STAGE 7 SPOTLIGHT Mercy Health: 50% Reduction in Opioid Prescriptions
The eight-stage Electronic Medical Record Adoption Model (EMRAM), developed by HIMSS Analytics more than a decade ago, measures the adoption and usage of electronic medical record (EMR) systems within healthcare organizations. Stage 7 EMRAM organizations, an elite group of over 350 organizations worldwide, have used the technology to streamline hospital services, improve the quality of care and reduce costs.
Let's examine the Stage 7 validation process of Mercy Health, a Catholic healthcare ministry serving Ohio and Kentucky.
Mercy Health is one of the largest healthcare systems in the country, with more than 33,500 employees in seven markets. Placing emphasis on poor and under-served populations, Mercy Health provides nearly one million dollars per day in charity care.
When Mercy Health began exploring EMRAM validation, Ohio's average annual death rate from drug overdose was twice that of the U.S. rate; the drug overdose crisis had hit epidemic levels, and hospitals in the area needed to develop tools and protocols to facilitate improved outcomes, streamline hospital services, and reduce risk for patients. At Mercy Health, their main goals were to ensure early detection, intervention and referral for opioid overdoses, as well as to decrease unnecessary prescriptions of opioids.
The EMRAM Implementation
Mercy Health took a three-pronged approach to achieving EMRAM validation and improving detection, intervention and outcomes for drug overdose patients:
1. Screening, Brief Intervention and Referral to Treatment (SBIRT) Protocol.
First, Mercy Health implemented SBIRT, an efficient and evidence-based protocol to facilitate intake and detection for mood, alcohol and drug use patients. The SBIRT was built into the EPIC EMR and consists of four components, including:
- A four-question prescreening for patients 18+ years old.
- Three full-screen measures given to those who score positively on the prescreen.
- A brief scripted intervention tailored to alcohol or drug use, triggered by a positive score on the previous screening.
- Referral information for patients for alcohol, drug use and/or mental health treatment.
2. Opiate Withdrawal Focused Order Set and Clinical Opiate Withdrawal Scale (COWS).
Mercy Health then developed an evidence-based order set for patients experiencing opiate withdrawal, as well as the COWS nursing assessment to facilitate treatment. The results of the COWS assessment corresponds with treatment options from the order set.
3. Reduced Opioid Prescriptions in the Emergency Department.
Finally, Mercy Health saw a distinct need to reduce the number of opioid prescriptions being given out, and instead offer other options where appropriate, especially in cases of chronic illness or pain. To reduce the number of prescribed opioids in their hospitals, they piloted an opiate-free ED program in one of their markets. In the 18 months since the initiative was kicked off, there has been over a 50% reduction in opioid prescriptions written.
In the 18 months since Mercy Health's EMRAM initiative kicked off, data captured via EPIC reporting showed that:
- Opioid prescriptions have reduced by over 50 percent.
- 83 percent of patients do not meet criteria for intervention or referral.
- 13 percent of patients warrant a brief intervention.
- 3 percent of patients need a referral to specialized treatment.
Overall, Mercy Health found that the new protocols complemented the fast-paced environment of the ED and gave providers the necessary tools for fast, flexible and effective treatment. The order set has been used nearly 900 times across three locations since its creation.
When it comes to better opiate management, one of the greatest and most nebulous challenges for healthcare organizations is removing personal bias and instilling the importance of recognizing addiction as a chronic disease which must be treated. By taking a physician-led, multi-disciplinary approach and integrating a process within the EMR to allow for streamlined services and improved continuity of care, Mercy Health was able to overcome these biases and ultimately, improve the health of their population.
“That order set has made believers out of non-believers regarding opioid withdrawal and chemical addiction,” said Stephen Feagins, M.D. Vice President Medical Affairs of Mercy Health East Market. Like the team at Mercy Health, healthcare organizations everywhere can use the EMRAM as a roadmap for transforming the culture, processes, treatment plans and outcomes of their organizations.