Clinical Decision Support for Chronic Pain Management

From 2009 - 2019, the mortality rate due to opioid overdose was consistently rising, 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 o 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, the CDS Connect initiative concentrated on chronic pain management, including developing an interoperable Pain Management Summary or “dashboard” that consolidated patient-specific, pain-related information, which is normally scattered throughout an electronic health record, into a single view for clinicians.

RTI International, along with partners at Vanderbilt University Medical Center, University of Chicago, iParsimony, LLC, MD Partners, and Dynamic Content Group, LLC, 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. It developed implementation guides and reusable, shareable CDS knowledge artifacts that were suitable for public posting on CDS Connect. These shared decision-making tools were evaluated by assessing impact and lessons learned during the development, implementation, and dissemination phases.