ONC, CDC say Integration Framework can combat opioid crisis

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


The tool is meant to give guidance to help improve integration of state prescription drug monitoring programs (PDMPs) within clinicians’ 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 scale PDMP integration with IT systems, such as electronic health records, health information exchanges and pharmacy systems. 

The Integration Framework’s practical tips are aimed at hospital, primary care and outpatient settings, according to the ONC and the CDC, and are meant to help with project execution, management and communications.

To help inform the development of the Integration Framework, the agencies worked with eight health systems across five states. 

Six health systems in three states served as PDMP-EHR integration technical demonstration sites, enabling 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 comprises these key elements:

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

Integration Taxonomy describes a variety of approaches for integrating with the state PDMP.

Training Guidance addresses common questions raised during the project.

Auditing Guidance has tips relevant to recording transactions for PDMP-EHR integrations.

MOU Guidance outlines key topics and points for consideration in developing PDMP-EHR data integration and sharing agreements.

Testing Guidance provides specific test scenarios for integration sites to conduct testing prior to actual integration.

Testing Template offers templates that may be helpful for testing documentation.

Two additional health systems – University of Colorado Denver and UC Health and University of Washington – served as proof-of-concept sites to test the feasibility of statewide clinical decision support implementation. The CDS tools were developed using the 2016 Guideline for Prescribing Opioids for Chronic Pain. 

The agency is currently updating that document, with an eye toward a new release later this year. That new guidance will offer recommendations for clinicians providing care 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 the electronic CDS tools based on the final recommendations included in the forthcoming 2022 Clinical Practice Guideline.

In a blog post, ONC and CDC officials also spotlight other resources PDMP and opioid management resources for states, providers and healthcare administrators.


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

Technology has long shown promise in helping providers keep their patients safe, and the U.S. government has funded many IT-centered initiatives to help combat the opioid crisis – but challenges remain.

In the current episode of HIMSSCast, Healthcare IT News Managing Editor Bill Siwicki spoke with David Bucciferro, vice chair 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 addressed. Research data published August 23 by Epic and the University of Maryland shows that just 5% of U.S. overdose patients are tested for fentanyl and other synthetic opioids in the emergency room setting.


“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 describing their Integration Framework. “Integrating PDMP data into EHR systems addresses barriers to accessing and using PDMP data to help inform clinical practice to improve opioid prescribing.”

Twitter: @MikeMiliardHITN
Email the writer: [email protected]

Healthcare IT News is a HIMSS publication.

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