Table 4.

Socio-Technical Strategies for Storing and Accessing LtOT Patient–Related Data

EHR-linked registryData extracted directly from the EHR into the registry.Easy to access detailed reports.Required significant resources to build (time, skills, funding).Clinicians had to click out of the EHR to reach the registry.“Once the data is there and the structure is built, the work is just finding the data. A lot of the work was collaborative with the folks who work with the EHR. Digging and finding where the template data was stored.”
Excel spreadsheetEasy to control (change variables, edit entries, track elements for updating).Inexpensive.Provided an interim system until an EHR-integrated system was possibleRequired manual chart review or data entry by clinical personnel (e.g., medical assistant) to populate with data.Hand-entered data from chart reviews onto excel spreadsheet (errors more likely, time consuming).Needed a cue to know when there were new data to enter. Cumbersome to keep historical data, therefore difficult to track trends.Required IT support to make more usable (e.g., turning the font red when patient overdue for a urine drug test).Not integrated with the EHR for use in patient care.Excel is a “quick and easy reference.”“If I was gone or something, I would miss getting the flags from the nurses saying that hey, we refilled this medication. So I never really took the time to go and backtrack, I just went forward from there.”
Proprietary softwareData from the EHR extracted with proprietary software into a report.Simple to use, others could step in with minimal training.Not all proprietary software in use at organizations was nimble enough to easily create LtOT reports.Proprietary software still needed a list of patients to query, which required maintenance.“They’re adding COT module, but they haven’t done that yet; we’re already married up to them and we like it, but they aren’t there yet.”
EHR queryData extracted directly from the EHR.Did not require additional system or proprietary software.Required translation of query into a tracking report.Required double-checking via chart review or provider consultation as reports often included errors.Difficult to troubleshoot why errors occurred.Difficult to limit to current patients on LtOT.Exporting from EHR to Excel produced a report that took hours to make readable.“Inquiries in [EHR] are pretty primal; created several of our own, but they’re fraught with problems; we never get the same list of patients.”“Exporting is a pain… It does not produce a usable spreadsheet—it takes hours to go through it to make it usable.”
  • COT, chronic opioid therapy; EHR, electronic health record; IT, information technology; LtOT, long-term opioid therapy.