Column: Tackling Florida’s opioid crisis requires clinical collaboration

A Florida law is helping to drive much-needed change by sharing information between pharmacies and health care access points across the state, but there is more work to do.
A shared database can help health care providers suss out abuse of controlled substances such as OxyContin. [AP file photo]
A shared database can help health care providers suss out abuse of controlled substances such as OxyContin. [AP file photo]
Published May 2

The opioid epidemic has reached frightening proportions throughout Florida — with an estimated 2,798 opioid-related overdose deaths in 2016 alone, higher than the national average. Emergency medicine physicians have advocated strongly for the sharing of information across systems. Right now, emergency medicine physicians are primarily dependent upon information that patients are able or willing to provide.

Last July, Florida passed legislation requiring mandatory drug-lookups in compliance with the state’s Prescription Drug Monitoring Program. The law is helping to drive much-needed change by sharing information between pharmacies and health care access points across the state. In August, state officials reported that more than 92,000 healthcare providers registered to use an electronic database that tracks patients who are prescribed controlled substances. That’s more than double the number of providers who were registered to use the system the year before. While this has been an important step, it is not enough.

This past year, in collaboration with the Florida Hospital Association, the Florida College of Emergency Physicians was able to find a new technology system, provided by Collective Medical, that culls records from healthcare systems throughout the state, analyzes them and pushes that data to emergency physicians pro-actively. The Florida Hospital Association represents more than 200 member hospitals, placing it at the front lines of fostering a statewide culture of collaboration.

An important consideration of both groups is workplace safety issues. If someone has a history of violent outbursts, emergency physicians need to have that information to protect health care providers. Sharing information has been a game changer for hospitals in other states across the country. The relevance of the shared database is dependent upon participation: the more institutions, physician practices, and health care venues that contribute to the database, the more powerful and useful the tool becomes. For example, all 129 of Virginia’s hospitals were brought into the network and have seen valuable results so far.

According to Dr. Bruce Lo from Sentara Norfolk General Hospital, “A patient came to our emergency department with abdominal pain, representing a ‘Crohn’s flare,’ but did not share that he had been to 10 other emergency departments from other health systems within the past several months. Because we were able to review his outside records and see that he had four CT scans done of the abdomen within this time frame for the same complaint, we were able to skip the unnecessary CT scan and reiterate the plan that was given to him for his follow-up visit. Best of all, no narcotic prescriptions were given.”

The benefits for emergency departments alone is enormous: reduction of readmissions, decreased redundancy and unnecessary testing, mitigation of workplace violence risk and fewer prescriptions for controlled substances.

As emergency medicine physicians, we depend on access to information to offer the best care to our patients. The opioid epidemic is claiming the lives of our youth, our aging and complex patient population requires better communication around plans of care, the risk of harm due to violence in the workplace is a reality, and healthcare expenditures are increasing at an unsustainable rate. Now is the crucial time to come together across the state with a collective voice to advocate for improvement in the infrastructure of Florida’s health care system.

Dr. Kristin McCabe-Kline is president-elect of the Florida College of Emergency Physicians.

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