This blog explores health informatics—a collaborative activity connecting people, process, and technologies to produce trusted data for better decision-making.
Editor’s note: This is the second part of a two-part series. Click here to view part one.
By Barbara A. Ryznar, RPh, MSHI, RHIA, CHDA, CPHI, CPHIMS, CAPM
Every new day, it seems, brings a new report in the news related to the opioid crisis. Sometimes it is a promising solution, other times it is an update on the epidemic’s death rate or a profile on the scope of the grip of opioid addiction on a community. A glimmer of hope for real impact came with news of the passage of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT for Patients and Communities Act). This law includes a variety of provisions to tackle the problem by targeting it from many directions, such as prevention, treatment, and recovery for opioid substance abuse, as well as law enforcement measures directed to stop the influx of illicit drugs and diversion. It also makes some changes to the disclosure of medical records for patients with substance abuse disorders (SUDs). As many health information management (HIM) professionals are aware, 42 CFR Part 2 deals with the confidentiality of SUD patient records by restricting the disclosure of medical records involving addiction treatment by any federally-assisted drug abuse program (which represents the majority of patients) without patient consent. While this provision is very good at maintaining strict confidentiality for the patient, it could also restrict information that would identify SUD patients and subsequently channel them to treatment resources.
As mentioned in the first installment of this two-part series, the Centers for Medicare and Medicaid Services’ FY 2019 IPPS provisions requiring query of the Prescription Drug Monitoring Program before prescribing narcotics to patients as a meaningful measure of interoperability can be a tool for identifying opioid-addicted patients and channeling them to treatment. This is a relatively low-cost initiative using aggregated data to make a high impact on population health and access to care.
So, what is the current treatment? Medication-assisted treatment (MAT), which uses a medication such as methadone or buprenorphine with or without naloxone—in conjunction with counseling and behavioral therapies for the treatment of SUDs—is an evidence-based treatment for opioid addiction. While methadone is restricted to federal treatment centers, the buprenorphine/naloxone sublingual tablet and film strip products can be obtained in pharmacies with a prescription from a physician authorized by the Drug Enforcement Administration to prescribe these products. It has been shown that MAT keeps the patient in therapy and reduces opioid-related overdose deaths and the risk of infectious disease transmission from intravenous drug use. Newer dosage forms, such as injectables and implants—are long-acting forms that can ensure patient treatment compliance. As more patients enter MAT and initiatives get underway to increase the availability of Narcan nasal spray (the emergency treatment of known or suspected opioid overdose), overdose deaths should begin to decrease. In order to confirm the effectiveness of these efforts, the data that tracks the population in MAT, along with success or failure in the treatment programs, is of vital importance.
The US Department of Health and Human Services (HHS) implemented a five-point strategy to address the opioid crisis with multifaceted initiatives and a focus on innovation at each point:
- Better addiction prevention and treatment.
- Betterpain management
- Bettertargeting of overdose-reversing drugs
“Better data” is the link to the integration of the other points listed above, and provides important support for undertaking meaningful action in the multiorganizational and multidisciplinary environment in which we are addressing opioid abuse.
While there are data set of many types from surveys and diverse sources, the analysis is often retrospective—using data from years prior that do not necessarily reflect the current situation. Currency and timeliness are data qualities needed for better surveillance. In 2017, the HHS sponsored a national opioids code-a-thon, with teams of data experts and computer scientists joined together in the quest to find solutions for the epidemic using data sets. Innovative ideas for leveraging data provide tools to follow trends, assess treatments for best outcomes, and identify solutions with value.
The answers to the opioid crisis and other healthcare problems are almost within our grasp, and big data is likely just the tool we need to finally reach it.
Energy and Commerce Committee. Combating the Opioid Crisis: Legislation. US House of Representatives. https://energycommerce.house.gov/opioids-legislation/.
National Institute on Drug Abuse. “Effective Treatments for Opioid Addiction.” November 1, 2016. https://www.drugabuse.gov/effective-treatments-opioid-addiction-0.
Department of Health and Human Services. “5-Point Strategy to Combat the Opioid Crisis.” August 7, 2018. https://www.hhs.gov/opioids/about-the-epidemic/hhs-response/index.html.
Barbara A. Ryznar is a community pharmacist at a Medicine Shoppe Pharmacy and a part-time adjunct instructor in the MSHI program at University of Cincinnati.