National EDDS
Hospital electronic health records (EHR) contain important information about patients’ laboratory test results, diagnoses, and treatment. Urine specimens collected from patients as part of routine care may also be used to better understand the drugs to which emergency department (ED) patients have been exposed. The Emergency Department Drug Surveillance (EDDS) system collaborates with hospitals to obtain both quarterly exports of ED patients’ de-identified EHR information and a one-time sample of approximately 150 de-identified urine specimens from each participating hospital site.
The University of Maryland provided CESAR with funding from 2017-2020 to pilot EDDS in 7 hospitals in Maryland. The success of the pilot project led the Office of National Drug Control Policy (ONDCP) to sponsor the subsequent Phase I project (2020-2021), which expanded EDDS to 8 hospitals outside of Maryland. ONDCP funding of Phase II (2021-2023) is enabling the addition of 23 hospitals affiliated with HCA Healthcare.
Methodology
The EHRs submitted to EDDS contain information on patient urine drug test results, chief complaints, diagnostic codes, and some limited demographic information. The de-identified urine specimens sent to EDDS are re-tested for a panel of 500+ drugs by the EDDS collaborating laboratory.
The quarterly exports of EHR drug test results are used to analyze the trends and patterns in the drugs to which ED patients have been exposed. The expanded re-testing of a sample of patients’ urine specimens enables EDDS to identify emerging drugs and gaps in each hospital’s more limited testing protocols. EDDS findings disseminated on CESAR websites can be used to help inform patient treatment at each hospital, update their testing protocols, and serve as a national drug surveillance system.
Maryland EDDS (MD-EDDS)
The State of Maryland’s Opioid Operational Command Center (OOCC) recently awarded the Center for Substance Use, Addiction and Health Research (CESAR) at the University of Maryland, College Park, with a grant to launch the first statewide EDDS program in the nation. MD-EDDS is working with 20 hospitals across the state. Hospitals were selected so that all areas of the state are participating. MD-EDDS collects two types of data from each participating hospital: 1) a limited data set of hospital drug test results, demographic, and clinical information stored in patients’ electronic health records (EHRs) for all patients treated in the ED for a drug overdose, and 2) fentanyl dipstick test results for 50 deidentified urine specimens where the specimen had tested positive for at least one drug on the hospital’s standard urine drug screen. The quarterly EHR data are used to track trends in the urinalysis results for all drugs included in the hospital’s standard panel. The dipstick testing enables hospitals that do not currently test for fentanyl to determine if their routine testing is missing patient exposure to fentanyl.
- Preliminary Fentanyl dipstick testing results are available here (March 3, 20023)
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