An IT solution to the opioid crisis


At the annual HiMMS conference in Las Vegas this week, we take a look at how the cloud can be used to fill the gaps in healthcare provision.

To understand where CRM in healthcare is going, you should focus your gaze on the HiMMS conference in Las Vegas this week. At the same time, if you wish to understand the opioid epidemic and how it will be resolved, you can get a glimpse in courtroom 18B, in the federal courthouse in Cleveland, OH site of settlement proceedings involving more than 400 federal lawsuits brought by cities, counties, and Native American tribes against a variety of figures in the opioid crisis including doctors, pharmaceutical companies, healthcare organizations, pharmacy chains and more.

To understand how these disparate events intersect, keep reading.

According to an article in the New York Times, Federal Judge Dan Arron Polster is implementing a somewhat novel (it has been tried before but it is not considered mainstream) approach to resolution. Said the Times:

During the first hearing in the case, in early January, the judge informed lawyers that he intended to dispense with legal norms like discovery and would not preside over years of “unraveling complicated conspiracy theories.” Then he ordered them to prepare for settlement discussions immediately.

The approach goes by the abbreviation MDL for multidistrict litigation and its purpose is to by-pass potential years of discovery and individual litigation to achieve a settlement fair to all parties. In this case perhaps even an end to the opioid crisis. The Times said Polster:

Believes that when parties have gotten this far down the road in a lawsuit, they already have at least 80 percent of the information they need to negotiate; the longer litigation continues, he said he has found, the more entrenched each side can become.

In addition to trying to stir the legal pot Polster is also going after root causes of the opioid epidemic, said one lawyer involved in an early hearing in the case, “His questioning focused on reducing the number of pills in the chain of distribution.” But the parties, while eager to approach root causes, appear to not understand what those causes are. One unidentified lawyer in the article floated some approaches that are almost guaranteed to prolong the problem including taking the strongest doses off the market and funding addiction treatment and public education. Interesting approaches if you want to maintain the status quo while saving more lives but not addressing the problem.


The key to a solution is in understanding the distribution channel mentioned above. The distribution channel is entirely manual. There might be computer systems managing inventory at distribution centers and pharmacies and there are certainly systems of record used by providers to record diagnoses and prescriptions. But the only distribution channel that counts involves handing a prescription to a person or phoning in the order, manually counting out pills and affixing a (computer generated) label to a bottle and handing it to a patient (consumer).

Too often, the consumer doesn’t take all the pills prescribed, forgets where they are, gets overlapping prescriptions, or sells them on the black market. This is inventory shrinkage and it was solved decades ago in the manufacturing process. But you can’t solve this human supply chain problem with manufacturing techniques. People are not robots, after all.

To get a sense of what a root causes-focused solution might look like, fly a couple thousand miles west of Cleveland to Las Vegas to the Healthcare and Management Systems Society (HIMSS) conference this week. On Monday Salesforce introduced Health Cloud Care Gaps which, according to a Salesforce press release, “enables providers to monitor a patient’s adherence to a care plan and proactively fill gaps.”

Such a solution might be useful in tightening up the human supply chain to enable a more just-in-time approach to opioid distribution.

Technologies like outbound calling, long a staple of enterprise sales and marketing can easily be tuned to patient outreach. In fact one of the most important trends in medicine today is converting from a break-fix model of healthcare to one of wellness or preventing recurrence of illness by keeping patients engaged in their treatment plans.

Not long ago Aetna insurance and CVS, a large pharmacy chain, announced they were merging. CVS is building out a chain of in-house clinics designed to attend to the needs of the communities each store serves. This would be an ideal situation to introduce cloud computing into specifically to check patients’ adherence to treatment plans. It would enable doctors and pharmacists to keep running totals of pills in a patient’s possession and enable rapid resupply when needed. This won’t stop the opioid epidemic in its tracks, but it will take a great deal of supply out of the system that really doesn’t need to be there and only causes downstream problems.

With almost no computer gear to install other than PC’s and a small network with Internet access, a local health clinic might be able to use some combination of Salesforce’s technology along with population health care technology offered by various healthcare software suppliers. At HIMSS this week software giant Cerner announced its partnership with Salesforce to deliver an advanced solution. It seems the big pieces are falling into place and that Judge Polster may be prescient.

My take

The healthcare industry is a notorious late adopter of information technology. Although it has used systems of record for decades, it is somewhat behind the curve on developing systems of engagement and even systems of intelligence. But don’t blame the industry. Data security has always been of paramount importance in healthcare and the enterprise record of keeping data safe is unacceptably low.

Also, you can’t say that the healthcare industry can’t afford modern IT solutions; more than one in every six dollars of GDP flows through the allied health industries in the US.

Providing healthcare is a big and hairy problem to solve and half measures don’t usually cut it. That’s why the announcements coming out of HIMSS this week and the stark reality of the opioid crisis make such an interesting mashup. The crisis represents a dead end in care delivery that doesn’t get better on its own no matter how much education you give to doctors, pharmacists, and 16 year-olds. But it is a problem amenable to a 21st century solution which appears to be on the horizon.

Image credit - Via pixabay

Disclosure - Salesforce is a diginomica/government premier partner at time of writing.

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