Cornell University, Joan & Sanford I. Weill Medical College

The opioid epidemic continues to wreak havoc throughout New York State and across the nation. In 2014, prescription opioids were responsible for more than 2,000 overdose deaths in New York State and 19,000 throughout the United States.

In 2015, these deaths reached a historic record, exceeding deaths from guns or cars, and even the toll from the HIV/AIDS epidemic at its peak in 1995. One of several critical factors causing the opioid epidemic is physician-prescribing practices. Almost all prescription opioids involved in abuse or overdose originate from misused or diverted prescriptions. Misused prescription opioids also contribute to the epidemic of heroin use and heroin and fentanyl fatalities. In 2017, NYHealth awarded Weill Cornell Medicine a grant to encourage physicians at hospitals and federally qualified health centers (FQHCs) to prescribe opioids at levels consistent with Centers for Disease Control and Prevention (CDC) guidelines.

Under this project, Weill Cornell Medicine adapted a highly successful electronic health record (EHR) prescribing interface for generic drugs and modified it specifically for opioid prescriptions. The modified EHR defaulted opioids to CDC-recommended short-duration and low-dose formulations, but allowed defaults to be overridden by providers to ensure that clinical judgment was not constrained. The adapted EHR was piloted first in a small setting to ensure that the system performs as expected, and then it was implemented at primary care sites within Weill Cornell Medicine’s system. The EHR was evaluated by whether provider prescribing rates meet various compliance criteria. Based on provider experiences with and evaluation of the EHR, a freely shareable implementation procedures toolkit was developed and disseminated throughout the State. The toolkit was used to replicate this intervention at the Institute for Family Health, an FQHC with 19 sites in New York City and rural regions outside of the City. Weill Cornell Medicine published the project results in peer-reviewed informatics and public health journals.