integrates state PDMP data into EHRs and into physician and pharmacist workflows to provide real-time data at the point-of-care. Appriss Health also operates the PMP InterConnect, an interstate prescription drug data sharing platform that now includes 45 states.
One promising strategy to address the prescription opioid epidemic is optimizing PDMPs through integration with the IT systems of patient care organizations. Maryland is one state that has made inroads in this area, as CRISP (Chesapeake Regional Information System for our Patients), a regional HIE, provides access to PDMP data and has successfully integrated with a number of EHR vendors. Providers also can access PDMP data directly in their workflow through CRISP’s SMART on FHIR (Fast Healthcare Interoperability Resources app, which is accessed 100,000 times a day, according to CRISP.
As Healthcare Informatics Managing Editor Rajiv Leventhal noted in a recent article, Michigan state leaders utilized Appriss Health’s technologies in its ongoing fight against opioid abuse. Michigan state officials conducted an assessment utilizing Appriss Health’s artificial intelligence (AI) and machine learning technologies, including its “overdose risk score” that predicts the likelihood of a drug-related death to enable more advanced interventions and responses.
However, Tate notes that PDMP integration with health IT systems is not yet widely adopted. Case in point, more than a year ago, Michigan state officials announced an upgrade to the state’s aging opioid-tracking system and efforts to integrate it with EHR systems, at a cost of $2.8 million. A year later, only 42 percent of the state’s prescribers and dispensers have automatic access to the PDMP, according to an article in Crain’s Detroit Business.
Leveraging Data and Analytics
Many hospitals and health systems have moved forward to leverage their own IT systems, such as their EHR systems and population health tools, to collect and analyze data in order to address opioid abuse and addiction, and to prevent overdose deaths.
At the Danville, Pa.-based Geisinger Health System, clinical leaders are grappling with the fact that Pennsylvania’s opioid overdose death rate was the fourth highest in the country, and many of the counties with the highest death rates in 2016 were served by Geisinger Health System.
As detailed in a Healthcare Informatics article, Geisinger’s clinical IT leaders developed a strategy to address this by utilizing data and health IT tools to change providers’ prescribing practices. As a result of this effort, the health system has slashed opioid prescriptions in half, from a monthly average of 60,000 opioid prescriptions to 31,000 prescriptions per month.
John Kravitz, CIO at Geisinger Health System, notes that data and IT were foundational to these efforts, as physician leadership developed a provider dashboard linked to the EHR to identify current practice patterns among providers. “Having the dashboard linked into the EHR has been critical to success,” he says. The health system’s IT leaders also leverage the state’s PDMP and is currently working to build APIs (application programming interfaces) to connect to providers’ workflow.
“There are organizations that are further along down the path and they see the vision of where technology could take them and how it could be leveraged,” Tate says. “Those who are advanced and deep into this are looking to use big data and social determinants of health to further engage and understand their patient populations, and then also looking for those tools that are going to be disruptive. There’s a growing appetite for these new, smaller, innovative technologies.”
There are a number of startups working on digital opioid solutions. Princeton, New Jersey-based Braeburn Pharmaceuticals developed a prescription implant that provides those who are addicted with a steady low dose of buprenorphine rather than opioids. RxAssurance, a healthcare startup based in Denver, built an app that can be used by patients to fill out a survey about family and personal health histories, and the platform then gives doctors assessments to determine a patient’s risk for opioid abuse.
At Brigham and Women’s Hospital in Boston, the emergency department piloted the use of capsules embedded with ingestible wireless sensors to measure patients’ prescription opioid use. The hospital partnered with eTectRx, a Newberry, Fla.-based technology company that develops the digital pills, to test the use of the pills on patients admitted to the ED for bone fractures and who were prescribed oxycodone.
When swallowed, the capsules are dissolved by digestive acids in the stomach and emit a radio signal that is picked up by a reader worn around the patient’s neck. That wearable device then forwards the message, via Bluetooth technology, to a smartphone app, where a clinician or pharmacist can view the patient’s medication adherence. Peter Chai, M.D., an emergency medicine physician and a medical toxicologist at Brigham and Women’s Hospital, says the technology can help to detect a pattern in how patients are taking pills and can help physicians to intervene if there’s a change in that pattern.
“Prescription opioids are the only medication where the onus of how you use it is placed on the patient. Patients are told, ‘take it as needed for your pain,’ but there is a huge gap between what patients think ‘as needed’ means, and what physicians think,” Chai says. “The cool part about the technology is that now that we can detect changes in digestion patterns or dangerous escalations, so we can then develop intervention and outreach.”
Chai and his colleagues plan to test the digital pills on post-operative spinal fusion surgery patients to track digestion patterns several months after surgery.
Peter Chai, M.D.
There are also startups developing innovative tools, from wearables to therapy apps, on the consumer-facing side to aid people battling opioid addiction. Trigger, based in Chicago, developed an app that monitors phone use to determine when someone recovering from addiction is most at risk. Chrono Therapeutics is developing a wearable patch to help patients overcome nicotine addiction and has plans to make a similar patch for opioid addiction.
Many healthcare leaders say that while innovative digital tools can help address some aspects of the problem, the technology needs to seamlessly integrate into the health system to be scalable and to make a significant impact. “You can prescribe a digital oxycodone pill in a research study, but I think the real gold is to develop this as something that a primary care physician could prescribe and a pharmacy would know how to interact with it,” Chai says.
Chai also notes that technology alone will not combat the growing opioid abuse and overdose problem, and that patient engagement is still a key part of the solution.
“There are many innovative devices out there, a dime a dozen, but none of it is going to work unless you deliver a message about appropriate medication use correctly to the patient,” he says.