Yale New Haven Health is Connecticut’s largest healthcare provider. With 1,548 beds, Yale New Haven Hospital is the fourth largest hospital in the United States. Its adult emergency department treats as many as 300 patients a day, two-thirds of them at off hours.
THE PROBLEM
The hospital faced an ongoing challenge in treating patients with substance use disorder in the adult emergency department. It experienced a 30% increase in ED visits for opioid overdose in just one year, from mid-2016 to mid-2017.
Accessing patients’ opiate and other controlled substance prescription history required clinicians to separately log into the state prescription-drug-monitoring program to check a patient’s prescription history.
This cumbersome process involved frequent login ID changes, and often tracking down an IT staffer for help. That process could often take as long as 10 minutes. For that reason, a patient’s controlled-substance history often was never checked. The technology struggle of looking at multiple websites was a burden.
PROPOSAL
Yale New Haven Hospital looked at health IT vendor Appriss Health, which offers a system that would integrate the PDMP and an opioid-risk-assessment platform into the hospital’s Epic electronic health record system. Appriss says it offers the nation’s most comprehensive platform for opioid stewardship and the early identification, prevention and management of substance use disorder.
Their system’s answers to the problem are threefold, explained Dr. Vivek Parwani, medical director of the adult emergency department at Yale New Haven Hospital.
“First, we needed a substance use disorder advanced-analytics platform that would empower prescribers and dispensers to identify patients who may be at risk for prescription drug addiction, overdose and death, and equip clinicians and care teams with the tools and technology they needed to help those patients,” Parwani said.
“Appriss Health introduced us to NarxCare, which aggregates and analyzes prescription information from providers and pharmacies and presents interactive visual representations of that information, as well as advanced analytics and risk scores to help our physicians, pharmacists and care teams provide better patient safety and outcomes.”
"The technology has helped us combat the opiate epidemic by allowing us to quickly and easily view a patient’s controlled substance history, detecting abuse earlier, and allowing our doctors to intervene in those cases."
Dr. Vivek Parwani, Yale New Haven Hospital
This technology had the biggest impact of any tool that the hospital integrated into the EHR, and staff is able to see the Narx Score on the patient’s profile within the EHR. That’s really what has made a big difference, Parwani said. With this tool, staff has everything in one place to fully evaluate the patient’s history, and the graphs make the evaluation fast and streamlined, he added.
“The second proposal was we needed a managed-service platform to provide our healthcare providers with comprehensive connectivity, clinical-decision support, patient support and engagement, and care coordination,” he explained.
“We also needed a tool that would simplify integration of controlled substance prescription information into our health IT systems. This would save us the effort of building and sustaining individual integrations with each state PDMP through a single access point with existing integration of most EHRs.”
Fortunately for the hospital, the nation’s largest EHR and pharmacy-management systems have established connectivity with the Appriss Health PMP Gateway to integrate PDMP data, analytics, tools and resources directly into their clinical workflows, Parwani noted. With this tool, staff could gain the benefit of a rules-driven, data-integration service and platform that supports multiple protocols and states with just one interface, he added.
“The third was we needed an identity resolution system to process records from various data sources to identify a single individual’s records and provide an accurate record of a patient’s history,” he said.
“In health IT, patient record mismatches often occur when connecting information from multiple facilities or systems, and manual consolidation methods are subject to human error. ApprissID helps us prevent medical identity theft, medication errors and testing errors, wrong person procedures, or even death.”
It also gives the hospital peace of mind knowing that a patient’s history is up to date, as it links records and adapts to new information in real time, he said. The ApprissID alerts users when multiple patient matches are found.
“In an emergency department, where every second is critical, it’s imperative that a patient’s controlled substance information be easily accessible,” Parwani said. “The successful integration of an opioid-stewardship solution – which includes a substance use disorder platform, advanced analytics and patient-matching technology – would achieve that.”
NarxCare has helped the hospital combat the opioid epidemic by quickly and easily viewing patients’ controlled substance histories, detecting abuse earlier and allowing doctors to intervene in those cases, he said. From a provider’s perspective, it has been exceptionally reliable and one of the few interventions or tools that have been praised across the board by staff, he noted.
MEETING THE CHALLENGE
Frequently, patients present with an altered level of consciousness, and even as unresponsive. Often, there is no information available to help figure out the cause. Having quick, easy access to controlled substance prescription history can make a huge impact on decision-making in the ED. Seeing a patient’s controlled substance prescription history in a matter of seconds, rather than the several minutes it might have taken before, gives the doctor the ability to potentially save a patient’s life, Parwani said.
“For instance, Yale New Haven Hospital treated ‘JW,’ a 78-year-old female patient who was having a hard time breathing and presented to her primary care office with hypoxia, a low oxygen level,” Parwani recalled. “JW was a former smoker who had suffered a heart attack and chronic obstructive pulmonary disease. The clinicians who sent her to the ED were unsure which condition was causing her hypoxia. Testing for both heart failure and COPD were unrevealing.”
A check of NarxCare revealed a Narx Score of 571, which caused concern. The physicians who sent her to the ED were unaware of other prescribers. Like many patients, JW did not understand the risks of polypharmacy, the simultaneous use of multiple drugs to treat a single ailment or condition.
Access to NarxCare in the EHR allowed the ED physician to very quickly see what was wrong, Parwani noted. Yale New Haven physicians worked with JW’s team of doctors to assure a single provider and transparency of her prescriptions. On that day in the ED, NarxCare helped save her life, Parwani stated.
“The technology has helped us combat the opiate epidemic by allowing us to quickly and easily view a patient’s controlled substance history, detecting abuse earlier, and allowing our doctors to intervene in those cases,” he said.
RESULTS
Today, 100% of patients have a Narx Score visible on banners since intervention, Parwani said, pointing to the JW example as to how the technology achieves results.
ADVICE FOR OTHERS
“Any overlay to current EHR that requires fewer passwords and clicks is a success,” he advised. “Healthcare providers are overburdened with IT hurdles. Anything to simplify access to critical information is a win.”
Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himss.org
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