Choice Architecture in Opioid Safety Alerting.

The need for effective and efficient clinical decision support (CDS) embedded in electronic health record (EHR) processes is growing. Using choice architecture design strategies may increase effectiveness of CDS solutions. The authors describe implementation of an opioid risk alert and subsequent revisions of that alert to increase effectiveness and reduce alert volumes. The first version of the alert used an opt-in choice architecture when recommending naloxone and the second version used an active choice design. The percentage of opioid prescriptions ordered with naloxone prescribed within the last 12 months increased significantly after implementation of the first version of the alert and then further increased significantly after implementation of the second version. Alert volumes decreased over the same timeframe. An education campaign was also implemented during the timeframe studied and likely also contributed to the naloxone outcomes seen.

Embedding a State-Wide Prescription Drug Monitoring Program into the Electronic Health Record.

A new FHIR-based (fast healthcare interoperability resource), EHR-integrated (electronic health record) application was created that embeds directly into prescribers' workflows. The intervention automatically performs MME (morphine milligram equivalent) calculations, highlights unsafe thresholds, while also presenting controlled-substance medications each patient is using. Using this intervention, the number of clinicians who have checked a patient's controlled substance prescription data has increased 57.4%. The number of patients being checked increased by 9.2%. The number of opioid prescriptions written after checking the new interventions data increased from 9% to 14%. Integrating these data into the EHR has saved over 1600 hours of labor per year. This work has also led to accruing five bonus points from the Medicare promoting interoperability attestation program. This initiative, and others like it, have helped Intermountain Healthcare decrease controlled substance pills by nearly 11 million, in the past five years.