Clinical Decision Support for Chronic Pain Management

From 2009 to 2019, mortality rates due to opioid overdose consistently rose, with evidence that overuse, misuse, and abuse of prescription opioid pain medication was one of the major contributing factors. The U.S. Department of Health and Human Services (HHS) demonstrated its commitment to addressing opioid abuse, dependence, and overdose by developing a five-point comprehensive strategy: 1) better data; 2) better pain treatment; 3) more addiction prevention, treatment, and recovery services; 4) more overdose reversers; and 5) better research. During this time, the Agency for Healthcare Research and Quality (AHRQ) produced data, fostered research, and developed tools to support the HHS strategy to address this epidemic.

Since 2016, AHRQ has supported an initiative to advance evidence into practice through CDS and to make CDS more shareable, standards-based, and publicly available. One component of the initiative, CDS Connect, focused on prototype infrastructure for sharing CDS resources. In 2018, CDS Connect focused on chronic pain management, including developing an interoperable Pain Management Summary or “dashboard” that consolidated patient-specific, pain-related information normally scattered throughout an electronic health record into a single view for clinicians.

MedStar Health Research Institute along with partners at Georgetown University, George Washington University, Vessel Partners, INC, and American Institutes for Research was one of two contracts that built on the CDS Connect experience, including developing, implementing, disseminating, and evaluating CDS for both patients and clinicians in the area of chronic pain management.

The specific aims of the research were to create CDS that:

• Was interoperable and publicly shareable.
• Met the needs of both patients and clinicians through both patient-facing and clinician-facing channels and formats.
• Demonstrated impact through the evaluation with appropriate measures and outcomes.

The research leveraged Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR) standards and built upon resources available on CDS Connect, such as the Pain Management Summary. It explored methodologies to identify patients at high risk of adverse outcomes from opioids. The use case of the app changed from tapering of opioids to tracking of outcomes that included touch points of care to facilitate and encourage provider-patient engagement. The project developed implementation guides and reusable, shareable CDS knowledge artifacts that were suitable for public posting on CDS Connect.