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Combatting the Opioid Crisis with Pain Management Technology

Introduction

The treatment for chronic pain has long been debated as its management offers a wide array of options for both clinicians and patients to choose from. Medicines for depression have the potential of becoming addictive due to their calming effect on the patient. While conventional treatments have become outdated, the administration of prescription-based and over the counter drugs has exploited susceptible individuals to the harmful effects of opioid overuse. It is vital that clinicians find a solution to monitoring the use of opioids to help bring the drug epidemic to its demise and simultaneously encourage non-pharmacological options to their patients. 

Monitoring chronic pain and depression 

Traditional Methods 

Depression and chronic pain can overlap due to them possessing a few common neurotransmitters that are responsible for delivering messages between neurons. They also have similarities in their pathways of the brain and the spinal cord. Chronic pain has the propensity of eliciting signs and symptoms of depression. Its severity and impact on a person’s life are what contribute to depression manifesting. With underlying chronic pain, a person begins to experience struggles in how they handle losses, more extended periods of inactivity, a decrease in sociability, diminished interest in relationships, and poor work performance. People who are susceptible to depression and are simultaneously managing the effects of a chronic illness are treated for both conditions simultaneously.

Traditional medicines and management are regarded as safer and there are ample choices a doctor can implement. Conventional medicines for the management of pain are based on the many theories and beliefs of different cultures that are targeted at reducing or improving pain. Among the many opted treatment regimes, the few common ones are acupuncture, herbal medicines, and Ayurveda medicines, which have been regarded as the most common and recognized treatments universally. Regardless of their effect or cultural support, these treatments aren’t evidence-based, and their underlying mechanisms aren’t common knowledge. This limits their use by doctors in their clinics.

There has been a notable rise in the treatment of pain and depression through the use of opioid medications. The opioid epidemic brought the attention of the masses in 2017. Many federal agencies, including the US Food and Drug Administration (FDA), the Joint Commission, and the National Academies of Sciences, Engineering, and Medicine (NASEM), have begun advising clinicians to regulate prescription-based opioid drug administration and to offer more options than just medications.

Overview of the Opioid Crisis 

It’s inevitable that with many drugs being conveniently available over the counter, patients have taken to self-medicating themselves. More importantly, due to the potent effects of opioid drugs, immune-deficient or overly busy people, rely on opiates to help them get through a tough day. The use of chronic opioid therapy for non-cancer related pains has taken risen exponentially in just the previous two decades. This was noted to occur concomitantly with the increase in prescription-based opioid use as well as abuse or accidental overdose using these drugs. Opioids are sometimes even called narcotics. Some of the strongest prescription-based opiates are tramadol, hydrocodone, fentanyl, and oxycodone. Even heroin, which is an illegal drug, is an opioid. Opioids are both human-made and synthetic. Regardless of what combination of a drug is made available, they all promise to act as immediate pain relievers.

The relationship between depression and opioid abuse is a two –way relation, meaning that when a person is suffering from depression or opiate withdrawal, he will likely develop symptoms of the other condition as well. Opioid drug abuse refers to the use of this drug without the use of a prescription. It’s either used in a non-medical context or is taken in larger quantities than is required, and this inadvertently is linked to higher rates of depression, bipolar disorders, and anxiety.

Current problems associated with a standardized method of treating pain 

Currently, pain management within the oncology department, its effective pain-relieving abilities, and there were limited alternatives for relieving pain in severe conditions have increased the reliance patients, and doctors have for these potent drugs. With an increase in drug reliance, even the risk for aberrant and inappropriate behavior has risen. Also, standardization in treating cancer-related pain lacks among the clinicians who prescribe it. It’s recommended that residents and doctors who practice medicine should vary in misuse and abuse of drugs.

Coping skills for patients dealing with chronic pain

Patient Education 

Non–pharmacological pain management means managing pain without the inclusion of medications. This mode of treatment targets the mind of the patient and hopes to influence and encourage positive thoughts or alter thoughts to reduce the effect of pain felt anywhere in the body. There are many non-pharmacological options that one can subscribe to. They include:

Educational and psychological conditioning of the mind

Many people are entirely in the dark about what to expect when dealing with depression or chronic pain. It is quite stressful for them, and it is their caretaker’s responsibility to educate them about their condition to make it easy for them. If a patient has been made prepared for what they’re about to endure, it helps reduce cortisol levels and thereby reduce the amount of stress they can experience. To decrease their anxiety, the clinicians should consider engaging the patient in conversation and explaining to them vital pathological signs regarding their debilitating pain or their depression. Even explaining treatment options thoroughly might allow them to make a more well-informed decision. The use of pictures or diagrams will help everyone understand the pathway of their illness properly. Any questions that the patient has should be written down and answered diligently.

Alternative treatments to pain medication (opioids)

Among the variety of treatment options available to patients, some critical and recognized suggestions are:

  • Hypnosis

A psychologist or doctor helps guide the patient into a state of altered consciousness, and this helps reduces the pain experienced by the patient by narrowing their thoughts. The method for such treatment involves guiding the patient’s thoughts through mental images based on sight, smell, taste, and feel. This helps deviate their thoughts from the pain they are experiencing. If a child or adolescent is experiencing chronic pain or depression, then various methods of distraction should be employed. Videos, songs, and storytelling are among the multiple techniques that can be applied. Many relaxation techniques are also used, such as deep breathing and stretching, which can also help ease the discomfort.

Among other options available to the patient and doctor are comfort therapy, occupational therapy, physical therapy, psychosocial counseling, and neuro-stimulation. These can be utilized instead to help relieve pain, and many patients find comfort in them instead of ingesting large amounts and frequent doses of medications. To further elaborate, these therapies are listed below:

  • Comfort Therapy

It involves companionship, hot or cold compresses, exercises, massages, meditation, drama or music therapy, counseling, and occupational therapy.

Physical and occupational therapy are beneficial and can be implemented through aqua-therapy, desensitization, psychosocial therapy, and strengthening exercises for the muscles that may have lost power and tone due to immobility.

  • Psychosocial Therapy: 

It involves counseling in the form of family, group, or individual counseling. This method helps a patient become more accustomed to their condition and helps teach coping mechanisms.

  • Neuro-stimulation: 

This method involves electrical nerve stimulation, which immediately helps relax tense muscles and improves neural impulses through fatigued muscles, acupressure, and acupuncture.

How does cliexa monitor its patients? 

Remote Monitoring

Clinicians need to have a profound grip on opioid use. The only solution to narrowing down the prevalence of this epidemic is by finding a method to track the intake, risks, and effects on a patient dealing with crippling chronic pain. The way clinicians can do this is by using cliexa to their advantage. The cliexa platform allows patients and their clinicians to seamlessly track the activity and progress of the disease, whether in-clinic or through a remote monitoring program. Their proprietary technology is exceptional and allows for intelligent correlations between the dosage of medicine the patient is ingesting, their frequency of drug use, and whether symptoms have heightened or lessened. Managing chronic pain has become better because the best way to reduce an opioid or drug overuse is by ensuring that drug intake stops once the patient becomes better and shows no reason to continue his drug intake. The system allows their patients to connect to software that will enable them to communicate with their physicians without any interruption. This technology assists the providers through its ability to adequately document changes in any baseline metrics and helps patients get access to timely treatment. This would inevitably result in lesser complications.

The remote monitoring services allow patients to use their phones to send any healthcare data to their providers, and easily covering either a range of diseases and make necessary amendments in their ongoing treatment. This trend is powered by cliexa through its ability to provide clinically validated assessments with an automated disease activity score, all through its ability to gain real-time data through the wearable devices their patients wear. The wearable allows for data collection that could easily go undetected in many patients. This helps to improve the reported outcome vastly and improves patient satisfaction immensely.

Connect to claims data to visualize prior hospitalizations

The data is made available to clinicians through cliexa’s Evaluation and Management services. It’s responsible for medical coding and medical billing. These E/M services integrate history, exam, and medical decisions that are vital for establishing patient visits that are thorough and detailed. Medical compliance is based on proper documentation of medical records that help physicians and extended healthcare professionals evaluate their patients excellently. Treatment options are then made optimal and accessible. Real-time data that is gathered for the patients is used by the physicians to provide the utmost high quality of care when dealing with their patient’s mental health.

Wearable devices for real-time, activity data collection

Among their numerous mobile applications, cliexa-SENSE is routinely implemented in behavioral clinics where patients dealing with depression, alcohol abuse, narcotic abuse, and opioid abuse are treated. cliexa-EASE is a mobile application that is a pain assessment model for monitoring chronic pain. This app helps maximize reimbursements and helps improve chronic care management. cliexa- RA is responsible for reporting rheumatoid arthritis symptoms using patient-reported outcomes using clinically validated assessments. The disease activity scores are reported diligently through this, and quality care is further optimized for patients. cliexa-COPD is tasked with providing preventive and value-based care for people who are afflicted with COPD.

Identifying opiate risk 

cliexa has partnered with Colorado Clinic, New Health Services, and more pain, behavioral health, and mental health facilities to combat the opioid crisis exceptionally. This is their method of improving chronic pain care and management. cliexa has digitized the entire process of the patient’s arrival, consent documentation, and chief complaints. At-risk patients will be monitored in this manner and will have to fill out screener questions that will be based on the Screener and Opioid Assessment for Patients in Pain model. This model is designed in such a manner that it will help self-report and address the extent or appropriateness of therapy in patients suffering from chronic pain. They will receive intelligent treatment options that will be aimed at minimizing the extent of pain. This information will be entered into the EMR system. The scores that will be generated after the patient is screened, and their responses gave the appropriate score, their risk of opioid abuse will be graded as low, medium, or high. This will help clinicians strategize treatment and duration of drug administration accordingly. The health care providers will even have to ensure they use urine drug monitoring as a necessary part of their clinical assessment, as this will help monitor the patients before their drug therapy and following their drug therapy. Random and routine urine analysis can help manage low and high-risk patients fruitfully. It’s even been studied and proven that urine drug monitoring will help drug compliance and prevent misuse of drugs. cliexa’s AI helps software hopes to optimize pain management by continually producing intelligent solutions from patient input. 

Conclusion

Innovative methods to manage patients are continually being used by clinicians and hospitals as they wish to optimize the quality of care that they deliver to their patients. Patient education must be encouraged as this will make patients self-aware of the harm they can inflict upon themselves by poorly complying with drugs. Doctors and patients must work together to reach a solution that aims at reducing the number of medications ingested to manage pain and related mental disorders. This way, drug complications will be narrowed down, and the risk assessment for many patients liable to misuse drugs will decrease.

 

 References

  1. https://www.ncbi.nlm.nih.gov/m/pubmed/28226333/?i=2&from=/29149119/related
  2. https://www.practicalpainmanagement.com/amp/22565
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1069064/
  4. https://www.hindawi.com/journals/prm/si/674036/cfp/
  5. https://www.webmd.com/depression/guide/depression-chronic-pain
  6. https://medlineplus.gov/opioidmisuseandaddiction.html
  7. https://www.psycom.net/depression.central.opioid.abuse.html
  8. https://www.cliexa.com/evaluation-management-services/
  9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6699803/
  10. https://www.cliexa.com/?cat=-1
Doctor looks at the patient's electronic chart on the tablet. Health care concept. 3d isometric. Concept for web design-01

Overview of the Physician Burnout Problem

The demanding work pace, time constraints, and emotional fatigue are the aspects that make physicians vulnerable to burnout. Symptoms caused by long-term stress such as depersonalization, low sense of accomplishment and emotional disparity due to work-life imbalance make the doctor prone to exhaustion leading to a feeling of quitting.

The WHO terms burnout as an ‘occupational phenomenon’ which, in its latest update of the definition, is referred to as a ‘syndrome’ that occurs due to chronic work stress that is not effectively managed.  The physician burnout is metaphorically referred to as the bank account of energy.

There are three main types of energy; physical, emotional and spiritual energy that keeps on adding up and depleting with time and circumstances. The highly demanding doctors’ profession and the workplace norms generally have a downward trend towards energy levels that puts clinicians at a high risk of burnout. 

According to a study published in the Annals of Internal Medicine in 2019, Physician burnout costs around $ 4.6 billion to the United States. Dr. Lotte Dyrbye of Mayoclinic opines that whoever enrolls in medicine is aware of the fact that it is a demanding and stressful profession.

Over the past years, the sprouting cases of physician burnout have led to cynicism about its repercussive effects on patient access to care, care quality as well as patient safety. Burning out inflicts the doctors to quit their jobs making access to care, less likely. Lack of attention and focus, as well as memory constraints, hamper patient safety and quality of care.

According to several studies, 1 out of every 3 physicians is suffering from burnout at a time. Thus, every physician precisely is at risk of burnout and it rightly needs to be dealt with as a crisis. Although the physicians can take the necessary steps themselves to improve the work-life conditions and keep the burnout symptoms at bay, big changes are needed at the institutional level to bring forth evident outcomes.

A recent report from Harvard states that physician burnout is a public health catastrophe that urgently needs a solution. Among the recommendations stated by the report, changes to the practice of Electronic Medical Record (EMR) or Electronic Health Record (EHR) are declared to be a significant measure to provide a medium-term solution for physician burnout.

Problems that are focused on EMR-related issues

The patient record used to be written on paper for ages and has consumed an ever-increasing space and remarkably deferred access to proficient medical care. As of today, EMRs collect individual patient data and clinical information electronically, facilitating immediate accessibility of this information to all healthcare providers. It is thus said to assist the provision of coherent and regular care.

Electronic Medical Records (EMRs) are automated medical information systems that assemble, store and present patient information. They are a way to produce reliable and structured recordings to access clinical data about patients. Hence, EMRs have replaced paper-based medical records which most practitioners have been long familiar with.

There are a number of potential advantages EMR is known for. These include

  • Optimizing the records of the patients
  • Improving communication of patient data to clinicians
  • Improving access to patients’ healthcare information
  • A substantial decline in errors
  • Optimizing payments and advancement in reimbursement for services
  • Formation of a data storage area for research and quality enhancement
  • Reduction of the use of paper

EMRs are envisioned to have great potential for enhancing quality, stability, protection, and efficacy in healthcare. These are the reasons why they are being implemented throughout the world.

In spite of the high expectations and focus on the technology worldwide, there are several EMR-related issues associated with them that have kept their overall implementation rate relatively low. They are viewed to oppose a physician’s customary working style and also entail the following barriers to acceptance by physicians.

  1. Financial Barriers

    EMRs necessitate a greater competence in dealing with computers. Further, installing a system entails significant financial resources; high startup expenditure, high maintenance cost as well as uncertainty about Return on Investment (ROI).

  2. Technical barriers

    Lack of computer skills of the clinicians and the other staff, deficiency of technical training and support, complexity and limitation of the system, etc. are the factors considered as technical barriers to EMRs.

  3. Time constraints

    The physicians find it too time-consuming to select, purchase and implement the system, to learn the system, to enter data, to convert the records and requiring more time per patient. 

  4. Psychological barriers

    Based on their personal reservations, understanding, and perceptions, clinicians have concerns about using EMRS. Their observation of the uncertain quality improvement associated with EMRs and doubts about the loss of specialized autonomy lead to a lack of belief in the EMR.

  5. Social barriers

    The social barriers include uncertainty about the vendor, lack of support from external parties, from other colleagues and from the management. Also, the physicians find EMR to be a system that interferes with the doctor-patient relationship.

  6. Legal barriers

    Clinicians think that keeping the patient records and medical information safe is vital to avoid legal issues. Nonetheless, there is a lack of clarity about the security standards to keep the patient records safe and confidential. 

  7. Organizational size and type

    A small practice is estimated to face greater difficulties in working out the financial issues than a large practice.

  8. Change process

    Implementation of EMRs in the medical practices demands a major change for clinicians who have their own working styles developed over the years. This renders them unwilling to adapt to variations in their methodology of work. Therefore, the change process is a challenge as well as a problem at the same time. Problems that occur during the change process include a lack of suitable organizational culture, lack of incentives, lack of leadership and reluctance in participation from physicians, nurses and other staff members.

According to a study, the slow rate of EMRs adoption implies the fact that resistance amongst medical doctors is strong. This is because the clinicians are the frontline users of EMRs and whether or not the other user-groups like nurses and administrative staff support and use EMRs, largely depends on EMR’s acceptability by the clinicians. Consequently, doctors have a great influence on the adoption level of EMRs. 

Additionally, a study found that most of the physicians who are stressed out are due to the work conditions and time pressures. The family responsibilities, time demands, chaotic environment at workplace, lack of control of the pace, unfavorable institutional culture; all are attributes associated with dissatisfied and stressed out doctors who inculcate a feeling of switching fields. However, these factors, not necessarily translate into poor patient care by the doctors. However, when a drop in the patient care quality was seen, it was rather due to burnout caused by the organization than by the doctors themselves.

The study also found that the implementation of the EMR contributed to burnout instead of reducing the stress levels as it was hoped. It was claimed that practices that implemented EMR caused an increase in stress to the doctors, the levels of which then reduced as the use of EMR matured. However, the stress level was never found to drop to the lowest. Furthermore, it was found that the fully established EMR systems, particularly coupled with shorter visits caused burnout, stress and an intention to leave the practice.

Causes of the EMR-Related Issues

Like all other technologies, EMRs can be used in a variety of ways for a variety of purposes. In regards to our current healthcare structure, one important performance requirement of EMRs is to generate clinical revenues. This means that it should support physicians’ billing and documentation to produce as much revenue as possible for each medical service. Moreover, EMRs should also help clinicians meet regulatory necessities that may have monetary or endorsement implications.

This implies that existing EMRs are not designed in a way so as to support many of the matters that clinicians, patients, and policy-makers value including improved care experiences, decreased cost, improved care quality, and inhabitants’ health management. Current EMRs have not been created to facilitate the physicians to improve in their diagnoses or become more cost-effective prescribers. This is because the present-day health care system generally does not compensate for these actions.

Having said so, EMRs have very minimum capacity pertaining to clinical decision making (which increases the quality of care), for the data collection on duplicate and needless tests, or on the collective health of the patients.

Simply put, the advancement of the EMRs will necessitate the changing of prime considerations regulating their design. This includes moving towards risk-sharing by clinicians and eventually, some form of potential reimbursement rather than the current fee-for-service culture. Till then, optimizing the usability and worth of EMRs will be an ascending effort.

READ NEXT: cliexa Partners with the athenahealth Marketplace Program

cliexa PTSI Press Release

We are proud to announce that we have officially joined forces with Preventative Technology Solutions, who will now become apart of the cliexa family.

Here is the link to the press release about the acquisition: //www.pr.com/press-release/768313

 

Digital health benefits

2018 has seen a significant boom in the application of technology in digital health innovation, which are poised to disrupt the healthcare industry. Innovations have included advances in mobile health (mHealth), health information technology (IT), as well as wearable and Internet-of-Things (IoT) devices.

cliexa has identified six specific areas of medicine already reaping the benefits of digital health innovation:

1. Rheumatology

Disease Activity Scoring (DAS) metrics remotely collected by cliexa from patients are used by physicians in their offices when assessing the severity of rheumatoid arthritis through a Q & A approach. cliexa empowers patients with the ability to communicate their patient-reported outcomes to their physicians at the touch of a finger, on their own mobile devices, providing physicians with instantly-scored clinically-validated assessments. The application of cliexa innovations in rheumatology drastically increases the efficiency and quality-of-care for both patients and their providers.

Check out the cliexa mobile platform for Rheumatoid Arthritis, cliexa-RA: //www.cliexa.com/cliexamobile/rheumatoid-arthritis/

2. Pain Management, Primary Care, & Integrative Medicine

Chronic pain, affecting over 10% of American adults, is a leading cause of opiate abuse. Managing and overcoming chronic pain is a complex obstacle for many healthcare providers. With the increased shift away from the prescribing of opioids in the treatment of chronic pain, cliexa enables providers to remotely monitors opioid-prescribed patients while empowering them to relay their patient-reported outcomes and track their mental health conditions in association with their chronic pain, while catering specifically towards the individual needs of each patient-provider relationship.

Check out the cliexa mobile platform for Pain Management, cliexa-EASE: //www.cliexa.com/cliexamobile/pain-management/

3. Behavioral Health & Addiction Treatment

Though struggles with addiction are becoming increasingly more prevalent in society, the present methods of addiction treatment are limited. Through innovations in health technologies, patients and providers are shifting towards new ways of treating addiction. The monitoring of patients in real-time is essential for positive treatment outcomes for both patients and their providers. By leveraging patient-reported data, patients adhere to their treatment plans and overcome addiction as a disease, rather than as a fault.

Check out the cliexa mobile platform for Behavioral Health, cliexa-SENSE: //www.cliexa.com/cliexamobile/behavioral-health/

4. Digestive Health

Through cliexa innovations, providers better manage chronic gastrointestinal diseases, such as inflammatory bowel disease or ulcerative colitis, using specifically-designed, highly-structured treatment plans that leverage disease activity scoring models taken from qualitative patient responses to assessments which quantify and track symptoms over long periods of time.

Check out the cliexa mobile platform for Digestive Health, cliexa-IBD: //www.cliexa.com/cliexamobile/inflammatory-bowel-disease/

5. Respiratory Care

cliexa enables providers to qualitatively track chronic diseases of the respiratory system, like chronic obstructive pulmonary disease (COPD), through remote patient-reported outcomes. The ability to structure individualized and specialized care leads to improved patient-provider experiences.

Check out the cliexa mobile platform for Respiratory Care, cliexa-COPD: //www.cliexa.com/cliexamobile/chronic-obstructive-pulmonary-disease/

6. Pediatric Care

cliexa health technology drives innovations in mental health resiliency in adolescents, a hot topic in today’s health community. cliexa’s clinically validated medical assessment applications, coupled with its mHealth prevention services, help providers identify and reduce risk behaviors in adolescents and young adults. cliexa’s mobile patient-engagement applications equip providers with the tools adolescents use to overcome anxiety and depression, increasing the overall quality-of-care for both patients and providers.

Check out the cliexa mobile platform for Pediatric Care, cliexa-OPTIONS: //www.cliexa.com/cliexamobile/adolescent-resiliency/

cliexaRA Press Release

cliexa® partners with the Colorado Arthritis Center to identify how screening and monitoring of Rheumatoid Arthritis patients through a customized electronic platform, cliexa-RA, impacts clinical efficiency.

See the full press release from PR.com: https://www.pr.com/press-release/765307

Download the Case Study here: https://www.cliexa.com/cliexa-ra-case-study/

Learn more about cliexa-RA: https://www.cliexa.com/cliexamobile/rheumatoid-arthritis/