The Prescription Opio

Documentation and 

Surveillance (PODS) Sys

Barth Wilsey MD

VA Northern California Health Care SysteVA Northern California Health Care Syste

PM&R UC Davis Medical Center

blwilsey@ucdavis.edu 
OUTLINE

• PODS is a computer‐assisted survey

inst u e t r m n

• PODS utilizes validated medical and 

health questionnaires

• PODS is used by a patient prior to fa

face vi it s

• PODS information is incorporated int

progress note
OUTLINE

• PODS is a computer‐assisted survey

inst u e t r m n

• PODS utilizes validated and mental h

questionnaires

• PODS is used by a patient prior to fa

face vi it s

• PODS information is incorporated int

progress note
Opioid Rx Documentati

Clark JD. Chronic pain prevalence and analgesic prescribing in a ge

population. J Pain Symptom Manage 2002; 23: 131-137

•300 random charts •50% suffered from at least one type of chronic pain•44% R f i id 44%

Rx 

for an opioid

•PE documented infrequently

•comment on a specific opioid treatment plan or 

follow-up of that plan in a minority of cases
Paper and Pencil Tool

"4 A's"

Analgesia

Activities of daily living

Adverse side effects effects

Aberrant drug‐taking behaviors



OUTLINE

• PODS is a computer‐assisted survey

inst u e t r m n

• PODS utilizes validated medical and 

health questionnaires

• PODS is used by a patient prior to fa

face vi it s

• PODS information is incorporated int

progress note
Initial Evaluation

Prior to Face-to-Face Meeting

Val

S

• an• ac

liv

• so

• de• an
B i f P i I t B

r

i

ef P

a

i

n Inven

tor
Brief Pain Inventory
Brief Pain Inventory
Patient Health Questionnair
I

f Q PH

Q-2 is e

qg 

ual or 

greater 

branches to PHQ-9
PHQ

-15
PHQ

-15
Hosp yp ital Anxiety Depres

Scale
Addiction Severity Ind
Addiction Severit

y 
Addiction Severity Index
Comp p uter vs. Paper 

Pencil
Non-Validated Questi

Non-Validated Questi

Non-Validated Questi
OUTLINE

• PODS is a computer‐assisted survey

inst u e t r m n

• PODS utilizes validated medical and 

health questionnaires

• PODS is used by a patient prior to fa

face vi it s

• PODS information is incorporated in

progress note




OUTLINE

• PODS is a computer‐assisted survey

inst u e t r m n

• PODS utilizes validated medical and men

health questionnaires

• PODS is used by a patient prior to face‐to

face vi it s

• PODS information is incorporated into

progress note
Follow-Up Evaluatio

Monthly Intervals
PAIN RELIEF
PAIN RELIEF TREND
SOAPP
COMM EVERY VISI
ABERRANT BEHAVIOR

RECORDED EVERY VIS

Chabal C, Erjavec MK, Jacobson L et al. Prescription opiate abuse in 

patients: clinical criteria, incidence, and predictors. Clin J Pain 1997
ENDORSED SUBSTAN

FROM INITIAL VISI

ASI ER ED EVER

QUER

IED EVER

VISIT

PAST 30 DAYS
PHQ-9 QUERIED EVERY V

SERIALIZED SCORES BY DATE
PHQ-9 ITEM ON 

SUICIDALITY 
ANXIETY SCALES
RANDOM URINE TOXICO

SCREENS

30% CHANCE OF BEING SELECTED AT EACH VISI
All Follow Up Evaluation Completion Time Histogra

All Follow Up Evaluation Completion Time Histogra

250200150

ncy

100

Freque

50

0

1

3

5

7

9

1

3

5

7

9

1

3

5

7

9

1

3

5

7

9

11

13

15

17

19

21

23

25

27

29

31

33

35

37

39

4

Time (min) 

COMPUTER-ASSISTE

SURVEY INSTRUMENT

• all relevant information is requested all relevant information is requested• physician has ready access to this 

information d ring the patient’s isit information

d

uring the patient’s visit

• the information is entered into the pat

medical record

• the information is readil

y available for 

types of review
ADVANTAGES

• quantified multidimensional pain and fu

scores 

• consistent tracking of key outcome targ

each visit

• surveillance of behaviors or symptoms• individualized branched questionnaire d

individualized branched questionnaire d

targets issues of particular concern
INADVEE E 

ERT

ENT OV

ERD

Bohnert AS, Ilgen MA, Galea

S et al. Accidental poisoning mortality among patients in 

Veterans Veterans Affairs Affairs Health System. Med Care 2011;49:393 2011;49:393‐6.

Bohnert AS, Ilgen MA, Ignacio RV et al. Risk of death from accidental overdose a

psychiatric and substance use disorders. Am J Psychiatry 2012;169:64

Bohnert AS, Valenstein M, Bair MJ et al. Association between opioid prescribing pa

overdose overdose‐related related deaths. Jama 2011;305:1315 2011;305:1315‐21

• Veterans Heal ht

h

A

d ii i m

nistration patient

nearly twice the rate of fatal accidental 

compare

d

wi ht

h

a

d l u ts in

t

h

e general US

population

• Furthermore, accidental overdose is str

associated with substance abuse disord

depressive disorders, and anxiety disord
FUTURE

• smartphones

– “always on, always worn”– repeated samp g lin of key health outcome

measures, obtained in the user’s natural

environment

• more frequent frequent measurement measurement (sometimes (sometimes termed “e

e

momentary assessment”)

• suicide ideation

– passive assessment

• use of cell phones’ own accelerometers and microph

physical movement and sound and thus make infere

p yh sical activity and social interaction