Skagit Regional Health using data to combat opioid addiction
MOUNT VERNON — In 2017, 1,431 people were admitted to the Skagit Regional Health emergency division due to opioid overdose, according to organization materials.
In a county where 53 percent of people who have used heroin say they were “hooked on” opioids first, health care providers are working to prevent and mitigate addiction.
At Skagit Regional Health, staff are working on a project that will allow the organization to leverage data from its new electronic medical records system — installed in October and known as EPIC — to monitor and analyze opioid prescription practices.
In May, the organization launched the “Enhancing Safe Opioid Prescribing” project, which will use the system’s data to gather and display information that will help staff limit the number of opioids that are prescribed to patients.
Earlier this year, the organization chose not to sign onto a county lawsuit against pharmaceutical companies for the industry’s role in the opioid crisis.
“Because of the fact that we are basically providers of opioids and we have pharmacies, we thought it was kind of conflicting in terms of what we were doing in respect to how we’re providing for our patients,” Board of Commissioners member Bruce Lisser said previously.
Instead, Skagit Regional Health has turned its attention to monitoring its opioid practices.
Based on national and state guidelines, Skagit Regional Health has developed goals for addressing the opioid epidemic. Those include preventing opioid misuse and abuse, treating opioid dependence and preventing deaths from overdose, according to organization materials.
The electronic records project is intended to further these goals by using data to monitor and evaluate the organization’s opioid prescription practices, said Regional Vice President and Chief Medical Officer Connie Davis.
By the end of the project, the team hopes to gather and integrate 17 data points into the dashboard that providers see when a patient comes in for a visit, Chief Medical Information Officer Joshua Griggs said. Two of the data points currently show up on dashboards, while the rest are in progress.
Some of the data being gathered concerns the details of opioid prescriptions — the overall number of prescriptions written, what was ordered, how much was administered and which medical procedures result in the highest opioid prescriptions.
The new electronic system will allow this data to automatically flow onto providers’ dashboards, Griggs said.
Tracking those data points will not only allow leadership to monitor how the organization prescribes opioids, he said, but will let providers see how their practices compare to others.
In looking at the data, the focus is on bringing opioid dosage down and offering other ways to control pain, Chief Physician Officer Mary Ann Hink said.
“For me, I’m really looking for EPIC to be able to help our physicians, and all our providers, to know how they’re prescribing and where they can potentially target,” Hink said.
David Jefferson, a public health analyst for the county, said this effort is exactly what the department would like to see from health care providers.
“What’ll happen is a physician gets feedback on their prescribing behavior compared to similar people,” Jefferson said. “If they see themselves as an outlier — that they’re prescribing more than their peers — people will usually self-correct and start behaving more like the norm.”
Providers can be outliers for a variety of reasons, Hink said, such as having a disproportionate number of chronic pain patients.
If providers are simply prescribing too much, seeing the data will hopefully help them self-correct, Hink said.
The provider dashboard will also compare providers’ data to state and national prescription guidelines, Griggs said. If a provider prescribes a higher-than-recommended dosage, an alert will pop up on his or her screen.
The project will also reveal to providers a more comprehensive view of patient data, Griggs said. The records system can integrate with other organizations using EPIC, such as PeaceHealth, Providence, the Everett Clinic and Swedish.
Having that information close at hand when seeing a patient helps prevent “doctor shopping” — when a patient visits multiple doctors to get more opioid prescriptions — Griggs said.
“It makes a big difference in doctor shopping and just kind of knowing what other prescribers are doing in terms of the plans for the patient,” Griggs said.
The project also makes it easier to prevent putting patients on opioids in the first place, Hink said.
When a provider makes a prescription, his or her dashboard will offer suggestions for alternatives to opioids, such as chiropractic work or IV Tylenol.
“Presenting those as options without providers having to look and think ‘what about this one, what about that one’ is really beneficial. They’re all there and that makes (alternatives) the first choice,” Griggs said.
Before the new system, Skagit Regional Health was operating four different record systems that weren’t compatible with one other, Griggs said.
Without EPIC, he said the new project would be “completely impossible.”
When seeing patients, the EPIC dashboard will also show providers what data they’re missing.
“If you have a dashboard and you can see a patient hasn’t had a drug screen after several months, that’s going to make you be able to be proactive and order the test,” Griggs said. “So you can know if you’re checking all the boxes you’re supposed to be checking to safely prescribe the (opioids).”
While EPIC has provided Skagit Regional Health a much more comprehensive view of its opioid prescriptions, Davis said it still has some holes.
For one, it doesn’t include data from pharmacies. For that information, providers currently log into a separate state database.
“Right now, it’s cumbersome to get into the (state) system,” Davis said.
She said Skagit Regional Health is working to get the state database integrated with EPIC, “so the information is pushed, rather than you having to pull.”
With the goal of finalizing all 17 data points by mid-2019, Griggs said much work remains to be done. But with the steady advancement of technology, the project will never truly be over.
“Technology is just one aspect of many different tools we’re using to fight this battle,” he said.