HIM Can Play a Role in Preventing Opioid Abuse

The United States’ “opioid epidemic” is in the news seemingly every day, leaving some health information management (HIM) professionals to wonder what role they can play in easing the burden on health systems. A new study published in the Journal of General Internal Medicine identified one way to get involved via electronic health records (EHRs).

Investigators analyzed emergency department (ED) data from the hospital of the University of Pennsylvania and Penn Presbyterian Medical Center, which were collected between late 2014 and mid-2015, to determine whether placement of a default prescribing setting in the ED’s EHR could limit the total number of pills prescribed.

Starting in 2015 researchers tweaked the EHR so that the default number of hydrocodone/acetaminophen tablets prescribed was 10, a reduction from the typical 20 tablets—although 20 tablets was still listed as an option. Researchers found that physicians at the two hospitals prescribed a fewer number of opioid pills to their patients when the default setting was 10 tablets. According to a Penn Medicine press release about the study, “Initial prescriptions for that amount shot up by 22 percent, from a pre-default rate of 21 percent to 43 percent after the default option had been introduced.”.

“Our results represent a promising and much-needed scalable approach that could successfully nudge physicians managing acute pain to prescribe smaller doses of opioid medications for those who need them,” said lead author M. Kit Delgado, MD, MS, an assistant professor of Emergency Medicine and Epidemiology at the Perelman School of Medicine at the University of Pennsylvania. “We know that prescribing too many opioid tablets for acute pain increases a patient’s risk for long-term use or the potential to be abused if left in the medicine cabinet, so making it easier to prescribe quantities consistent with current guidelines while still keeping physician autonomy is an important part of addressing the opioid crisis we’re facing in this country.”

Even lawmakers have proposed instituting prescribing limits on opioids prescribed for acute and short-term indications. Arizona Gov. Doug Ducey has released draft legislation limiting how much could be prescribed to individuals who haven’t filled prescriptions for painkillers before, as well as limits on what can be prescribed after a surgery, Modern Healthcare reported.

The Office of the National Coordinator for Health IT (ONC) also recently released a two-page consumer-facing comic strip of sorts that clarifis HIPAA regulations surrounding release of information related to substance abuse issues. The scenario captured in the handout involves a man undergoing treatment for painkiller addiction when he injures his back on the job. The document reminds consumers that information about substance abuse is never disclosed without written authorization from the patient.

Mary Butler is the associate editor at The Journal of AHIMA.

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