In a study across five university-affiliated emergency departments, integrating the prescription drug monitoring program (PDMP) into the electronic health record (EHR) and adding a PDMP risk score showed small increases in PDMP review likelihood, but overall, the combination of EHR and PDMP did not significantly enhance PDMP use.

The following is a summary of “Implementation of Electronic Health Record Integration and Clinical Decision Support to Improve Emergency Department Prescription Drug Monitoring Program Use,” published in the January 2024 issue of Emergency Medicine by Hoppe, et al.

For a study, researchers sought to determine how well three electronic health record (EHR)-based interventions worked to get more people in the emergency department (ED) to use the prescription drug monitoring program (PDMP): integrating the PDMP into the EHR, adding a PDMP risk score, and adding an EHR-based clinical decision support alert to look at the PDMP when prescribing an opioid. A potential stepped-wedge design was used to carry out three intervention steps at 5 university-affiliated EDs split into three practice groups. 

PDMP use and prescription rates were compared with those at the start, before EHR integration, and those in a resilience stage where the clinical decision support warning was removed. Still, EHR integration and the risk score stayed the same. It was looked at using a generalized linear mixed model with a logit link function and a random intercept for doctors. At all times, the ED provider PDMP review that happened before administering opioids was low. 23.8% of people who got interruptive clinical decision support alerts looked them over, which is the highest rate (interquartile range: 10.6 to 37.5). 

Overall, the number of opioid prescriptions went down, and the PDMP review was not linked to a drop in opioid prescriptions. The chance of writing an opioid prescription went down as the number of previous opioid prescriptions went up (odds ratio: 0.92 [95% CI: 0.91 to 0.94] for every new prescription). The combination of EHR and PDMP did not lead to more PDMP use in the ED. However, a PDMP risk score and a clinical decision support warning were linked to small increases in the likelihood of a PDMP review. When the PDMP was looked at, ED doctors were less likely to give painkillers to people who have already been prescribed a lot of opiates.

Source: sciencedirect.com/science/article/abs/pii/S0196064423005590