Garden State hospitals will test computer software designed to reduce opioid prescriptions and improve the quality and continuity of care provided by their emergency departments, thanks to grants arranged by the New Jersey Hospital Association.
Already in use in 17 other states, the computerized tracking tool generates an easy-to-read summary of the patient’s medical history — with warning flags for certain suspect behaviors — enabling ER doctors to quickly identify those who may be addicted to opioids. The system also lists the patient’s regular physician and any established treatment plan, which allows another provider to zero in on the most effective response and coordinate with others for follow-up care.
The hospital association, which represents the state’s 72 acute-care facilities, announced earlier this month that it would invest $1.5 million to help these providers install and operate the system for the first year; the funding is provided by the NJHA’s affiliate, the Health Research and Educational Trust of New Jersey. Future costs will be the hospitals’ responsibility.
Developed by Collective Medical, a Utah-based healthcare technology company, the software has led to significant drops in opioid prescriptions in other states, while also allowing hospitals to avoid spending millions of dollars on unnecessary or improper care, the company said. Washington State, the first to roll it out statewide, saved $34 million the first full year it was in operation and reduced ER opioid prescriptions by nearly one quarter.
“It really ties in all of the care together, cuts down significantly on opioids, saves a ton of money for the hospital, and is a real crowd pleaser for the physician,” explained Dr. Marjory Langer, who heads the emergency department at St. Joseph’s Wayne Hospital. “But it’s also about doing what’s right for the patient.”
Langer, the state chapter president of the American College of Emergency Physicians, visited hospitals in Boston that are already using the system on a trip led by Collective Medical. “It’s a no brainer,” she said.
Stemming the opioid tide
The opioid epidemic has taken a significant toll on New Jersey, with some 76,000 seeking treatment last year. More than 2,000 deaths were attributed to drugs in 2016, and data that suggests the state is on track to lose at least 3,000 lives to the disease this year. While these numbers include heroin and prescription opioids, in addition to other illicit drugs, research suggests four out of five recent heroin users first got hooked on pills — either legally prescribed or illicitly obtained.
Efforts to reduce the flood of legal opioids have started to have an impact, with prescriptions dropping 20 percent since 2015, according to the state Department of Health. New Jersey now has the nation’s strictest limit on new opiate prescriptions (five days only) and has expanded its prescription-monitoring program, or PMP, a database that is designed to provide detailed information on a patient’s opioid use.
The Alternatives to Opioids program, or ALTO, developed by experts at St. Joseph’s Health, has also helped ER doctors at its Paterson hospital cut addictive prescriptions by 84 percent in two years. Health officials are now seeking to expand this effort statewide, while New Jersey’s federal delegation hopes to implement a national pilot program based on the initiative.
(NJ Spotlight is hosting a series of roundtable discussions on opioid addiction; the first event, on prevention, held last week, touched on these efforts. A panel on treatment is scheduled for September, followed by a session on recovery in October.)
Langer said the prescription database is helpful, but can be cumbersome and slow, which presents problems for emergency room use in particular. The software from Collective Medical — which grew out of an emergency room social worker’s frustration with the lack of quality patient information — can be set up to draw information from the PMP, plus electronic health records from multiple hospital networks, insurance companies, and other data systems. It is designed to be accessed with a single click, avoiding time consuming log-in processes common to most medical technology.
An official endorsement
While other systems have been developed, Langer said they tend to work within a single insurance network, which limits the information available to providers; the academy of emergency physicians has officially endorsed the Collective Medical tool. The company is now working with New Jersey hospital administrators to secure contracts, Collective said, and the program should be implemented soon.
“We’ve seen far too many drug victims come into our EDs when it’s already too late to save them,” NJHA president and CEO Cathy Bennett said. “While opioid abuse is one of our most urgent needs, this resource has the potential to be a powerful population health tool through better coordination across care settings.”
Dr. Mark S. Rosenberg, who heads the emergency medical department for St. Joseph’s Health, which includes the Wayne hospital, and led the development of the ALTO system, stressed the multiple ways the Collective Medical tool can benefit patient care.
In addition to helping providers avoid fueling an addiction, Rosenberg said it enables them to offer more effective treatment to patients with complex chronic conditions that require multiple therapies. If one of his patients shows up at another emergency room, anywhere in the state, the information allows the ER doctor to rule out certain conditions, potentially eliminating the need for costly screenings or admission.
“Oftentimes we see patients jump from hospital to hospital to hospital,” Langer added, but, in the past, “there was really no good way for me to find out where they’ve been.”
But the advantages go beyond any one patient, Rosenberg said, underscoring the system’s role as a population health tool. Nationwide, 17 percent of emergency room patients are prescribed an opioid, he said, so any tool that can help reduce those will help providers chip away at the epidemic.