Implementing and Scaling Electronic Health Record (EHR) Clinical Support Tools to Optimize Prescribing of Pain Medications

With support from the Cardinal Health Foundation in partnership with the Alliance of Integrated Medication Management, the National Alliance of State Pharmacy Associations, and the American Association of Colleges of Pharmacy, the Wisconsin Pharmacy Foundation, the Pharmacy Society of Wisconsin, and the University of Wisconsin School of Pharmacy Sonderegger Research Center for Improved Medication Outcomes are partnering with Fort HealthCare, Cerner, and community pharmacies to promote safe pain medication use and increased dispensing of life-saving naloxone in Jefferson County.

Wisconsin was one of five states selected to be a part of Cardinal Health Foundation’s Optimal Prescribing in Pain Management Collaborative.

Fort HealthCare is a Cerner electronic health record (EHR) “ITWorks” site, making it a perfect environment to implement and evaluate the initiation of an EHR-based clinical decision support (CDS) toolkit developed by Cerner to improve opioid prescribing.

The overarching goals for this 2-year project are:

• improve opioid prescribing by prescribers affiliated with Fort HealthCare,
• improve the rate of naloxone dispensing to Fort HealthCare patients, and
• facilitate scalability and sustainability of opioid prescribing improvement and naloxone dispensing.

Project Aims

1. Evaluate the implementation and effectiveness of the CDS toolkit related to opioid prescribing in Fort HealthCare’s EHR. We anticipate that implementing the CDS toolkit will reduce the incidence of initial high-dose prescribing and long-term, high-dose opioid prescribing.
2.  Engage with Fort HealthCare to design, implement, and evaluate the involvement of community pharmacists in increasing naloxone prescribing/dispensing. We will evaluate the implementation and effectiveness of the CDS toolkit related to a naloxone co-prescribing alert and independent community pharmacists dispensing naloxone to FHC patients via a standing order.
3.  Elicit feedback from Fort HealthCare prescribers and community pharmacists about barriers and facilitators to using the toolkit and dispensing naloxone.

In 2018, FHC began to implement an EHR-based clinical decision support (CDS) functionality, referred to as the “opioid toolkit” which extracts and evaluates patient data contained in the EHR and alerts providers in real-time while they are prescribing opioids when certain patient-related criteria are met. Table 1 provides details of the three alerts FHC implemented.

Table 1. Fort HeatlhCare CDS Opioid Toolkit Alerts

Preliminary Results

This project is ongoing, but some preliminary findings are described in this, “Wisconsin Team Performance Story”.

Oral and Poster Presentations

Kaur A, Pagenkopf S, Mott D, Chui M, Maurer M, Rotzenberg K, Prickette T, Martin E, Barron C. Interprofessional stakeholder engagement process in the implementation of a targeted clinical decision support opioid toolkit to improve naloxone prescribing. Presented at the 2021 American Pharmacist’s Association Annual Meeting and Exposition, Virtual, March 2021.

Kaur A, Mott D, Chui M, Maurer M, Rotzenberg K, Pagenkopf S, Prickette T, Martin E, Barron C. Implementation and effectiveness evaluation of an opioid toolkit to increase naloxone prescribing in a rural health system. Presented at the 13^th Annual Conference on the Science of Dissemination and Implementation in Health, Virtual, December 2020.