In a July 2020 Safety Matters post, “A Near Miss, an Important Reminder,” we discussed how one of our General Surgery residents identified a glitch in our electronic medical record that resulted in the option to order significantly more opioids for patients than were necessary.
The post below, written by one of our team members, Scott Weiner, MD, MPH, emergency physician, medical director of the Brigham Comprehensive Opioid Response and Education Program (B-CORE) and assistant professor of Emergency Medicine at Harvard Medical School, continues to explore how technology and innovation can be used to reduce the risk of medication abuse and overdoses.
The federal government’s name for the group of medications that can lead to abuse or have high risk of overdose is “controlled substances.” These are strong medications, including opioid painkillers (like oxycodone and morphine), benzodiazepine sedatives (like lorazepam and diazepam) and other drugs (like stimulants), and prescribers must be careful when prescribing them to avoid patient harm.
One of the biggest challenges to safety occurs when patients either mix controlled substances or obtain them from more than one provider. For example, if I am going to prescribe a brief course of oxycodone for a patient after a broken leg, I need to know if they are already getting opioids from another prescriber to ensure they are not receiving an unsafe number of pills that may lead to an addiction, or even overdose. Furthermore, some patients with a substance-use disorder may seek prescriptions for controlled substances from different health care providers concurrently. Unfortunately, these duplicate prescriptions are not easily detected.
A Database Innovation
To address this problem, Massachusetts, like nearly every other state in the U.S., instituted a special website, called the Massachusetts Prescription Awareness Tool (MassPAT), to enable secure access to its Prescription Drug Monitoring Program database. The database allows prescribers to see a patient’s complete controlled substance prescription history by licensed providers in Massachusetts regardless of who wrote the prescription, or where it was filled. This safety check is so important that Massachusetts now requires prescribers to check the database prior to issuing any new opioid or benzodiazepine prescriptions.
However, accessing this database is not easy. Prescribers need to register to use the site and then log in to the database using a different URL. It’s a cumbersome process that can take several minutes1 to complete, preventing providers from performing all necessary steps due to their busy schedules and competing priorities. In 2018, Brigham and Women’s Hospital became the first health care system in the state to provide a direct connection to that data. Now, providers can enter our electronic medical record (EMR) system and within a few seconds can access the controlled substance prescription history for each of their patients.
A study of this innovation was recently published in the journal Pain Medicine. In the study, we found that the number of MPAT searches by Mass General Brigham providers in the EMR increased from about 209,000 in the six months before the integration to approximately 298,000 in the six months following integration — an increase of 43 percent. The study also discovered that the quantity of opioids prescribed decreased by about 5 percent, possibly reflecting times when the prescriber thought it might be safer to prescribe fewer opioids.2
A team at the Brigham was pleased to be able to help the state complete this integration for the first time, paving the way for other health care systems to use this same technology by integrating their own EMRs with MPAT, as we all strive to prescribe these medications as safely as possible.
- Poon et al. Usability of the Massachusetts Prescription Drug Monitoring Program in the Emergency Department: A Mixed-methods Study. Academic Emergency Medicine. 2016 January. PMID: 26806310.
- Weiner et al. Opioid Prescribing after Implementation of Single Click Access to a State Prescription Drug Monitoring Program Database in a Health System’s Electronic Health Record. Pain Medicine. 2021 February. PMID: 33561288.