Appl Clin Inform 2022; 13(02): 419-430
DOI: 10.1055/s-0042-1745830
Case Report

Impact of a Vendor-Developed Opioid Clinical Decision Support Intervention on Adherence to Prescribing Guidelines, Opioid Prescribing, and Rates of Opioid-Related Encounters

1   Department of Family and Community Medicine, University of Missouri School of Medicine, Columbia, Missouri, United States
Bernie Eskridge
2   Department of Child Health, University of Missouri School of Medicine, Columbia, Missouri, United States
Brandi Ross
3   Tiger Institute, Cerner Corporation, Columbia, Missouri, United States
Matthew Wright
4   University of Missouri Health Care, Columbia, Missouri, United States
Thomas Selva
2   Department of Child Health, University of Missouri School of Medicine, Columbia, Missouri, United States
› Author Affiliations
Funding This study was funded directly by the University of Missouri Health Care.


Background Provider prescribing practices contribute to an excess of opioid-related deaths in the United States. Clinical guidelines exist to assist providers with improving prescribing practices and promoting patient safety. Clinical decision support systems (CDSS) may promote adherence to these guidelines and improve prescribing practices. The aim of this project was to improve opioid guideline adherence, prescribing practices, and rates of opioid-related encounters through the implementation of an opioid CDSS.

Methods A vendor-developed, provider-targeted CDSS package was implemented in a multi-location academic health center. An interrupted time-series analysis was performed, evaluating 30 weeks pre- and post-implementation time periods. Outcomes were derived from vendor-supplied key performance indicators and directly from the electronic health record (EHR) database. Opioid-prescribing outcomes included count of opioid prescriptions, morphine milligram equivalents per prescription, counts of opioids with concurrent benzodiazepines, and counts of short-acting opioids in opioid-naïve patients. Encounter outcomes included rates of encounters for opioid abuse and dependence and rates of encounters for opioid poisoning and overdose. Guideline adherence outcomes included rates of provision of naloxone and documentation of opioid treatment agreements.

Results The opioid CDSS generated an average of 1,637 alerts per week. Rates of provision of naloxone and opioid treatment agreements improved after CDSS implementation. Vendor-supplied prescribing outcomes were consistent with prescribing outcomes derived directly from the EHR, but all prescribing and encounter outcomes were unchanged.

Conclusion A vendor-developed, provider-targeted opioid CDSS did not improve opioid-prescribing practices or rates of opioid-related encounters. The CDSS improved some measures of provider adherence to opioid-prescribing guidelines. Further work is needed to determine the optimal configuration of opioid CDSS so that opioid-prescribing patterns are appropriately modified and encounter outcomes are improved.

Protection of Human and Animal Subjects

The University of Missouri institutional review board (IRB) determined that the project was quality improvement activity, not human subject research, and did not require additional IRB review. The requirement for consent was waived.

Supplementary Material

Publication History

Received: 20 September 2021

Accepted: 18 February 2022

Publication Date:
20 April 2022 (online)

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany