Moderator: Monique Dever
Presenters: Mike Bajorek & Sonali Luniya
Good afternoon, everybody. Thanks for joining our webinar on Combating the Opioid Crisis Using EHR, GIS, and Wastewater Sampling.
My name is Monique Dever, and I’ll be moderating today’s presentation.
We have two presenters:
- Mike Bajorek, a civil engineer with a master’s in business management. He has served as the Deputy Town Manager for Cary for over 30 years and is now the project champion for their opioid measurement project.
- Sonali Luniya, Co-founder and VP of Customer Experience at Patagonia Health. She has extensive experience in electronic health record (EHR) research and development and will demonstrate how healthcare agencies can use data, like Mike’s, to make informed decisions in combating the opioid epidemic.
Mike, take it away.
Thank you, and good afternoon—or morning, depending on where you are. It’s an honor to talk with you today.
About Cary, North Carolina
For those unfamiliar with Cary, we’re a town of about 162,000 people—highly educated, engaged citizens, sometimes a little too involved. Cary sits in the heart of North Carolina’s Research Triangle and is known for its tree-lined streets, planned subdivisions, and vibrant downtown.
For over a decade, we’ve ranked among the FBI’s top 10 safest mid-size cities in the country.
But like most communities, we also face an opioid problem.
Recognizing the Problem
Before you can make change, you must first acknowledge the problem.
For us, that moment came on November 28, 2016, the Monday after Thanksgiving. During a department director meeting, our fire chief reported that his team had responded to five overdoses over the weekend—three of them fatal due to opioids.
That’s when it hit home: this was happening in Cary.
By January 2017, our mayor took decisive action, declaring in his State of the Town Address that combating the opioid problem was a top priority. Though we weren’t yet in crisis, six opioid-related fatalities and 40 additional overdoses the previous year showed we needed to act.
Learning from Baseball: Data Analytics in Action
To address this, I’d like to explain how lessons from baseball analytics 20 years ago are guiding our efforts to fight the opioid epidemic.
For full disclosure—I love baseball. My wife will tell you I think everything in life can be explained with a baseball analogy.
When the mayor set this as a priority, we began meeting with public health officials and organizations to ask how we could help. Cities like ours don’t typically have a public health mission—that’s handled by the county—but we wanted to contribute.
Rethinking the Data Problem
We quickly learned that the data being used to measure the opioid problem was:
- Reactive: Based on overdose deaths
- Delayed: Autopsy reports could take 6–12 months
- Limited: Derived from questionnaires and aggregated at broad municipal levels
These data sets made it difficult to respond proactively.
This is where baseball analytics comes in.
The Biobot Analytics Partnership
Through research and networking, we connected with Biobot Analytics, an MIT spinoff that measures opioid metabolites in wastewater. Their approach estimates the total amount of metabolized drugs consumed—both legal and illicit—expressed as doses per day per thousand people.
Unlike previous research that analyzed wastewater from massive treatment plants, Biobot’s technology allows smaller catchment areas (populations of 10–15,000) to be analyzed.
This allows us to combine chemical analysis with additional data layers such as:
- Demographics
- Socioeconomic indicators
- Land use
- Proximity to parks, schools, or grocery stores
All of this data can feed into an open data platform to provide near-real-time, community-level insight.
From Data to Action
Just like a baseball manager coaches from the dugout—not from the blimp—public health officials need proactive, localized data.
As Billy Beane said: “Better data, better insights, more wins.”
For us: Better data, better insights, more lives saved.
The Bloomberg Philanthropies Mayor’s Challenge
In February, Cary was named a Champion City in the Bloomberg Philanthropies Mayor’s Challenge, receiving a $100,000 grant to launch a pilot program.
Our proof-of-concept sampling is set to begin this spring, with a full-scale pilot to follow in the summer.
We’ll later apply for further funding—potentially up to $5 million—to expand across North Carolina and beyond.
Project Partnerships and Goals
We’ve partnered with:
- Biobot Analytics
- Local and state public health officials
- Data modeling groups from RTI and SAS Institute
- Engaged citizens in our community
Our goals include:
- Citizen engagement: Reduce stigma and encourage open discussion about opioid misuse.
- Data integration: Develop an open data platform for analysis, predictive modeling, and planning.
We believe that talking openly—parent to parent, neighbor to neighbor—can help break the cycle of isolation fueling this epidemic.
Mike’s Closing Thoughts
This initiative is about early intervention, collaboration, and using technology to save lives. We may not have all the answers yet, but we’re building a model that others can follow.
Together, we can have a huge impact on this crisis—not just in Cary, but nationwide.
Thank you.
Sonali Luniya’s Presentation
Thank you, Mike. Now let’s explore how EHR systems can complement these data-driven efforts.
The Scale of the Epidemic
Nationwide statistics from the CDC show:
- 12.5 million people misuse opioid prescriptions annually
- 259 million prescriptions for painkillers are written each year
- 40 people die every day from prescription opioid overdose
This is truly a national crisis.
How EHR Technology Can Help
Thanks to the HITECH Act (2008), most clinicians and public health departments now use EHR systems. With roughly 90% adoption nationwide, we can now leverage EHR data to address large-scale health issues like opioid misuse.
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Electronic Prescribing of Controlled Substances (EPCS)
Electronic prescriptions improve:
- Safety: Automatic drug and allergy interaction checks
- Accuracy: Eliminates handwritten errors
- Security: Reduces prescription fraud
Currently, fewer than 25% of providers use EPCS due to setup complexity and authentication requirements, but it’s expected to become mandatory nationwide soon.
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Prescription Drug Monitoring Programs (PDMPs)
Every state has a PDMP—a centralized database that tracks controlled substance prescriptions. Pharmacies report filled prescriptions within 24–48 hours.
Challenges include:
- Low usage (only ~14% of providers regularly access PDMPs)
- Poor integration with EHRs
- Lack of interoperability across state lines
Integrating PDMP data into EHRs, or using systems like Surescripts, can help clinicians detect doctor shopping and identify at-risk patients more efficiently.
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Clinical Decision Support and Risk Assessment
EHR systems can include tools such as:
- GAD-7 (Anxiety Scale)
- PHQ-9 (Depression Assessment)
- DLA-20 (Daily Living Activities)
- COWS (Clinical Opioid Withdrawal Scale)
These help identify behavioral or withdrawal symptoms and guide safe prescribing decisions.
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Patient Follow-Up and Outreach
Once patients are identified or treated, EHR data can be used to:
- Generate follow-up reports
- Send text or email reminders for appointments
- Share educational materials or videos about opioid safety and recovery
This helps maintain engagement and monitor recovery progress.
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Geographic Information Systems (GIS) Integration
GIS tools can visualize:
- Where patients with opioid-related diagnoses are located
- Overlaps with wastewater data, lab results, or socioeconomic layers
- Hotspots for targeted outreach and prevention
GIS mapping can also be used for other public health initiatives like tobacco cessation, STD tracking, or HIV prevention.
Q&A Highlights
Q: Is Patagonia Health capable of prescribing controlled substances through EHR?
A: Yes, the system supports EPCS functionality.
Q: What about small counties wanting to analyze wastewater?
A: Current costs (via Biobot Analytics) are around $18,000 per series of tests for smaller residential areas (10–15k population). Grants and partnerships can help offset this.
Q: Can prescriptions be predated to avoid extra visits?
A: Yes, clinicians can predate prescriptions within the EHR module.
Q: Can EHR or PDMP data interact with GIS dashboards?
A: Yes. EHR data integrates with GIS tools for visualization of diagnoses, labs, or prescriptions by region.
Both technology and community collaboration are essential to combating the opioid epidemic.
By combining data analytics, EHR tools, and wastewater sampling, we can identify problems earlier, guide interventions, and ultimately save lives.
Thank you to our presenters, Mike and Sonali, and to all who joined today’s webinar.
