December 13, 2019: EMBED Update: Challenges and Solutions (Edward Melnick, MD, Gail D’Onofrio, MD)


Edward R. Melnick, MD, MHS
Assistant Professor of Emergency Medicine
Program Director, Yale-VA Clinical Informatics Fellowship Program
Principal Investigator, EMBED Trial

Gail D’Onofrio, MD
Professor & Chair
Department of Emergency Medicine
Yale School of Medicine


EMBED Update: Challenges and Solutions


Embedded clinical research; Buprenorphine; EMBED; Opioid use disorder; Emergency department; Electronic health record; Clinical decision support tool; User-centered design; Clinical informatics

Key Points

  • Evidence shows that buprenorphine (BUP) treatment for patients with opioid use disorder (OUD) can safely and effectively be initiated from the emergency department (ED). As yet, BUP is rarely initiated as a part of routine ED care. Clinical decision support could accelerate adoption of ED-initiated BUP into routine emergency care.
  • The EMBED pragmatic trial is evaluating the effectiveness of a user-friendly, web-based clinical decision support tool to enable ED-initiated buprenorphine treatment for OUD. The goal is to optimize the tool’s usability, EHR integration, automation of EHR workflow, and scalability across a variety of healthcare systems.
  • EMBED is being conducted in 20 EDs across 5 healthcare systems.

Discussion Themes

The study team developed a computable phenotype to identify ED patients with OUD. Validation was conducted through physician chart review.

EMBED clinical decision support is a flexible tool that supports clinicians with varied levels of experience with the intervention by providing one-click options for direct activation of care pathways and user-activated support for critical decision points.

Newer versions of EHR systems have integrated pathways to allow for more automation of clinical decision support.

Read more about the challenges of the EMBED pragmatic trial and visit the EMBED web page.

#pctGR, @Collaboratory1