(29) Prioritizing Integration of Prescription Drug Monitoring Program into the EHR

Background & Introduction: The opioid epidemic is an ongoing public health emergency. In response, the Centers for Medicare & Medicaid Services (CMS) updated the regulations for the Promoting Interoperability program for 2023 to include an objective measure requiring that participating hospitals query their state Prescription Drug Monitoring Program (PDMP) using their certified EHR Technology (CERHT). (1) In compliance with this directive, many California academic medical centers have integrated the PDMP into their EHR systems, addressing previously reported usability issues with the state's web-based platform by using single sign-on and automating patient matching(2). Usability and efficiency of health information technology have been shown to affect how well providers deliver quality patient care by impacting their work efficiency and preventing burnout(3). Our study aims to assess how the integration of PDMP in the EHR, with single sign-on and improved patient matching, may impact task efficiency, usability, and other human factors while also reducing EHR burnout among physicians.

Methods: We used a mixed methods analysis in a single-site study to compare two methodologies for accessing PDMP data: the website method (WM) and the integration method (IM) within the EHR that automates patient identity matching. Basic demographic data was collected through a survey. Workflow efficiency involved a time-motion study comparing the time physicians in Primary Care, Addiction Medicine, and Emergency Medicine took to use the PDMP website method versus the integration method for three patients in a scenario involving opioid refill. User satisfaction and usability were evaluated through a survey conducted following each method's use, utilizing the System Usability Scale (SUS) and the Net Promoter Score (NPS) for assessment, supplemented by qualitative data from semi-structured interviews. Data normality was verified with the Shapiro-Wilk test. Statistical analyses were conducted using Python (Version 3.8.5), ChatGPT4.0, and Microsoft Excel.

Results: Five Emergency Medicine, four Primary Care, and two Addiction Medicine physicians were recruited. Mean task efficiency using WM was 102.16 seconds and 39.15 seconds for IM. Analysis using a paired t-test revealed a significant 63.01 second improvement in task efficiency with IM (t-statistic: -5.4797, p < 0.05). Across all specialties, IM demonstrated significant time saved over WM, averaging approximately 56 seconds per patient in Addiction Medicine, 71 seconds in Emergency Medicine, and 59 seconds in Primary Care. The Mean SUS scores were 55.45 for WM and 85.91 for IM, while the NPS ratings were -81.82 for WM and 83.33 for IM. Qualitative data analysis highlighted thematic saturation in ease of use, improvements in quality of life due to reduced need for password memorization and additional clicks and tasks, and a high level of perceived reliability in the integration method.

Conclusion & Discussion: The integration of PDMP into EHR enhanced workflow efficiency and user satisfaction. High usability scores and user experience indicate a positive impact on reducing physician EHR-related burnout. A strength of this study is our engagement with physicians across various specialties and patient care environments, acknowledging their unique workflows and pain points as well as their different interaction points with patients within the healthcare system. Our findings suggest that the integration method benefits both inpatient and outpatient settings, resulting in substantial time savings and reduced EHR cognitive burden for healthcare providers, with potential to impact better quality of care for patient safety. Feedback from our addiction medicine providers, who often prescribe controlled substances such as buprenorphine in high volume settings, tells us they could greatly benefit from the integrated method of reviewing controlled substance history. An integrated PDMP offers the end-user information at their fingertips and facilitates ease of review with one click.

References: 1. Centers for Medicare & Medicaid Services. FY 2023 IPPS Final Rule Home Page [Internet]. [cited 2023 Nov 30]. Available from: https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/fy-2023-ipps-final-rule-home-page
MEDICARE PROMOTING INTEROPERABILITY PROGRAM 101 (cms.gov)
2. Hussain MI, Nelson AM, Polston G, Zheng K. Improving the design of California’s prescription drug monitoring program. JAMIA Open. 2019 Jan 28;2(1):160–72.
3. Middleton B, Bloomrosen M, Dente MA, Hashmat B, Koppel R, Overhage JM, et al. Enhancing patient safety and quality of care by improving the usability of electronic health record systems: recommendations from AMIA. Journal of the American Medical Informatics Association [Internet]. 2013 Jun 1;20(e1):e2–8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3715367/