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. 2020:5:e200003.
doi: 10.20900/jpbs.20200003. Epub 2020 Feb 21.

Progress Report on EMBED: A Pragmatic Trial of User-Centered Clinical Decision Support to Implement EMergency Department-Initiated BuprenorphinE for Opioid Use Disorder

Edward R Melnick  1 , Bidisha Nath  1 , Osama M Ahmed  2 , Cynthia Brandt  1   2 , David Chartash  3 , James D Dziura  4 , Erik P Hess  5 , Wesley C Holland  2 , Jason A Hoppe  6 , Molly M Jeffery  7 , Liliya Katsovich  4 , Fangyong Li  4 , Charles C Lu  4 , Kaitlin Maciejewski  4 , Matthew Maleska  8 , Jodi A Mao  2 , Shara Martel  1 , Sean Michael  6 , Hyung Paek  9 , Mehul D Patel  10 , Timothy F Platts-Mills  10 , Haseena Rajeevan  4 , Jessica M Ray  1 , Rachel M Skains  5 , William E Soares 3rd  11 , Ashley Deutsch  11 , Yauheni Solad  9 , Gail D'Onofrio  1
Affiliations

Progress Report on EMBED: A Pragmatic Trial of User-Centered Clinical Decision Support to Implement EMergency Department-Initiated BuprenorphinE for Opioid Use Disorder

Edward R Melnick et al. J Psychiatr Brain Sci. 2020.

Abstract

Buprenorphine (BUP) can safely and effectively reduce craving, overdose, and mortality rates in people with opioid use disorder (OUD). However, adoption of ED-initiation of BUP has been slow partly due to physician perception this practice is too complex and disruptive. We report progress of the ongoing EMBED (EMergency department-initiated BuprenorphinE for opioid use Disorder) project. This project is a five-year collaboration across five healthcare systems with the goal to develop, integrate, study, and disseminate user-centered Clinical Decision Support (CDS) to promote the adoption of Emergency Department (ED)-initiation of buprenorphine/naloxone (BUP) into routine emergency care. Soon to enter its third year, the project has already completed multiple milestones to achieve its goals including (1) user-centered design of the CDS prototype, (2) integration of the CDS into an automated electronic health record (EHR) workflow, (3) data coordination including derivation and validation of an EHR-based computable phenotype, (4) meeting all ethical and regulatory requirements to achieve a waiver of informed consent, (5) pilot testing of the intervention at a single site, and (6) launching a parallel group-randomized 18-month pragmatic trial in 20 EDs across 5 healthcare systems. Pilot testing of the intervention in a single ED was associated with increased rates of ED-initiated BUP and naloxone prescribing and a doubling of the number of unique physicians adopting the practice. The ongoing multi-center pragmatic trial will assess the intervention's effectiveness, scalability, and generalizability with a goal to shift the emergency care paradigm for OUD towards early identification and treatment.

Trial registration: Clinicaltrials.gov # NCT03658642.

Keywords: buprenorphine; clinical decision support systems; electronic health records; health informatics; health information technology; medication for opioid use disorder (MOUD); opioid use disorder; opioid-related disorders; quality improvement; user-centered design.

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Conflict of interest statement

CONFLICTS OF INTEREST The authors have no financial conflicts or competing interests to disclose.

Figures

Figure 1.
Figure 1.
Flow diagram of the ED OUD EHR-based computable phenotype. Reprinted from JMIR [22] with permission of the authors.
Figure 2.
Figure 2.
Conceptualization of EHR screen from patient chart showing the EMBED app with the button that launches it.
See this image and copyright information in PMC

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