Harm related to opioid use is an on-going and escalating public health crisis, one with devastating consequences to our social and economic welfare. In 2020 alone, the CDC reports an estimated 69,710 opioid overdose deaths occurred in the United States, an increase of 36.7% from the estimated 50,963 deaths occurring in 2019. In one rural county, clinicians and administrators confronted the worsening epidemic head-on by proactively implementing the Cerner Opioid Toolkit, yielding life-saving results.
Fort HealthCare in rural Jefferson county, Wisconsin, is the sole hospital and only local resource of opioid stewardship. Between 2015-2017, the county death rate due to opioid overdose nearly tripled,1 and in 2017 alone, the county death rate due to opioid abuse exceeded the entire state of Wisconsin by 31%.2
In 2018, a standard opioid treatment agreement (OTA) was in place at Fort HealthCare, but presented a host of logistical and social hurdles. The agreement was difficult to locate within an individual's chart and depended on a voluntary patient disclosure. As a result, not only were clinicians frequently unaware of an active OTA, but a significant social barrier emerged for those who might be uncomfortable self-reporting opioid usage due to negative social stigmas surrounding addiction. At-risk patients were left to potentially shoulder their burdens alone, without the support of available programs or providers. More critically, gaps such as these can prevent access to interventional therapeutics, including naloxone, leading to increased suffering, adverse events, and overdose mortality.
The Cerner high risk alert for naloxone provisioning went live on Feb. 4, 2022. The alerts are designed to respond to individual prescription history and trend analytics, notifying physicians and care team members when a patient is under an OTA and could be considered vulnerable. These near real-time alerts enable providers to lift the social burden of self-disclosure, prompting crucial conversations about naloxone provisioning and providing relief to those reluctant to self-identify.
Martha Mauer, a researcher from the University of Wisconsin Sonderegger Research Center, testified to this benefit. "Reminding providers about patients “at risk,” and prompting providers to initiate a conversation about naloxone provisioning and prescribing are significant benefits of the clinical decision support (CDS) - Opioid Toolkit."
Patient accessibility to naloxone, both as a safeguard and therapeutic intervention tool, is a critical touchpoint during these patient-provider conversations. Should an at-risk individual suffer an overdose, naloxone can restore normal breathing within 2-3 minutes and reverse harmful effects. Clinical decision support (CDS) helps provide insights on patient prescription trends, aiding in the prevention of overprescribing opioids, as well as other drugs that could contribute to comorbidity. After resourcing the Cerner opioid management solution, Fort HealthCare saw a 53% decline in the number of patients with opioid prescriptions, and a 49% decline in the number of patients with benzodiazepine prescriptions.3 This served as a key benchmark toward eliminating harm caused by concurrent prescriptions. While benzodiazepines are not considered opioids, use of these medications, in conjunction with opioids, increases the risk of overdose.4
Dr. Jennifer Winter, Fort HealthCare internist and pediatrician/CMIO, aims to ensure that every patient, no matter what, has access to naloxone. “I think it [alert] helps me get closer to my goal of having naloxone on everybody and on patients that are on more than 50 MMEs a day. I think it’s [alert] been helpful to remind me to do that, and I think the more I see it, the more I remember when I am with patients.”
Affirmative feedback was consistent across the organization. Chris Barron, executive director of population health and clinical services at Fort HealthCare, also stated, “A provider from our practice shared with us that he knows his prescribing of naloxone has gone up since that alert has been in place.”
Fort HealthCare's journey is one of many along the way toward overcoming the complex issues associated with opioid-related harm. Through coordinated interventions, we can mitigate risk, enable critical provisioning of life-saving therapeutics, and work toward eliminating opioid mortality across the globe. As an ally in opioid stewardship, Cerner is committed to meeting patients where they are, and supporting patient-driven, not process-driven, interactions.
Addiction is treatable. If you or someone you know is struggling, treatment is available. While no single treatment method is right for everyone, recovery is possible, and help is available for opioid addiction.
Recovery is Possible: Treatment for Opioid Addiction | Drug Overdose | CDC Injury Center
1Based on data provided by Fort HealthCare showing 2015-2017 death rate per 100,000 population due to opioids across Jefferson County and the state of Wisconsin.
2Based on data provided by Fort HealthCare showing 2015-2017 death rate per 100,000 population due to opioids across Jefferson County and the state of Wisconsin.
3Based on data provided by Fort HealthCare comparing data between August 2019 and July 2020.
4Based on data from the National Institute of Drug Abuse.