ONC and CDC say integration framework can tackle opioid crisis

For the past five years, the Office of the National Coordinator for Health Informatics and the Centers for Disease Control and Prevention have worked together on an interactive resource for states and health systems called the Integration framework.


The tool is intended to provide guidance to help improve the integration of state prescription drug monitoring programs (PDMPs) into clinician workflows. It includes best practices for implementing advanced clinical decision support systems to help flag potential opioid abuse, and it outlines steps to help advance and evolve the integration of PDMP with IT systems, such as electronic health records, health information exchange, and pharmacy systems.

According to the ONC and CDC, the integration framework’s practical guidance is intended for hospitals, primary care, and outpatient settings, and is intended to help with project execution, management, and communications.

To help inform the development of the integration framework, the agencies worked with eight health systems in five states.

Six health systems in three states served as PDMP-EHR integration technical demonstration sites, allowing the project team to observe the successes, challenges, and impacts of PDMP-EHR integration.

These sites were Baptist Health System and Grace Health in Kentucky; Utah Navajo Health System and Blue Mountain Hospital in Utah; and Nemaha County Hospital and Ponca Health Services in Nebraska.

The integration framework includes these key elements:

  • Quick Start Guide provides context and background related to terms, acronyms and other technical and non-technical terms used in integration planning.

  • Integration Taxonomy describes a variety of approaches for integration with the state’s PDMP.

  • Training tips addresses common questions that arise during the project.

  • Audit tips contains transaction recording guidance for PDMP-EHR integrations.

  • Memorandum of Understanding Guidelines describes key topics and points to consider when developing PDMP-EHR data integration and data sharing agreements.

  • testing guide provides specific test cases for onboarding sites to perform testing before actual onboarding.

  • Testing model offers templates that can be useful for testing the documentation.

Two additional health systems – the University of Colorado Denver and UC Health and the University of Washington – served as proof-of-concept sites to test the feasibility of implementing clinical decision support statewide. The CDS tools were developed using the 2016 guidelines for prescribing opioids for chronic pain.

The agency is currently updating this document, with a view to a new version later this year. These new guidelines will provide recommendations for clinicians caring for acute, subacute and chronic pain.

CDC officials say they plan to release a suite of translation and communication resources to facilitate effective implementation, and will refine and update CDS electronic tools based on final recommendations included in the upcoming clinical practice guidelines 2022.

In a blog post, ONC and CDC officials also highlight other PDMP resources and opioid management resources for States, health care providers and administrators.


The CDC estimates that more than 107,000 Americans died from drug overdoses in 2021, an increase of nearly 15% from about 93,655 deaths the previous year.

The technology has long shown promise in helping providers keep their patients safe, and the U.S. government has funded numerous IT-centric initiatives to help tackle the opioid crisis — but challenges remain.

In the current episode of HIMSCast, Healthcare IT News Editor Bill Siwicki spoke with David Bucciferro, vice president of the HIMSS Electronic Health Record Association and co-chair of its Opioid Crisis Task Force, about using EHRs to better manage how patients are prescribed pain relief.

Meanwhile, some more fundamental workflow challenges could be resolved. Research data released August 23 by Epic and the University of Maryland shows that only 5% of U.S. overdose patients are tested for fentanyl and other synthetic opioids in the ER.


“Today, clinician use of PDMPs is a promising state-level intervention to improve opioid prescribing, inform clinical practice, and support safer and more effective patient care,” said ONC and CDC officials in a blog post outlining their integration framework. “Integrating PDMP data into EHR systems removes barriers to accessing and using PDMP data to help inform clinical practice to improve opioid prescribing.”

Twitter: @MikeMilliardHITN
Email the author: [email protected]

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