Complexities and approaches for deriving longitudinal daily morphine milligram equivalents using electronic health record prescription data.

Abstract

ObjectiveTo describe challenges and solutions for calculating longitudinal daily opioid dose in morphine milligram equivalents from electronic health record prescriptions for a clinical trial of voluntary opioid reduction in patients with chronic non-cancer pain.Materials and methodsResearchers obtained opioid prescriptions for 525 participants from the National Patient-Centered Clinical Research Network datamart at three health systems. Daily opioid dose was calculated using dose conversions and summing across prescriptions after applying assumptions, reviewing suspect prescribing patterns, and removing spurious prescriptions.ResultsOut of 16 071 extracted prescriptions, 1207 (8%) were unusable, and 14 864 (92%) were analyzed.DiscussionNumerous challenges were identified related to incomplete data, inaccurate refill dates, and overlapping or duplicate prescriptions.ConclusionUsing electronic prescription data to calculate daily doses of opioid consumption is challenging and requires significant cleaning prior to use in research. This paper recommends steps to review and clean electronic opioid prescription data.