Morphine Equivalence and Detected Issues

Hi Kristin,

Just wanted to tell you about some work that is currently happening at Infoway.

I am co-chairing the PrescribeIT^TM Advanced Clinical Decision Support working group, and we are exploring clinical requirements. Providing morphine equivalents at point of care is within our scope. If you would like to connect to discuss further, please contact me at This email address is being protected from spambots. You need JavaScript enabled to view it..

Kind regards,
Seema Nayani
Pharmacist Leader, Infoway

Kristin,

From an HL7 perspective, I am looking into how we would the codes you requested. HL7 International has decided that clinical codes should be found/created in clinical code systems like SNOMED, LOINC, etc. They no longer want to add clinical codes into the HL7 code systems. Thus I believe that your first step would be to request these codes be created in the Canadian extension of SNOMED and then we could bring a proposal forward to HL7 to add the codes to the specific value set that you need. I am still getting confirmation of this and will respond when I have confirmation.

Sincerely,

Jean Duteau

Which jurisdiction are you involved with? How are you detecting the alert? (I am DIS AB)

Yes, primarily prescribers and pharmacists at the time a prescription is submitted to the DIS (e-prescription) or dispensed at the pharmacy. This information would also be associated to the patient's DIS profile and made available to other authorized clinicians who have access to the DIS profile of the patient.

Thank you very much for the work that you are doing. When you mean clinicians do you mean prescribers or pharmacists who will be reviewing the prescription.

We are in the process of working on a solution to communicate Morphine Equivalence information to clinicians via the Drug Information System. As part of this solution, the system will be conducting a review based on Morphine Equivalence thresholds to determine if a person is taking a certain amount of opioids on a daily basis. If the person meets a certain threshold, then an issue will be generated and communicated to the clinician.

In order to do this, we would like to utilize a value from the ActDetectedIssueCode code set. However there appears to be no suitable values that could be used to transmit this particular issue message. We would like to suggest adding the following values to this codeset to support Morphine Equivalence.

MORPHEQ –
Display Name – Morphine Equivalency Alert
Description - Proposed therapy may be inappropriate and differ from standard practice

MORPHEQH -
Display Name – High Morphine Equivalency Alert
Description – Proposed therapy exceeds standard practice

We are looking for some feedback and guidance on this request on how to handle this process.

Also, our organization had posted some inquires about 10 months ago on supporting Morphine Equivalence data via the CeRx messages. I was wondering if there has been any movement on that topic? I am hoping to hear from other jurisdictions and how they may be handling Morphine Equivalence data using messaging.

Thanks
Kristin