Clinical Decision Support for Chronic Pain Management

The mortality rate due to opioid overdose has been consistently rising over the last decade, with evidence that overuse, misuse, and abuse of prescription opioid pain medication are major contributing factors. The U.S. Department of Health and Human Services (HHS) has 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. The Agency for Healthcare Research and Quality (AHRQ) has been producing data, fostering research, and developing tools to support the HHS strategy to address the epidemic. Computerized clinical decision support (CDS) is an area where innovative solutions may hold promise.

Since 2016, AHRQ has supported an initiative to advance evidence into practice through CDS and to make CDS more shareable, standards-based, and publicly available. One component of the initiative, CDS Connect, focuses on prototype infrastructure for sharing CDS resources. In 2018 CDS Connect focused on chronic pain management, including developing an interoperable Pain Management Summary, or “dashboard,” that consolidated patient-specific, pain-related information normally scattered throughout an EHR 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, represents one of two contracts that will build 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 are to create CDS that:

• Is interoperable and publicly shareable 
• Meets the needs of both patients and clinicians through both patient-facing and clinician-facing channels and formats 
• Has demonstrable impact by evaluating with appropriate measures and outcomes. 

The research will leverage Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR) standards and build upon resources available on CDS Connect, such as the Pain Management Summary. It will explore methodologies to identify patients at highest risk of opioid overdose or other adverse outcomes from opioids. It will develop implementation guides and reusable, shareable CDS knowledge artifacts suitable for public posting on CDS Connect or other platforms. These shared decision-making tools will be evaluated by assessing impact and lessons learned during the development, implementation, and dissemination phases. At the conclusion of the research, the findings will be disseminated via a final report that will be posted on the AHRQ website and a peer-reviewed publication.