As we reported, a Johns Hopkins Medicine researcher criticized the industry-leading Epic electronic health record (EHR) system for having a default of a five-day prescription set up in the system, saying five days are too long (“The EPIC Problem With the CDC Opioid Guideline,” Orthopedics This Week, November 21, 2018.)
Have Opioid Prescribing Defaults in Your EHR System? Tell Us!
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#opioidSecondary#opioidprescriptions#electronichealthrecords
It seemed unfair to single out Epic. So, we polled these other vendors by email through their media relations staffs: Cerner Corp., NextGen, GE, Allscripts, and eClinicalWorks, with plans to ask others when we heard back from the first batch. Our first set of inquiries went out November 18; we sent a follow-up Novembe 26 with this subject line: “NO RESPONSE SEEN YET Re: Default prescription values for opioids?”
The Results So Far
NextGen: Robert Murray, M.D., Chief Medical Informatics Officer: “We do not have defaults set up and we do not currently display the morphine equivalents of prescribed opioids, for either system. Clients in NGE can get access to this information with our built-in connect (via partner APPRISS) to their state PDMP (Prescription Drug Monitoring Database), which will show it not just for the narcotics they prescribe but for all narcotics the patient is receiving. NGO clients can log in with a web browser (NGO is web based, of course) to get the info.”
“These features are relatively new in the clinical literature and have not been implemented. The system, of course, does allow and encourage ‘favorite’ prescriptions which include med, dose, SIG, etc., for all medications. Use of them is very common in our client base; for many physicians who commonly prescribe opioids, this would be the default way they do so. They have control over their favorites.”
In other words, NextGen puts the responsibility where it belongs, with the individual prescriber.
Cerner: Media relations staff: “Thank you for reaching out, but we will not be participating in this opportunity.”
GE, Allscripts, eClinicalWorks: No answer from any of them.
With useful information from only one of five, we’re turning to readers. Can you help? If you know the default or defaults (if any) in your EHR vendor’s system when it comes to opioid prescriptions, or whether it’s left up to the prescriber, please post a comment below. You’ll be helping to inform the debate on how opioid prescriptions should be managed in an EHR.
Email robin@ryortho.com with your answers.
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Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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