Effect of an Electronic Health Record “Nudge” on Opioid Prescribing and Electronic Health Record Keystrokes in Ambulatory Care

作者：Jessica S. Ancker, J. Travis Gossey, Sarah Nosal, Chenghuiyun Xu, Samprit Banerjee, Yuming Wang, Yulia Veras, Hannah Mitchell, Yuhua Bao · 发表于：Journal of General Internal Medicine · 年份：2020 · DOI：10.1007/s11606-020-06276-1 · 被引用次数：19 · 研究领域：Electronic Health Records Systems、Opioid Use Disorder Treatment、Medication Adherence and Compliance

BACKGROUND: Multiple policy initiatives encourage more cautious prescribing of opioids in light of their risks. Electronic health record (EHR) redesign can influence prescriber choices, but some redesigns add to workload. OBJECTIVE: To estimate the effect of an EHR prescribing redesign on both opioid prescribing choices and keystrokes. DESIGN: Quality improvement quasi-experiment, analyzed as interrupted time series. PARTICIPANTS: Adult patients of an academic multispecialty practice and a federally qualified health center (FQHC) who received new prescriptions for short-acting opioids, and their providers. INTERVENTION: In the redesign, new prescriptions of short-acting opioids defaulted to the CDC-recommended minimum for opioid-naïve patients, with no alerts or hard stops, such that 9 keystrokes were required for a guideline-concordant prescription and 24 for a non-concordant prescription. MAIN MEASURES: Proportion of guideline-concordant prescriptions, defined as new prescriptions with a 3-day supply or less, calculated per 2-week period. Number of mouse clicks and keystrokes needed to place prescriptions. KEY RESULTS: Across the 2 sites, 22,113 patients received a new short-acting opioid prescription from 821 providers. Before the intervention, both settings showed secular trends toward smaller-quantity prescriptions. At the academic practice, the intervention was associated with an immediate increase in guideline-concordant prescriptions from an average of 12% to 31% of a...