Table 4.

Provider recommendations for opioid prescription drug monitoring program and clinical decision support tools in the military hospital setting

Domain	Specific Examples
Information to Include	Prescription
	Drug names (controlled and noncontrolled)
	Number of prescriptions
	Dates of prescriptions
	Prescription doses
	Number of tablets/quantity
	Indications
	Prescribing provider(s)
	Name
	Specialty
	Service/clinic (eg, primary care, emergency)
	Location
	Date of visit
	Sole provider contact information
	Number of providers being seen
	Prescription filled
	Yes/no
	Date
	Location
	Form of payment (eg, cash, insurance)
	Refills
	Number of refills
	Refill attempts
	Dates
	Location(s)
	Early refills
	Form of payment (eg, cash, insurance)
	Patient history
	Reported reason for visit(s)
	Prior overdose
	Prior hospitalization for opioid misuse
	Chronic pain
	Doctor shopping
	Urine drug screens
	Involvement in a sole provider program
	Patient summary
	Prior controlled medications
	Trends in opioid and pain therapy over time
	Age
	Provider visits
	Dates
	Service/clinic (eg, primary care, emergency)
Suggested Alerts	When patient fills medication
	When patient fills early
	When patient fills medication from another provider
	Patient is high risk
	Develop threshold for average prescriptions/year (for this type of patient/case) and alert if patient is higher than average
	When another medication might be more appropriate (eg, “consider using something less potent”)
	Alerts delivered by e-mail
Report Content and Presentation	Real-time data reporting
	Easily accessible (eg, 1 button to open from main chart, desktop login)
	Easy login (eg, 1 step, user-friendly)
	Easy to use (eg, requires minimal patient information)
	Populated by data from both military and civilian providers
	Integrated with existing military EHRs
	Automated to minimize provider burden
	Automated reports easy to copy and paste into EHRs
	Report should facilitate pattern recognition for the provider
	Report should/should not be presented as a popup
	Report should be in a different color to make easily visible
	Report should trigger creation of accompanying face sheet to include basic patient data (vitals, chief complaint, recent medications)
Personnel with Access to PDMP or Reports	Physicians
	Nurses
	Any prescriber (eg, residents, physician assistants, nurse practitioners)
	Pharmacists
	Everyone on patient’s care team
	Sole provider
	Medical review committee
	Group cost manager
	Nursing or administrative assistants
	No nonproviders (including command, administration)
Other Recommendations	Create easily visible red flags for patients at high risk
	Receive alerts in e-mail
	Provide information on recommended next steps for flagged patients
	Develop threshold for average prescriptions/year
	Include information on requirements for prescribing
	Develop tracking program to categorize risk based on medications prescribed within specific time span
	Develop standardized risk score to describe risk
	“It would be helpful to have some sort of pattern recognition”
	Alert triggers a pain provider consult
	Alert should trigger review by pharmacist
	Provide information on opioid equivalence to facilitate comparison between medications
	Definitely establish a diagnosis of opioid misuse to provide a synthesis for busy providers
	Make it easy to see patient medications and refills globally
	Create provider-level opioid prescribing reports
	Have social worker assigned to every emergency department to support patients who need additional resources
	Offer additional education and ongoing training for providers
	Develop hospital-level committees to review at-risk patients
	Provide medication return program for patients who find no benefit from initial medication prescribed
	Double facility’s pain management capacity