Abstract
Background Provider prescribing practices contribute to an excess of opioid-related deaths in
the United States. Clinical guidelines exist to assist providers with improving prescribing
practices and promoting patient safety. Clinical decision support systems (CDSS) may
promote adherence to these guidelines and improve prescribing practices. The aim of
this project was to improve opioid guideline adherence, prescribing practices, and
rates of opioid-related encounters through the implementation of an opioid CDSS.
Methods A vendor-developed, provider-targeted CDSS package was implemented in a multi-location
academic health center. An interrupted time-series analysis was performed, evaluating
30 weeks pre- and post-implementation time periods. Outcomes were derived from vendor-supplied
key performance indicators and directly from the electronic health record (EHR) database.
Opioid-prescribing outcomes included count of opioid prescriptions, morphine milligram
equivalents per prescription, counts of opioids with concurrent benzodiazepines, and
counts of short-acting opioids in opioid-naïve patients. Encounter outcomes included
rates of encounters for opioid abuse and dependence and rates of encounters for opioid
poisoning and overdose. Guideline adherence outcomes included rates of provision of
naloxone and documentation of opioid treatment agreements.
Results The opioid CDSS generated an average of 1,637 alerts per week. Rates of provision
of naloxone and opioid treatment agreements improved after CDSS implementation. Vendor-supplied
prescribing outcomes were consistent with prescribing outcomes derived directly from
the EHR, but all prescribing and encounter outcomes were unchanged.
Conclusion A vendor-developed, provider-targeted opioid CDSS did not improve opioid-prescribing
practices or rates of opioid-related encounters. The CDSS improved some measures of
provider adherence to opioid-prescribing guidelines. Further work is needed to determine
the optimal configuration of opioid CDSS so that opioid-prescribing patterns are appropriately
modified and encounter outcomes are improved.
Keywords clinical decision support system - electronic health record - opioids - quality improvement
