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In this episode of the ��ݮ���� Podcast, Dr. Joshua Liu, Co-founder & CEO at ��ݮ����, and marketing colleague, Alan Sardana, discuss how Digital Patient Engagement combats the opioid crisis. See the full show notes below for details.

Guest(s): Dr. Joshua Liu (), Co-founder & CEO at ��ݮ����

Episode 5 – Show notes:

[02:40] High level summary of the opioid crisis; what opioids are, why they're used, and how they've lead to unnecessary deaths; 

[03:55] How high or unnecessary opioid prescriptions after surgery contributes to the opioid crisis;

[04:40] How 10% of opioid-naïve Cardiac surgery patients become long-term opioid users;

[04:55] Summary of research by Dr. Nimesh Desai (@NimeshDesaiMD), Cardiac surgeon at Penn Medicine, regarding Cardiac surgery opioid use (and abuse) ();

[06:40] How opioid-risk tools help us to quantify patient risk of addiction, but do not change prescription practices;

[08:35] How Digital Patient Engagement platforms like ��ݮ���� empowers patients to track opioid consumption so teams can make data-driven decisions to adjust prescription practices;

[08:46] How research by the University of Michigan Health System showed 73% of opioid pills for surgery go unused ();

[09:14] How the state of Michigan did an opioid-recovery drive which collected 17,500 unused opioids;

[09:50] How technology can help providers to personalize opioid use based on patient risk factors;

[11:23] Brief history on the Blue Cross Blue Shield funded and other state-wide quality collaboratives;

[11:55] Michigan OPEN (Opioid Prescribing Engagement Network) led by Dr. Mike Engelsbe and Dr. Jennifer Waljee which provides safe opioid prescribing guidelines for surgical procedures ();

[12:30] Research led by Dr. Michael Engelsbe and Dr. Jennifer Waljee at University of Michigan Health System on how opioid-naïve patients recovered successfully using non-opioids and reported the same satisfaction and pain scores as opioid-prescribed patients ();

[14:50] How Dr. Engeslbe re-engineered patient education to set proper expectations for patients recovering without opioids and maintained the same patient satisfaction scores;

[15:15] How Blue Cross Blue Shield in Michigan incentivized surgeons ($300-700 per case) to follow practices in opioid-sparing modalities;

[16:35] The importance of expectation-setting and how Enhanced Recovery After Surgery relies heavily on expectation-setting and opioid-sparing modalities;

[17:20] Dr. Liu's thoughts on whether more payers will introduce new billing codes to incentivize opioid-sparing modalities;

[18:05] Dr. Liu's thoughts on why payers should incentivize providers to follow best practices (e.g. ERAS, Prehab, etc.) and not just reimburse based on outcomes;

[20:20] How EHRs documents opioid prescriptions, and sometimes inpatient opioid consumption, but misses out on post-discharge opioid consumption Patient-Reported Outcomes (PROs);

[22:40] How ��ݮ���� reduces opioids by tracking patient consumption data so that teams can make data-driven decisions to reduce prescription ();

[23:20] How Atrium Health used ��ݮ���� to track post-discharge opioid consumption data for hepatobiliary (HPB) surgery patients and determined the average patient consumed only 10% of the prescribed opioids ();

[24:00] How Michigan looked at the number of pills prescribed after surgery and refills, and determined that patients will use the same percentage of pills that you prescribe regardless of the total number of pills. 7-8% of patients will refill their prescription regardless of the original prescription number;

[25:30] How opioid-risk tools can be built into ��ݮ����; how ��ݮ���� can combine granular patient-reported outcomes (PROs) with opioid risk scores to build a complete data set;

[26:45] How ��ݮ���� and Digital Patient Engagement platforms complete the data equation necessary for machine learning to personalize patient care and predict patient outcomes;

[27:37] How setting clear expectations is one of the most effective strategies for delivering optimal patient care; and

[29:25] How ��ݮ���� and Digital Patient Engagement can be used to change practice by standardizing best practices, and how teams can "set it and forget it" to collect and compare PROs;

Studies and articles mentioned:

Atrium Health research using digital patient engagement (��ݮ����) to track opioid consumption:

Penn Medicine Opioid Cardiac Surgery research:

Ladha KS, Neuman MD, Broms G, et al. Opioid Prescribing After Surgery in the United States, Canada, and Sweden. JAMA Netw Open. 2019;2(9):e1910734. doi:10.1001/jamanetworkopen.2019.10734.

Howard R, Hallway A, Santos-Parker J, et al. Optimizing Postoperative Opioid Prescribing Through Quality-Based Reimbursement. JAMA Netw Open. 2019;2(9):e1911619. Published 2019 Sep 4. doi:10.1001/jamanetworkopen.2019.11619.

Association of Opioid Prescribing With Opioid Consumption After Surgery in Michigan:

University of Michigan Research: 

Patient Satisfaction and Pain Control Using an Opioid-Sparing Postoperative Pathway

Michigan OPEN (Opioid Prescribing Engagement Network) safe opioid prescribing guidelines:

Surgeons report success in reducing opioid prescribing without increasing patients' pain (2019):

Research on surgery reimbursement for following opioid prescribing recommendations: