Leveraging the EHR in the War Against Opioids (ft. Ed Kopetsky)

Thanks for tuning to Digital Voices podcast, where we chat digital transformation, challenges, and opportunities across healthcare and life sciences. And now, your host, Ed Marx.

Ed Marx here, Digital Voices. We get to cover so many great topics, and I don't know that in our first 100 episodes if we've had a topic more important to talk about Uh, than today. And I have with me a very dear friend, colleague, uh, longtime industry luminary, uh, Ed Kopetsky. So Ed, welcome to our, our podcast.

Thanks, Ed. Great to see you again. Yeah.

And what's cool about this one, actually, we've done about 100 podcasts. This is the first one we're actually together, like physically. Everything's been virtual, which is nice and makes things simple, but this one we're actually together. So we've got the added element of being able to like full body see each other, you know, all that sort of thing. So it's kind of fun. And I'm with Ed at the sort of administrative campus, right, for Stanford Children's. And, um, it's, it's a great, uh, organization. We'll get into a little bit. But Ed has been with us before. But before we get into this, we're going to talk CHIME Opioid Task Force. And DJ, Megan, have you ever known anyone addicted to opioids?

I have. I've known a few people who've really struggled with the demons of addiction, particularly around opioids and alcohol. The opioid crisis and really addiction in general has always been an area that I'm pretty passionate about. I was a psychology major in college, and at one time I actually wanted to be an addiction therapist.

Oh, wow.

Very cool.

But yeah, it's, it's amazing. And the reason I asked the question, you know, your, your, your generation is pretty heavily impacted by opioids, but it's really a cross-generational thing which, which we're going to dive into. So really quick, Quick on Ed, we covered a lengthy introduction in episode 81, so we won't ask standard questions, but I don't want to embarrass Ed, but I'm going to tell you, this is July, August, September. We're in September 2022, and I've been up and down California this week, Ed, and everyone says, say hi to Ed Kopetsky. He's the greatest out there. I mean, you've got fans around the world, but definitely here when I was traveling California. So, so thanks for being on our podcast. I know you're super busy.

Welcome. Thank you.

All right, well, we're gonna jump straight into it, and I know this is highly personal for you and actually now for, for myself as well. But tell us about Tim and, and how— because we're going to talk about the CHIME Opioid Task Force— but how did it start? And it started with Tim.

Yeah, well, thank you. I mean, um, we had 2 beautiful children, and, uh, Tim was our second, and, uh, You know, really great life. And in college, unfortunately, Tim got into using OxyContin. It was going around at the time on the campus. And unlike other kids, he got addicted. And he came home for help in his junior year. And we immediately helped and got him into rehab right after the weekend. And that was the start of an experience I wish kind of no one ever had because he struggled for 9 years.

Wow.

And he saw homelessness and we saw just Unending fear, and it affected the entire family. My daughter, my wife, everybody loved him. And about halfway through that period, we really seeked awesome help, moved him to Dallas, was in one of the best rehab organizations in the country, Advancing the medication-assisted treatment, and he flourished. He came back to life. 4 and a half years we saw him progress. He was a month before completing his degree and going to go on for his master's degree in mental health and psychology and helping others.

Yeah.

And he was on a golf thing, he had a job, and One of his friends relapsed and had an overdose, and he tried to help and got exposed to heroin for the first time, trying to hide it from his friend, and didn't make it through the night.

Yeah.

That's how tragic and powerful these first addiction is. But he had no intent of that happening. He had no desire. You look at it and you say it was an accident, but I think anybody who knows addiction knows it never goes away. It's a lifelong mission, and it's just like a disease where you have to manage your blood pressure or diabetes. And we need to bring it out more about that.

Yeah.

Because it should not have the stigma It does. And people who help shouldn't have the stigma we had.

Yeah.

And so that's sort of what happened. And, you know, as you might have guessed, you're devastated. But I, I wanted to do something. Yeah.

Well, so that's an intense story, Ed. Thanks for, for sharing. I know it's not easy and You know, I can, uh, commiserate, uh, and empathize, sympathize with you now because I had— I shared with you previously a nephew recently, uh, very similar story. Grew up in a great home like your son and educated parents, you know, everything. Uh, it happens to everyone. It doesn't matter. You're not protected. Uh, uh, so, you know, it's another tragic story where this It affects everyone, Ed, and there's no lines of discrimination.

And, you know, it really has— it's been an epidemic. And it was the combination of our changes in pain management.

Yeah.

Combined with an invasion of black tar heroin into the East Coast and It really exploded. We are still dealing with the effects of that. But also now the use of fentanyl in street drugs everywhere is out there and the problem has expanded. So, you know, thank you for your interest.

Yeah.

And as we go through this, I think a lot of— as I— we started the opioid task force only 3 months after his passing. And I was amazed at how many people came out and helped. And everyone had a story, either directly or indirectly in the family. It was just like you said.

Yeah.

And, you know, I think when we grew up, we knew a lot of alcoholism. But since—

Yeah.

My age grew up, there was a lot more drugs and meth and other things. But the opiate thing is a national crisis and worldwide, frankly. And the healthcare system is, is, is both contributory to that, right, and needing, needing change, which we are— that's our goal.

Yeah, so I, I think it's outstanding what, what you and your wife did. You know, you, you did something as a result so that others wouldn't have to have the same pain.

That's right.

And so the opioid task force, let's, let's talk a little bit more about it. How long So how long has it been operationalized now? Maybe 1 or 2 accomplishments in the first couple of years. And I know there's a new strategy for the next—

Sure. Yeah, we started it just under 5 years ago in January. So almost 4 and a half, 5 years ago. And, you know, we tried to say, look, we can't boil the ocean, we can't do everything, but we can use healthcare IT and our foundation partners to improve things.

Yes.

And one of the first things we did was develop a book, an online book for hospitals to have improved stewardship of opiates, form an opioid task force, etc., and then educate others about leading practices. So we built a public website called the Opioid Action Center, and it's out there as a public site. And we are doing podcasts almost monthly now with leading practices across the country and exchanging this information across the country. I think the other thing that we have now advanced to is a clinical committee, subcommittee of the Task Force, and they are experts in pain management, addiction, emergency medicine frontline, and they're knocking it out of the park in terms of defining how can we leverage our EMR and interoperability of data to help clinicians treat patients better.

Yeah.

To catch these patients who are falling below the line And do the right thing and the safe thing for them with, with current data.

Yeah.

And that's what we're up to next.

Yeah, no, that's great. And I've seen the website, we'll put it in the show notes. So it's a great resource. If so, if your hospital doesn't have something like that yet, you can easily have a plan and see how to do it. And yeah, it's awesome. What about the next couple years? Because I know that you just recently went through the strategic planning process. What are one or two of the priorities coming up?

Yeah, the one I just mentioned is one of our newest priorities is to— we're meeting with all the EMR vendors.

Oh, great.

And talking about what the industry needs from a clinician perspective and a patient perspective, and what are their strategic plans on developing in this space. And I truly believe it's much more wide ranging in impact to all of addiction, not just opiates. Yeah, that's true. And that's the good thing.

Yeah.

The second thing is we're gonna continue to expand our education offerings and leading practice education. One of the things I've learned in joining the Santa Clara County, otherwise known as Silicon Valley, they have an opioid overdose prevention program. That meets monthly and garners all the health systems and doctors, and we're comparing notes about patient patterns. There's a huge increase in high school mortality because of fentanyl, and we are out educating high schools and teachers as well as students about the risks. We're distributing free naloxone. for high-risk patients, and we're linking all the healthcare in Silicon Valley together to combat this. So I am, I'm involved locally, but I'm also bringing that to the opioid task force at a national level.

Yeah, and really globally, because I know others around other countries are, are very interested in this topic and those materials. So I, I do want to end towards the end, talk about how can we engage the listeners that are perhaps touched by Ed's story and want to get involved, there's different ways for both vendor community and individual leaders to be engaged. Before we get there, we sort of touched on this already, Ed, without a lot of specifics, but this is very prevalent in society today. I mean, you can't— there's not a news day that goes by, news cycle, without something about opioid addiction and things like that, or companies being sued that perhaps Contributed to it and things like that. You once said that this is like bigger than a pandemic. So this is a pretty pervasive—

Well, I, I say a lot of things when I get excited. So, but seriously, I think it's— we are seeing more deaths from this now than any other disease. It's the leading cause of death in people in 25 to 35. One of the things that, you know, being in the health system and getting transparent about it, one of the things I've learned, and Dr. Polston from UC San Diego who's on our task force, he's educated me about, look, you have all these people who have been on pain management regimens And their needs are still there.

Yeah.

And so the entire industry now is having to change that. And there's pressure to reduce opiates. But what are alternative therapies?

Right.

And how do we prevent the shutoff of needed pain medication and pushing these people to desperate means like buying Beds on the street, right, which are the most dangerous. So it's, it's a— we think of addiction being homeless and criminal, and that's certainly what it leads to.

Yeah.

But we have a much broader population of legitimate patients. And, and all of us— I mean, my wife just went through surgery 2 weeks ago, and I think, and I'll be real quick, but one of the modern things we're now doing is sending them home with a nerve block pump. She only used opiates for like 2 days.

Yeah.

After the nerve block, it prevented that first 3 days from the need. And I, I'm like, I'm very interested in new methodologies.

Yeah.

The other thing, Ed, that I think is Top of mind right now with the crisis where it is, we must get into harm reduction. We must get into giving people free naloxone. We know they're going to use. We can't stop them from using. Teaching them new, safer methods. And that's what's happening in the Santa Clara County program as well. And I— You'd say, my God, we're going to have like safe injection sites is a harm reduction Yeah. Methodology. And unfortunately, our governor backed down to get, you know, get himself positioned for presidential election. But we were right on the verge of opening safe injection sites in San Francisco like they have in Amsterdam, have had for years.

Yeah.

So we have a lot to learn.

Yeah.

From other countries. Let's not be unrealistic about— let's be realistic about that.

No, I agree with you there. So Do you think that we've bent the curve yet as a society, or do you think it's still going up, opioid addiction?

You know, I don't think it's coming down, and I don't know if it's going up as a ratio. The ratio of risk is going up.

Yes.

Because of the fentanyl, and they're using— they're Street drugs are all laced with fentanyl.

Yeah.

So you're not even— you may think you're buying something, but you're getting it. So the mortality rate's going up.

Yeah.

The rate of addiction, I don't know about that.

Yeah.

But I do know we have inadequate community services to treat addiction.

Yeah, I—

So we are not taking, as a society and as a country, Proactive building of addiction services and what is needed out there. So our poor EMRs are sitting here. If you tour the ED, and I did recently, about our naloxone program and triage program, we have nowhere to send these patients for continued care. It's not an acute illness. It is a, you know, so that's the challenge I think in the addiction, but we've gotta add services.

Yeah, no, I agree completely with you. Obviously, as you mentioned, deeply personal story. Again, thanks for sharing. And even I was impacted. I was unlocked some emotion there that I, I didn't realize was there. So, so if there's someone out there like myself, you know, uh, how can they help? How can they engage? I know there's an opioid addiction center website you mentioned that we'll put in the show notes.

Sure.

Um, but let's say we're a digital leader, a CDO, CIO, which is the majority of our audience, what, what can we do to engage?

Well, I would encourage you to look at data. I would go to the Centers for Disease Control and look up mortality rates of addiction, look up opiates, look in your community, what data is out there in your community. There is data. Yeah. Look for programs that are offering help. We are now doing free naloxone distribution. We're teaching in our schools the risks.

That's good.

And educating, and I mean, just sharing things. You can get involved locally and nationally and statewide as well. I think advocate for data sharing. I know for Medicare treating organizations, by January 1st, they are required to have an electronic interface to the prescription drug monitoring program in the state. I don't know why it ain't Medi-Cal because children's hospitals are, but we'll get there. But there's things going on and our Action Center will keep you posted. Go on the Action Center there. We put new news on there all the time. So yeah, those are some ways.

Yeah, and it is a great site. And how about with the opioid task force in general? If someone wants to get involved and really help out, or, or, and so both from a personal individual level, but also, uh, here's a chance to— you're talking to the vendor communities, there are opportunities for them to come alongside. I know you do a golf tournament, like, as an example, right?

Oh, actually, yeah, actually I just talked to Russ yesterday and we're teeing it up for the, uh, VIVE event in the spring again. We're gonna have a benefit tournament, so that's easy way to get involved. We are gonna have a task force meeting for a couple hours the day before CHIME in the fall. And I don't know if you're at CHIME, but welcome anybody to come by. We're gonna have a guest speaker on one of the leading practices in one of our health systems.

That's great.

And then we are always open if anybody wants to talk of joining the task force or anything, just reach out.

Yeah, so we'll put Ed's contact information in the show notes. And so yeah, if you wanna get involved on the task force or Or if you are a member of Chime and you want to take part in this sort of pre-Chime activity, there are lots of different ways.

Yeah.

And it really is incumbent. I don't want to put words in your mouth, but as we finish, Ed, what's the message? Well, I have a question about 2 messages. One is a message to our peers, CIOs, CDOs in the industry. Again, I don't want to be too leading of a question here, but Do we have a moral, ethical responsibility to take action?

Well, I would put it a little different. And it was so obvious to me when we started the task force in January in Washington, CIOs rose above their position. You know, we're often thought of as technologists and data experts and all this. This was a healthcare problem that one would say, stay in your lane, Jane. But we didn't.

Right.

We didn't stay in our lane. We said, this is a big issue. It's at a critical moment in our history. This is time to look at how we can help and leverage our community. Leverage our network, leverage our technical capabilities, our partnerships. What can we do? And I think we made a difference.

Yeah.

We moved the needle with the tools and assets that are closest to us and the awareness. My biggest thing from all this wasn't starting the opioid task force. Russ just happened to be with me when I said, I, I hope some good can come. And we then organized it with Jim Turnbull and I. others. But the issue was changing the message on addiction. It was changing— this should not be shamed. This should be treated like any other illness we get and recognize, you know, it's not choice. It is not choice. Once they— I know my son, he didn't want it.

Yeah.

He just had the brain chemistry and the makeup that once he tried Percocet, he said, I never felt better in my life. And it was— I tried Percocet and I get weird. I can't stand it. Yeah, we're all wired differently and people don't have choice when they're addicted. Yeah, they have to be in recovery to get their choice back. Right.

Yeah.

And that's the key.

Yeah. Great, great words of wisdom. One last question sort of related to the first one, but what would your message be for our listeners? We just talked about it from a CIO role leadership point of view, but as parents, any— a lot of our listeners are parents still, kids maybe at home. Anything that comes to mind, Ed, on this whole topic?

Well, I think the same message is You know, look at it and learn about it and talk to people. And if you suspect your child is going to— your intuition's probably right.

Yeah.

And get help, because we processed that without help and the right kind of help for 3 or 4 years, and it was devastating.

Yeah.

We, we were getting all the wrong advice and all kinds of different stuff like tough love and great— no, you know, they need help.

Yeah.

When they are ill.

Yes.

And, uh, and if it's trending wrong, you don't want to catch it early. And talking— transparency is the key.

Yeah.

Transparency of the patient and transparency of the caregiver. And you've, you've got to get help.

Yeah.

And get objective help is my— if you see a problem, because, uh, I don't know, we did once we saw it, but we didn't really dig in. And we, we were just, you know, we had our hope on— we said, okay, this is just something they will get over. But yeah, addiction's not something you get over. Yeah, it's a— it's something you gotta manage and recover from.

Yeah. Well, powerful insights, Ed. Thank you so much for sharing a highly personal story. And, and, and what I really appreciate about what you and your wife have done is you've created the greater awareness, definitely in the healthcare industry, tech for sure, but broader, more broad than that. And you, by you sharing, I think you've, you all don't know, but you've probably saved a lot of other lives.

You know, another thing, and I'll just add it, I, was one of those that talked here about it and also then mental health as we went through COVID.

Yeah.

The number of employees that came up to me personally and thanked me and said, I had that happen or I'm going through. And we started a whole new transparency and openness in this department through COVID about mental health and addiction.

Yeah.

It's amazing that people, we all can talk about it and feel comfortable now. And we lost a couple people through the year, a couple last couple years, because— so it's important, it's out there, it affects every company and every family. So I encourage you, you know, open up about it.

Yeah, Ed, you're— like I started off with, you're an amazing leader. But, but as much as you're a great leader from a tech point of view and pioneer, and, you know, the, the even better part of you is as a human, and you're a beautiful man, and Thank you for sharing so openly. And again, if anyone has questions and wants to get involved, uh, you can reach out. We'll have the information in the show notes. And definitely reach out to others in your area if, if you need any help in any way. Definitely go get it.

All right.

Thank you. I echo the same. Uh, please reach out. Thanks much.

All right, that wraps up Digital Voices.

Thank you for listening to Digital Voices podcast with Ed Marx. If you enjoyed this If you enjoyed this episode, subscribe on your preferred streaming service and leave a rating and review. And most importantly, thanks again for listening.