Irv Lichtenwald

Opioid epidemic makes EHRs essential to public health

August 9, 2017

Behavioral Health, Healthcare Industry 6 Minute Read

When public health is threatened by an outbreak of SARS or Zika or avian influenza, widely disseminated information becomes a crucial tool used to curtail the spread of disease.

But transmittable diseases are not the lone threats to public health. Other metaphorically pathogenic events—the current opioid epidemic, for example—are more effectively managed by making sure doctors have complete information when evaluating patients and, especially, writing prescriptions.

Even if you know what the opioid epidemic is doing to America, you may not be familiar with the devastating numbers. Here are a few.

  • Drug overdose is the leading cause of death for Americans under 50.
  • From 2015 to 2016, drug overdose deaths rose 19 percent. In Ohio, they increased by more than 25 percent.
  • Summit County (Akron), Ohio, experienced 312 drug deaths in 2016, a 46 percent increase over the previous year. The county had to request refrigerated trailers to store bodies.
  • In 2016, Fentanyl became all the rage, and in January and February of 2017, the area around Dayton, Ohio, saw 100 overdose deaths—99 from fentanyl or something similar.
  • It’s estimated that more than 2 million Americans are dependent on prescription opioids, but more than 95 million—almost 30 percent—used prescription painkillers last year.
  • About 6 percent of patients who take a prescription opioid for one day will be using them a year later; that number jumps to 35 percent for those who take the pills for more than 30 days.

Opioids now represent the single greatest drug overdose crisis in U.S. history and one of the most significant threats to American public health in the last century.

“In 2016 alone, drug overdoses likely killed more Americans in one year than the entire Vietnam War,” writes German Lopez in Vox. “In 2015, drug overdoses topped annual deaths from car crashes, gun violence, and even HIV/AIDS during that epidemic’s peak in 1995. In total, more than 140 people are estimated to die from drug overdoses every day in the US. About two-thirds of these drug overdose deaths are linked to opioids.”

Even those who think opioid deaths are social Darwinism at work can’t deny that the epidemic hamstrings the U.S. economy.

“About 1.8 million workers were out of the labor force for ‘other’ reasons at the beginning of this year, meaning they were not retired, in school, disabled or taking care of a loved one, according to Atlanta Federal Reserve data,” writes CNN Money reporter Patrick Gillespie. “Of those people, nearly half — roughly 881,000 workers — said in a survey that they had taken an opioid the day before, according to a study published last year by former White House economist Alan Krueger.”

In many places and in specific industries, employers simply cannot find enough sober citizens.

So, if those are the results of rampant opiate use, what are the solutions? Certainly, there isn’t just one, but all of them require coordinated and reliable data like that revealed in a 10-year study conducted by Geisinger Health System. After evaluating the electronic health record (EHR) data of more than 2,000 individuals admitted to the hospital for overdoses. Of that group, nearly 10 percent were dead within a year of hospitalization.

The study supports what may seem like common sense in some ways. Those who were single and unemployed were most likely to use and overdose. But if this is common sense, why didn’t it occur to those who were so often prescribing opiates? Why weren’t the extenuating circumstances—employment and marital status, as well as existing chronic illness—a concern? And why are women more likely to be addicts and die?

Perhaps because medicine is a data-driven science and the data on addiction and opiate abuse, combined with individual patient information, simply wasn’t there. While acute care facilities are now approaching 100 percent EHR adoption and the push for full interoperability continues, behavioral health hospitals languish at well below 50 percent, making interoperability irrelevant. Patients with myriad issues on top of chronic pain won’t sound alarm bells for doctors that lack a complete picture.

“First, we need to identify individuals who are at high risk for opioid use,” write Brian Sites, MD, and Matthew Davis, PhD. “Second, we need to develop and put in place health policies and practice guidelines … that aim to reduce physicians’ dependency on opioids for treating pain.

“Third, we need to carefully vet policies regarding financial reimbursement for outcomes such as patient satisfaction to anticipate any indirect effects on opioid prescribing. Finally, we need to quickly put in place regulatory policies to identify fraudulent prescribing practices and improve access to drug addiction treatment.”

Largely agreeing with Sites and Davis, German Lopez also suggests we “address the other problems that lead to addiction.”

These solutions will probably be beneficial if they’re supported by robust, interoperable information systems. Doctors and public officials need data to make informed individual patient decisions and to design impactful community programs. Where will that information come from, otherwise?

The rapid adoption of EHRs in acute care settings is the result of federal government incentives based on the idea that complete, coordinated patient information leads to better care and saves lives. As the opioid crisis demonstrates, that idea is just as relevant in behavioral health settings and is arguably more urgent.

Some of that urgency is felt in Congress. Senators Sheldon Whitehouse (D-RI) and Rob Portman (R-OH) last week introduced legislation that included incentives to digitize behavioral health records. A similar measure introduced by Lynn Jenkins (R-KS) and Doris Matsui (D-CA) is making its way through the House. Contact your local representative and encourage them to support the bills.

For the next couple of years, public health experts expect that opiate-related deaths will continue along the same path or perhaps increase in certain areas. Tragically, too many are already addicted, and the power and availability of Fentanyl can’t be easily combatted. But doctors and public health officials armed with a greater awareness and information about a specific patient can begin to stem the tide.

When Americans look back at this chapter in history, will we see the number of deaths and regret that we didn’t include behavioral health in efforts to provide doctors with complete patient information? It’s a trivial price to pay for hundreds of thousands of lives.

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