Evidence on the Growing Use of Health IT to Address the Opioid Epidemic
Chelsea Richwine and Jordan Everson | January 19, 2023
In the midst of a growing drug overdose crisis exacerbated by the COVID-19 pandemic, clinicians’ use of prescription drug monitoring programs (PDMPs) and electronic prescribing of controlled substances (EPCS) technology is critical to improving opioid prescribing practices, informing treatment decisions, and supporting safe and effective patient care. Recent efforts, such as mandating use of EPCS technology and integrating PDMPs into electronic health record (EHR) systems, aim to improve prescribing practices by increasing the utility of information contained in PDMPs and decreasing prescription diversion and doctor shopping.
Tracking Progress towards Universal, High-Value Use of PDMPs and EPCS
ONC engages on several research projects to track progress and assess benefits from PDMP and EPCS use. Recently, two of these studies leveraged publicly available data from the National Electronic Health Records Survey (NEHRS) – a nationally representative survey of U.S. office-based physicians – to characterize physicians’ use of EPCS and PDMPs, and the benefits associated with their use. An ONC data brief released in June 2022 showed substantial growth in the use of EPCS among physician prescribers of controlled substances between 2017 and 2019, where adoption likely grew in response to state mandated EPCS laws and in anticipation of the federal Medicare Part D mandate that was announced in 2018 and would become effective in 2021.
A newly released ONC data brief shows that nearly three-quarters (71%) of physician prescribers used EPCS in 2021 with 62 percent reporting they used EPCS “often” – a significant increase from just over one-third of prescribers that reported using EPCS “often” in 2019 (37%). The new data brief covers the post-mandate period and shows continued progress in the use of EPCS among physician prescribers.
In addition to marked growth in the use of EPCS following the federal mandate, the data brief highlights widespread use of PDMPs among office-based physicians in 2021, with more than three-quarters (78%) of physician prescribers indicating they checked their state’s PDMP prior to prescribing controlled substances to a patient for the first time. While PDMP use remained relatively steady between 2019 and 2021, one-third of prescribers now access the PDMP through their EHR (compared with one-fifth in 2019).
Identifying Benefits of PDMP and EPCS
Identifying and measuring the benefits of PDMPs is an important step towards increasing their utility. A recent ONC study, using data from the 2019 NEHRS, added to the growing literature demonstrating benefits of PDMPs by showing greater frequency and ease of use among physicians with PDMPs integrated with their EHR. PDMP-EHR integration is beneficial to clinicians as it increases the accessibility of PDMP data at the point of care, making that information more actionable for clinical decision-making. Physicians who frequently checked their state’s PDMP and reported it was easy to use were more likely to report perceived benefits such as reduced prescribing of controlled substances, confirming the appropriateness of treatment, and improved care coordination. In 2021, a majority of physicians who checked their state’s PDMP reported experiencing at least one benefit associated with use.
Because EPCS only began to be adopted at scale a few years ago, evidence on the benefits of using EPCS has so far been scarce, with some mixed evidence. Earlier this year, an ONC study examining the impact of policy that mandated EPCS use in New York state showed that opioid prescribing fell by almost six percentage points following EPCS adoption. We’re hopeful that additional analyses focused on the Part D mandate will further confirm the impact of EPCS on opioid prescribing.
While the progress in physicians’ use of EPCS and PDMPs is promising, our recent analyses underscore important areas for improvement. First, despite high rates of EPCS and PDMP use at the national level, rates of use varied by specialty, practice size, ownership, and EHR developer market share, suggesting targeted support may be needed to increase access and use in lower-resource settings. Second, despite physicians’ widespread access to data from their state’s PDMP, the electronic exchange of PDMP data across state lines remains limited, restricting physicians’ ability to capture complete prescription histories of patients who received care in different geographic locations. Finally, while the share of physicians who reported accessing the PDMP through their EHR increased significantly between 2019 and 2021, over two-thirds of physicians still access the PDMP through an outside system, which may limit the use of PDMP data that are not well-integrated into clinical workflows.
This finding highlights the importance of continuing efforts to achieve PDMP-EHR integration, including the development of technical resources to guide organizations through the different phases of integration. Moreover, it is important to ensure that integration drives value by embedding data in clinician workflows and powering actionable decision support tools to combat the opioid crisis.