Organizational Approaches Used to Overcome Challenges in Identifying Patients on LtOT
| Approach | Strengths | Weaknesses |
|---|---|---|
| Program using prescriptions to pull patients into an EHR-linked registry | Can use multiple EHR variables to produce the registry list and update it efficiently | Required significant IT resources.Difficult to develop an LtOT definition that was searchable.EHR prescription data were sometimes identified as inaccurate when vetted. |
| Query EHR for patients with opioid treatment agreement | Organizations frequently prioritized getting opioid treatment agreements signed as an early step in improving care | Required developing a custom, searchable data field for the opioid treatment agreement if not already present in the EHR, or doing a chart review.Sometimes included patients taking other non-opioid controlled substances.Missed patients without a signed opioid treatment agreement. |
| Query EHR for patients with documentation of MED | Organizations frequently prioritized calculating MED as an early step in improving care | Required developing a custom, searchable data field for MED if not already present in the EHR, or doing a chart review.MED often not calculated or inconsistently calculated.If MED not updated to 0 after cessation of LtOT, over-counted patients.Assumed MED is calculated only for patients using LtOT. |
| Query EHR for patients with prescription for opioid medication | Directly uses the primary element of interest, opioid prescriptions | Search complicated due to many different types of opioids, each with many brand names.Opioid medication lists require updating as new opioid medications become available.Required significant manual cleaning time to target only patients who were “currently” receiving LtOT and who met the definition of LtOT rather than acute opioid therapy. |
| Query EHR for patients with a designated diagnosis used to code for LtOT | Clinician-led cohort identification increased accuracy of diagnosis | Clinicians resisted applying a designated diagnosis.At the time of the study, there was no clear diagnosis for patients on LtOT.Relied on care teams knowing how to consistently apply the diagnosis. |
| Pull provider reports from the state prescription monitoring database | Useful cross-check of internal data | Organizations thought the state drug database lists were inaccurate.Was not possible to run a clinic-wide report, required running individual provider reports.Required manual cleaning time to identify only those patients who met the definition of LtOT rather than acute opioid therapy. |
EHR, electronic health record; IT, information technology; LtOT, long-term opioid therapy; MED, morphine-equivalent dose.