Figure 1.

Opioid prescribing workflow in the electronic medical record. When providers write a prescription for opioid medications, they receive an alert to complete the Opioid Risk Tool (ORT) if not already done according the patient's age group. The ORT score stratifies patients into 3 categories of risk for opioid-aberrant behavior (low, medium, high). The rule engine for the chronic opioid registry then determines the recommended frequency of documenting best practices for safe management (eg, the annual pain contract and functional assessment). The recommended functional assessment includes at a minimum the Pain, Enjoyment, General Activity (PEG) 3-item pain scale and the 4-item Patient Health Questionnaire for Depression and Anxiety (PHQ-4). The chronic opioid health maintenance tool displays if high-risk patients have an active medication order for naloxone. This workflow does not apply to acute pain management. Benzo, benzodiazepines; MEDD, morphine equivalent daily dose; ORT, opioid risk tool; PDMP, prescription drug monitoring program; Rx, prescription; UDS, urine drug screen.