Using the Electronic Medical Record to Ensure Compliance with Opioid Prescription Laws in Texas

BACKGROUND: The American population currently finds itself in the midst of a prescription drug overdose epidemic. This crisis has been fueled by an overreliance on opioid medications for the treatment of chronic pain. The state of Texas medical board (TMB) enacted a law change that restricts and regulates the prescribing and dispensing of controlled substances with respect to patients experiencing chronic pain. LOCAL PROBLEM: At the onset of this project, the University of Texas Southwestern (UTSW) system had no comprehensive measures in place to ensure compliance with these rules, and the current state of compliance was unknown. METHODS: Three clinics were chosen for observation to help understand the process of opioid prescribing for chronic pain treatment and the steps necessary to comply with the new law. Multiple Plan, Do, Study, Act (PDSA) cycles were applied to the process of baseline data measurement culminating in a final estimate of 3.1% ± 0.4% of applicable patient records written by UTSW providers in compliance with the law. INTERVENTIONS: Tools in the electronic medical record system (EMR) for tracking the use of scheduled medications in the treatment of chronic pain as well as for ensuring compliance with the new law have been developed and are in the process of implementation at the clinics with the largest populations of opioid-prescribed chronic pain patients. RESULTS: A chronic opioid registry was created, containing about 200 patients. Data retrieval is in process to determine the current rate of compliance. CONCLUSION: This project has successfully created a registry of the patients at UTSW on chronic opioid therapy and built an EMR structure that will ensure that these patients are cared for in a fashion compliant with TMB laws.