Association between Electronic Medical Record Implementation of Default Opioid Prescription Quantities and Prescribing Behavior in Two Emergency Departments
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Larger quantities of opioid tablets for initial prescriptions are associated with transition to continued use.1 Default options, or conditions that are set in place unless an alternative is actively chosen, have been shown to influence behavior in many contexts, including increasing the rates of prescribing generic versus brand-name drugs to over 98% in primary care.2,3 Leveraging default options in electronic medical record (EMR) prescribing orders thus represents a promising approach to guide clinicians towards prescribing smaller quantities of opioid tablets, thus reducing continued use, misuse, and diversion.
In 2015, the emergency departments (EDs) of the Hospital of the University of Pennsylvania (HUP, annual volume 68,000) and Penn Presbyterian Medical Center (PMC, annual volume 41,000) adopted a new EMR (Epic, Verona, WI) to replace a homegrown EMR (EMTRAC). EMTRAC required the clinician to enter the number of tablets for opioid prescriptions. Since the...
KEY WORDSopioid prescribing defaults EMR
Research reported in this manuscript was supported by the National Institute on Drug Abuse and the National Institute of Child Health and Human Development of the National Institutes of Health under award numbers P30DA040500 (MKD, ZM, JP) K23HD090272001 (MKD). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Compliance with Ethical Standards
Conflict of Interest
Dr. Delgado reports receiving an honorarium for participating in an Expert Roundtable on Opioid Prescribing convened by United Health Group. Dr. Patel is the founder/owner of Catalyst Health, a technology and behavioral change consulting firm, and is a member of the advisory boards of Healthmine, Inc. and Life.io. All other authors declare that they have no conflict of interest.
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