Used to be, when doctors prescribed a drug, they’d open up a book summarizing drugs and dosages—or go by memory for the common stuff. But nowadays?
“Now you can type in whatever it is. It’s placing an order via the computer. So you type in an order of the name of the drug, and it'll prepopulate everything.”
Juan Carlos Montoy is an emergency medicine physician at San Francisco General Hospital. He also studies decision-making in health care. He says for an antibiotic, the default dose programmed into a doctor’s computer might be pretty standard. But for pain, the number of opioids prescribed might vary a lot, depending on the patient and their type of pain.
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“What we wanted to look at was: tell whether and to what extent the presets, the default settings we have in the electronic medical record, influenced provider prescribing.”
Specifically, would lower defaults result in fewer opioids being prescribed?
So Montoy’s team systematically changed the recommended-opioid-pill-number defaults in the computer systems of two hospitals in the San Francisco Bay Area during an eight-month period. Each hospital’s preexisting defaults were 12 and 20 pills, respectively. The researchers dialed in new defaults of five, 10, 15 or an unspecified number of pills.
Compared to doctors’ prior prescribing habits, the new default settings resulted in fewer opioid pills prescribed overall—and fewer prescriptions exceeding the maximum recommendations by the Centers for Disease Control and Prevention.
“This suggests that other hospitals, other emergency departments, can change those settings and impact opioid prescribing pretty much immediately. It’s a really low-cost intervention and can be done really quickly.”
The results are in the Journal of the American Medical Association [JAMA] Internal Medicine. [Juan Carlos C. Montoy et al., Association of default electronic medical record settings with health care professional patterns of opioid prescribing in emergency departments: A randomized quality improvement study]
“This is definitely not a silver bullet. The epidemic has a lot of different issues that need to be addressed, and this is one small tool we can use to address it.”
Still, it could be a useful prescription for physicians.
—Christopher Intagliata
[The above text is a transcript of this podcast.]
