Healthcare executives react to proposed opioid crisis response act of 2018

As the opioid crisis rages unabated, both sides of the political spectrum have joined together to effect real change.

The Senate Health, Education, Labor and Pensions (HELP) Committee introduced The Opioid Crisis Response Act of 2018 on April 17, and will consider and seek to approve the bipartisan bill on April 24. The goal of the bill is to address the nation’s opioid epidemic by leveraging technologies such as EHRs, telemedicine and prescription drug monitoring programs (PDMPs) to improve opioid prescription-related data collection, analysis and sharing.

We asked executives from across the healthcare landscape to share their reactions to the proposed bill and their thoughts on how it might help address the opioid crisis.

Note: Responses have been edited for length and clarity.

Question: "How do you think The Opioid Crisis Response Act could change the healthcare landscape and, specifically, improve efforts to resolve our nation's ever-growing opioid epidemic?"

Gregg Church. President of 4medica (Marina Del Rey, Calif.):
“It is heartening to see that the legislation takes square aim at prescription shopping by removing some of the regulatory barriers to sharing substance abuse data between providers and states. However, this alone won’t eliminate the ability to get prescriptions from multiple providers.

Thanks to the reality that patient records reside across different systems, it is shockingly easy for someone addicted to opioids to change his or her identity and go from one prescribing provider to another. Going forward, it is crucial to ensure that each person who is prescribed an opioid has a verified matched identity. Providers, HIEs, state agencies and others can do so with a master patient index technology that looks at current and historical data on all identities in a system to quickly and easily match data to the right person. This new ability, combined with regulatory approval to share data, will help us make substantial progress on ending what has become a truly devastating epidemic of addiction.”

G. Cameron Deemer, President, DrFirst (Rockville, Md.):
“While the Act appropriately emphasizes making better use of data and technology to identify the hardest hit areas, those most at risk, and those already abusing drugs or drug shopping, it falls short of addressing the significant work needed to make that data shareable to prescribers within states and across state lines.

State PDMP checks are essential, but the PDMP does not provide a patient’s complete medication history, which is critical to informed and safe prescribing. Currently, many states only allow prescribers to check their own state PDMP databases. What’s more, in many states, data cannot be displayed or downloaded to be contained within electronic medical records and does not follow a patient from state to state. Nor do PDMPs follow standard naming conventions for consistent patient look-ups making it exceedingly difficult for providers to find accurate medication history on their patients. Lastly, Methadone, a key drug for treating substance abuse, is covered by a separate privacy rule that precludes it from being included in PDMPs and addicts can get Methadone at clinics without a prescription.

At the end of the day, we are making progress, but we need to be better. We wonder if the lower opioid prescribing rates are due to the availability of safer alternatives or because doctors have stopped prescribing opioids, even when appropriate, due to the increased potential of prosecution based on incomplete medication histories.
Better and more complete medication history available for physicians, and more substantial treatment programs are the best tools available right now to combat substance abuse.”

Scott McFarland. President of HealthBI (Scottsdale, Ariz.):
“One of the most promising aspects of this bill is that it tackles the confusion over how to appropriately disclose patient health information—in this case, substance abuse disorder medical records. Thanks to HIPAA, this confusion has long reined over common sense and kept many important initiatives in behavioral and mental healthcare from getting off the ground. That said, the Opioid Crisis Response Act doesn’t eliminate privacy concerns, and as we get deeper into sharing such records, it will be important to work with technology vendors and other organizations that are experienced in keeping patient data private and confidential.

Also, it looks like this bill will accelerate the long-wished-for integration of physical healthcare with behavioral healthcare and substance abuse counseling. For example, there is a directive to train providers such as pain specialists in detecting substance abuse. It will naturally follow that these providers will want to connect any patient with a suspected substance abuse disorder to the appropriate resources for help.

The very good news is that the model for this is already established with the integration of primary care services and behavioral health, and the use of shared data platforms that show a whole picture of patient health. These platforms are also adept at keeping patient data private and confidential.”

Elizabeth Marshall, MD, MBA. Director of Clinical Analytics, Linguamatics (Santa Cruz, Calif.):
“In analyzing the opioid crisis, we must ask if we are doing our best to identify patients before prescribed. Clearly, we aren’t, although adopting new technologies like artificial intelligence (AI) to advance our efforts helps. At the practice level, Jessie’s Law is a good start because it helps physicians identify positive histories. The law requires HHS to develop best practices for prominently displaying this information in EHRs, but only at the request of the patient. It’s thus only helpful for individuals that know they have a problem and want it known to all involved in their care.

We must also help patients that don’t realize they have a problem. Clinicians, who are committed to doing no harm, must take steps to identify at-risk patients before they do further harm to themselves or others. We must continue utilizing technologies like AI, especially those with augmented intelligence tools. Clinicians are overburdened with current tasks and lack the time and energy to uncover dependency patterns for all their patients. We must make wider use of technologies such as natural language processing (NLP) to identify dependency patterns – before additional harmful events occur.”

Jay Anders, MD. Chief Medical Officer of Medicomp Systems (Chantilly, Va.)
“This legislation is much ado about very little. It’s vital to understand that the majority of the opioids that are being abused are not based on legitimate prescriptions from physicians. That is a minor part of a much larger problem. So, tightening monitoring of these providers will do little to stem the tide of abuse or even begin to tackle the real crisis that our nation is facing.

As a physician, my biggest concern is that this type of legislation will only serve to reduce treatment for those patients who can actually benefit from an opioid as the medical profession may shy away from prescribing these drugs in order to avoid being the focus of intensive scrutiny.”

David Hom. Chief Evangelist of SCIO Health Analytics (West Hartford, Conn.):
“The Act is a great start, but we also need to consider the following factors:
● What is the influence of opioids on the total cost of healthcare for patients who have chronic conditions like diabetes or low back/joint pain? Such patients are less likely to be compliant with the care plan recommended by their providers, which leads to adverse events such as hospitalization or emergency department visits that result in higher costs.
● We must develop a greater understanding of the role social determinants of health play in opioid utilization. These include variables such as unemployment, low income, poorer access to health care providers, poor educational systems due to lack of funding, etc.
● Lack of providers to manage this disease, plus long wait times to access providers, which create barriers to accessing care and treatments.

Sui Tong, PhD. CEO of Smartlink Health (Cary, N.C.)
“The Opioid Crisis Response Act provides several initiatives that are instrumental in addressing the opioid epidemic ravaging our country. The act recognizes that the challenges faced around this crisis are multi-faceted and will require a multi-faceted approach. By including prevention, crisis responding, reversal resources, treatment/support for families and medical education, communities may be better able to make a difference.

Technology can help address the opioid epidemic and reduce emergency department (ED) readmissions by identifying rising-risk opiate users, alerting ED physicians whenever they see such a patient, and then bridging the patient to outpatient treatment via peer support.”

Eric Rock. Founder/CEO of Vivify Health (Plano, Texas):
“The Opioid Crisis Response Act of 2018 has identified the need for public and provider education; new approaches to prevention; assistance for recovering addicts; and coordination across the government agencies carrying out these plans. Importantly, the bill also seeks to leverage health information technology, including electronic health records and telemedicine, to reduce opioid abuse and help addicts manage their condition.

Digital health platforms designed to distribute information about self-care pathways across mobile, web and voice response systems can help provider organizations and states scale this type of approach quickly to entire populations. When these tools are combined with remote monitoring and intervention capabilities, including virtual visits, providers will be able to rapidly reach those who are in immediate need. This could be especially valuable in rural areas where addiction is rampant and healthcare resources are scarce.

The National Institutes of Health is currently funding research into the value of digital health platforms that could help doctors remotely monitor rural patients’ adherence to anti-addiction drugs. Aided by platforms like this, patients can use their devices to record themselves taking a medication such as buprenorphine and send video to medical personnel for verification. Patients can also report side effects and other symptoms. Electronic pill bottles and cartridge systems have also been used to improve adherence to anti-addiction medications.

The opioid crisis requires a human touch, augmented by technology designed to apply anti-addiction solutions on a mass scale.”

Liz Boehm. Research Director, Vocera Communications (San Jose, Calif.):
“The opioid crisis is taking an incredible toll, not just on patients and families, but on the doctors, nurses and other care team members who serve them. Approaches to understanding and limiting the likelihood of opioid misuse are essential. But so are strategies to help caregivers do their jobs safely, effectively and without fear of repercussion or depersonalization. An emergency room doctor can’t be both an effective advocate for her patients and a “policer” of drug-seeking patients. Additionally, a patient in pain deserves dignity, respect and responsiveness from his care team. These are some of the hidden casualties of the opioid crisis.”

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