HCA Healthcare harnesses health IT to combat the opioid crisis

HCA Healthcare is investing in technology that helps physicians monitor narcotic prescribing to improve the way opioids are prescribed, while ensuring that patients have access to safe, effective pain management. Read on to find out how our scale and skill allows us to harness the power of data to improve more lives across the United States…

The numbers are staggering. Every day, on average, 130 Americans die from opioid overdose. In 2017, an estimated 1.7 million people in the United States suffered from substance use disorders related to prescription opioid pain relievers. To reverse the trajectory of this epidemic, leveraging data collected from more than 31 million annual patient encounters, HCA Healthcare healthcare has:

• Developed cutting-edge pain treatment protocols
• Promoted enhanced surgical recovery programs
• Launched national “Crush the Crisis” opioid take back events
• Deployed prescription monitoring and reporting programs

Leveraging prescribing data

“HCA Healthcare has made tremendous advances in how we use data collected from our network of hospitals and clinics to improve patient care,” said Dr. Christopher Ott, chief medical officer at HCA Healthcare’s Physician Services Group (PSG).

HCA Healthcare has employed our internally developed data, reporting and vendor information technology (IT) platforms to aid us in these efforts. In 2014, a multidisciplinary team began extracting prescribing data from the company’s electronic data warehouse (EDW) and ambulatory electronic health record (EHR) system to report on location, patient and provider specific prescribing data.

Dr. Carol White, director of pharmacy services and clinical therapeutics at HCA Healthcare, helped lead the initiative.

“It was a major undertaking,” Dr. White said. “We had to create an entire medication-specific reporting architecture within our enterprise data warehouse to house the data, develop algorithms for certain medications and calculations, and establish workflows for providers that streamlined their work, while capturing the data in a way that allowed us to utilize it more efficiently.”

Using HCA Healthcare’s in-house analytics, the team created a reporting dashboard to examine prescribing patterns across the organization. All of this aimed at improving the way opioids are prescribed and how data is shared with providers.

“This kind of deep insight creates opportunities to empower the provider with their own data,” Dr. White said. “Real trends began emerging in less than one year,” she added.

Electronic Prescribing for Controlled Substances (EPCS)

The team implemented the dashboard in tandem with the launch of Electronic Prescribing for Controlled Substances (EPCS), which allows providers to electronically transmit controlled substance prescriptions to a pharmacy. EPCS provides accountability, security, and has been shown to dramatically reduce medication errors and fraud.

Partnering with the National Academy of Medicine (NAM)

HCA Healthcare also established new processes and standardized safeguards to protect providers, patients and communities. In July 2018, HCA Healthcare joined the National Academy of Medicine’s Action Collaborative on Countering the U.S. Opioid Epidemic and provided $500,000 to help bolster the fight against the crisis.

Using data to develop new strategies for pain management

Enhanced Surgical Recovery (ESR)

HCA Healthcare developed new strategies to manage pain for the 1.5 million patients that have surgery annually in an HCA Healthcare facility. HCA Healthcare’s Enhanced Surgical Recovery (ESR) is an innovative surgical approach that uses evidence-based pre, intra, and post-operative interventions to optimize patient outcomes.

ESR, which features a multi-modal approach to pain management for patients, has demonstrated significant improvements in surgical recovery and – importantly – a drastic reduction in the use for opioids.

HCA Healthcare data from January 2018 through June 2019, collected from 47,400 major abdominal, joint, gynecologic oncology, spinal and bariatric ESR surgeries revealed an up to 50.4% decrease in opioid use for these patients. The data, collected from 114 affiliate hospitals, was compared to a non-ESR protocol patient population undergoing the same surgery procedures in the same time period.

The goal is to implement ESR in all HCA Healthcare facilities, in a least one major service line, by the end of 2019.

ALTernatives to Opioids in the Emergency Room (ALTO in the ER) 

With ALTO in the ER, HCA Healthcare’s goal is to manage painful conditions for emergency department patients and return them to a maximum quality of life, while recognizing and reducing the inherent risks of administering and prescribing highly addictive medications like opioids.

In 2017, affiliate Swedish Medical Center pioneered the first-of-its-kind strategy to curtail potential opioid misuse related to the use of opioids in the emergency department. With the ALTO in the ER program, rather than using opioids like oxycodone, hydrocodone or fentanyl, medications like ketamine and lidocaine are employed for frontline pain management.

Because of this emergency department initiative, patient opioid use at affiliate Swedish Medical Center from June – November of 2017 was reduced by 36%, compared to data from a non-ALTO patient population over the same time period in 2016.

HCA Healthcare plans to continue to expand the ALTO in the ER protocols enterprise-wide through the end of 2019.

Prescription Drug Monitoring Program (PDMP)

In its most recent step to combat the crisis, HCA Healthcare’s Physician Services Group (PSG) is installing a platform that seamlessly connects each state Prescription Drug Monitoring Program (PDMP) to a provider’s EHR.

The tool allows providers to quickly perform multi-state checks and monitor real-time controlled substance data directly from their patient’s health record, saving time, improving care and preventing patient harm. PSG successfully piloted the platform in Virginia earlier this year.

According to Dr. Ott, providers have appreciated the ease of use of the platform. “We have established safeguards and processes over the past five years to reduce the risks associated with medication management in the outpatient space. The integration of this platform is a huge step forward in helping to combat the opioid crisis and protect our patients, their families, and the communities we serve,” he said.