From the 2019 HVPAA National Conference
Dr. Ashley Deutsch (Baystate Medical Center – University of Massachusetts Medical School), Dr. Niels Rathlev (Baystate Medical Center – University of Massachusetts Medical School), Dr. William Soares (Baystate Medical Center – University of Massachusetts Medical School)
In response to the national opioid crisis, Massachusetts enacted legislation requiring emergency department (ED) providers search an online database (PDMP) before prescribing opioids. The PDMP is a pull alert; providers must navigate the website and enter information to retrieve data. In contrast, electronic alerts (eAlerts) are notifications with recommendations for patients with frequent ED visits that are automatically “pushed” when the medical record is opened. Research has demonstrated a significant reduction in opioid prescriptions in patients with a pushed eAlert.
Our study evaluates ED providers’ experiences using eAlerts compared with the PDMP as well as the perceived impact on care in ED patients whom providers are considering discharge opioids.
An anonymous survey evaluating providers’ experiences using eAlerts and the PDMP for patients discharged with an opioid was created. The survey was piloted and modified for clarity and content by ED physicians not involved in the study. The survey was administered electronically via REDCAP to sixty-nine attending physicians and advanced practitioners at a single urban teaching hospital which had employed eAlerts and PDMP. Data was analyzed using simple descriptive statistics. Thematic analysis was used to categorize open-ended questions.
Sixty participants (86%) responded to the survey, including 48 of 54 attending ED physicians and 12 of 15 advanced practitioners. 80% reported they used both the PDMP and the eAlerts, 7% used only the PDMP, and 13% reported using neither. The eAlerts rated easier to access (median score 75 vs 37, p<0.001) and more helpful in directing care (median score 72 vs 55, p<0.001). ED providers frequently stated that the eAlert being “pushed” to them had the biggest impact on improving care with minimal interruptions. Difficulties cited with using the PDMP included technical difficulties accessing the site and lack of up-to-date information.
ED providers preferred the pushed eAlert system to the pulled PDMP for its ease of use and minimal interruption to workflow.
Although the implementation of eAlerts for all patients is not feasible, our study offers insight into improvements that may be incorporated into future versions of the PDMP that would improve ease of use for ED providers.