{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:43:26Z","timestamp":1785545006514,"version":"3.56.0"},"reference-count":32,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Form Res"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Digital health data and infrastructure facilitate rapid analysis to provide actionable data, thereby fulfilling the principles of a learning health system. In response to a report from the UK Medicines and Healthcare Products Regulatory Agency (MHRA), a rapid service evaluation was carried out to identify patterns of modified-release (MR) opioid use after elective surgery.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n We aimed to describe the prescribing patterns of MR opioids, methods to repurpose existing infrastructure, and the experience of collaboration between clinical and research teams using shared data pipelines.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A retrospective case-control study was conducted at a tertiary care organization across multiple hospital sites in London, United Kingdom. Prescription and administration data for adult patients undergoing elective surgery between March 31, 2019, and June 20, 2025, were extracted from a standardized research data pipeline within 4 weeks of the publication of the MHRA report. Patients were screened for MR opioid prescriptions in the postoperative period and at hospital discharge. Counts and proportions of encounters in which MR opioids were administered or prescribed were evaluated across the study period. Reflections on the application of the infrastructure for this purpose were also documented.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Of 126,882 elective surgeries screened, 102,879 (81.1%) met the eligibility criteria. Over the study period, patients received a new MR opioid prescription after 7525 (7.3%) of the 102,879 eligible encounters, with 2438 (2.4%) encounters receiving a new MR opioid prescription at hospital discharge. Postoperative administration of MR opioids and prescribing at discharge have declined since 2020. As a result of this study, a new context-aware alert system was developed to monitor and reduce MR opioid prescribing in this surgical cohort. Reflections on the implementation experience demonstrated how collaboration between clinical and research teams in conjunction with integrated and seamless research pipelines allowed rapid knowledge generation. Key issues raised were the difficulty of validation between parallel data extraction systems and how the two different teams compared nonequitable data points and results.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Mature digital and analytical infrastructure within health care institutions can enable swift evaluation of local practices in the context of national medication safety alerts. This can shorten action response times and improve patient care but requires close collaboration between clinicians and research teams. Shared infrastructure between teams across the learning health system improves data quality and provides easy access to the key users. Further work is needed to understand the benefits and challenges of infrastructure built for other use cases and the effectiveness of the intervention.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/81355","type":"journal-article","created":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T13:15:08Z","timestamp":1780146908000},"page":"e81355-e81355","source":"Crossref","is-referenced-by-count":0,"title":["Use of Electronic Patient Record Systems for Rapid Response to an MHRA Public Assessment Report: Retrospective Observational Study"],"prefix":"10.2196","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6619-5846","authenticated-orcid":false,"given":"Dylan","family":"Whitaker","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5001-0253","authenticated-orcid":false,"given":"Matthew","family":"Wilson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4982-1374","authenticated-orcid":false,"given":"Steve","family":"Harris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5927-5429","authenticated-orcid":false,"given":"Yogini H","family":"Jani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,7,3]]},"reference":[{"key":"R1","unstructured":"Modified release opioids and treatment of post-operative pain: public assessment report. Medicines & Healthcare Products Regulatory Agency; 2025. URL: https:\/\/assets.publishing.service.gov.uk\/media\/67d01193d5ec5ed9e09f5ef4\/Modified_Release_Opioids_and_Treatment_of_Post-operative_Pain.pdf [Accessed 13-03-2025]"},{"key":"R2","unstructured":"Quinlan J Levy N Laycock H et al. Letter to MHRA - opioid stewardship. Safe Anaesthesia Liaison Group. 2023. URL: https:\/\/www.salg.ac.uk\/media\/l3sjmffw\/letter-to-mhra-opioid-stewardship-002.pdf [Accessed 21-06-2026]"},{"issue":"1","key":"R3","doi-asserted-by":"publisher","DOI":"10.1186\/s13741-022-00262-3","article-title":"The Perioperative Quality Improvement Programme (PQIP patient study): protocol for a UK multicentre, prospective cohort study to measure quality of care and outcomes after major surgery","volume":"11","author":"Moonesinghe","journal-title":"Perioper Med (Lond)"},{"issue":"6","key":"R4","doi-asserted-by":"publisher","first-page":"758","DOI":"10.1093\/bja\/aew381","article-title":"Patient reported outcome of adult perioperative anaesthesia in the United Kingdom: a cross-sectional observational study","volume":"117","author":"Walker","journal-title":"Br J Anaesth"},{"key":"R5","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j5790","article-title":"Postsurgical prescriptions for opioid naive patients and association with overdose and misuse: retrospective cohort study","volume":"360","author":"Brat","journal-title":"BMJ"},{"key":"R6","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g1251","article-title":"Rates and risk factors for prolonged opioid use after major surgery: population based cohort study","volume":"348","author":"Clarke","journal-title":"BMJ"},{"issue":"3","key":"R7","doi-asserted-by":"publisher","first-page":"290","DOI":"10.1016\/j.bja.2022.06.013","article-title":"No place for routine use of modified-release opioids in postoperative pain management","volume":"129","author":"Quinlan","journal-title":"Br J Anaesth"},{"issue":"10","key":"R8","doi-asserted-by":"publisher","first-page":"1225","DOI":"10.1111\/anae.16085","article-title":"Risks and benefits of oral modified-release compared with oral immediate-release opioid use after surgery: a systematic review and meta-analysis","volume":"78","author":"Liu","journal-title":"Anaesthesia"},{"issue":"10","key":"R9","doi-asserted-by":"publisher","first-page":"1237","DOI":"10.1111\/anae.16070","article-title":"Impact of modified-release opioid use on clinical outcomes following total hip and knee arthroplasty: a propensity score-matched cohort study","volume":"78","author":"Liu","journal-title":"Anaesthesia"},{"issue":"4","key":"R10","doi-asserted-by":"publisher","first-page":"520","DOI":"10.1111\/anae.15262","article-title":"An international multidisciplinary consensus statement on the prevention of opioid-related harm in adult surgical patients","volume":"76","author":"Levy","journal-title":"Anaesthesia"},{"issue":"11","key":"R11","doi-asserted-by":"publisher","first-page":"1220","DOI":"10.1111\/anae.16391","article-title":"Peri-operative pain management in adults: a multidisciplinary consensus statement from the Association of Anaesthetists and the British Pain Society","volume":"79","author":"El-Boghdadly","journal-title":"Anaesthesia"},{"issue":"10","key":"R12","doi-asserted-by":"publisher","first-page":"1169","DOI":"10.1111\/anae.16661","article-title":"An obituary for postoperative use of modified-release opioids","volume":"80","author":"Levy","journal-title":"Anaesthesia"},{"key":"R13","doi-asserted-by":"publisher","DOI":"10.1177\/23743735241228931","article-title":"Digital maturity as a strategy for advancing patient experience in US hospitals","volume":"11","author":"Snowdon","journal-title":"J Patient Exp"},{"issue":"2","key":"R14","doi-asserted-by":"publisher","DOI":"10.1136\/openhrt-2021-001784","article-title":"OpenSAFELY: impact of national guidance on switching anticoagulant therapy during COVID-19 pandemic","volume":"8","author":"OpenSAFELY Collaborative","journal-title":"Open Heart"},{"key":"R15","doi-asserted-by":"crossref","unstructured":"Hardie T Horton T Thornton-Lee N Home J Pereira P . Developing learning health systems in the UK: priorities for action. The Health Foundation; 2022. URL: https:\/\/www.health.org.uk\/reports-and-analysis\/reports\/developing-learning-health-systems-in-the-uk-priorities-for-action [Accessed 21-06-2026]","DOI":"10.37829\/HF-2022-I06"},{"key":"R16","doi-asserted-by":"publisher","DOI":"10.3389\/fdgth.2022.939292","article-title":"Clinical deployment environments: five pillars of translational machine learning for health","volume":"4","author":"Harris","journal-title":"Front Digit Health"},{"key":"R17","unstructured":"University College London Hospitals NHS OMOP dataset. Health Data Research Gateway. URL: https:\/\/healthdatagateway.org\/en\/dataset\/1336 [Accessed 11-05-2026]"},{"key":"R18","unstructured":"Data Access Process for Research (DAP-R). UCLH Biomedical Research Centre. URL: https:\/\/www.uclhospitals.brc.nihr.ac.uk\/safehr\/data-access-process-research [Accessed 26-06-2025]"},{"key":"R19","unstructured":"SAFEHR-data\/omop_es. GitHub. URL: https:\/\/github.com\/SAFEHR-data\/omop_es [Accessed 11-05-2026]"},{"key":"R20","unstructured":"SAFEHR-data\/emap. GitHub. URL: https:\/\/github.com\/SAFEHR-data\/emap [Accessed 11-05-2026]"},{"key":"R21","unstructured":"Whitaker D . DW10\/mhra_mr_opioids. GitHub. URL: https:\/\/github.com\/DW10\/mhra_mr_opioids [Accessed 11-05-2026]"},{"key":"R22","unstructured":"R Core Team. R: a language and environment for statistical computing. R Foundation for Statistical Computing. 2024. URL: https:\/\/www.R-project.org\/ [Accessed 21-06-2026]"},{"issue":"6","key":"R23","doi-asserted-by":"publisher","first-page":"733","DOI":"10.1002\/pds.3945","article-title":"A synthesis of oral morphine equivalents (OME) for opioid utilisation studies","volume":"25","author":"Nielsen","journal-title":"Pharmacoepidemiol Drug Saf"},{"issue":"12","key":"R24","doi-asserted-by":"publisher","first-page":"1175","DOI":"10.1056\/NEJMsb1900856","article-title":"Creating a learning health system through rapid-cycle, randomized testing","volume":"381","author":"Horwitz","journal-title":"N Engl J Med"},{"key":"R25","unstructured":"Foley T Horwitz L Zahran R . Realising the potential of learning health systems. The Health Foundation; 2021. URL: https:\/\/learninghealthcareproject.org\/realising-the-potential-of-learning-health-systems\/ [Accessed 21-06-2026]"},{"issue":"1","key":"R26","doi-asserted-by":"publisher","DOI":"10.1186\/s12961-024-01168-w","article-title":"Siloed mentality, health system suboptimization and the healthcare symphony: a Canadian perspective","volume":"22","author":"Lau","journal-title":"Health Res Policy Syst"},{"key":"R27","unstructured":"Valproate: managing reproductive risks in male patients under 55. Medicines & Healthcare Products Regulatory Agency; 2025. URL: https:\/\/www.gov.uk\/government\/publications\/valproate-managing-reproductive-risks-in-male-patients-under-55 [Accessed 21-06-2026]"},{"key":"R28","unstructured":"Review of the impact of recommendations for the prescribing of isotretinoin. Medicines & Healthcare Products Regulatory Agency; 2026. URL: https:\/\/www.gov.uk\/government\/publications\/review-of-the-impact-of-recommendations-for-the-prescribing-of-isotretinoin [Accessed 21-06-2026]"},{"key":"R29","unstructured":"Improving information supplied with gabapentinoids (pregabalin\/gabapentin), benzodiazepines and z-drugs. Medicines & Healthcare Products Regulatory Agency; 2026. URL: https:\/\/www.gov.uk\/government\/publications\/improving-information-supplied-with-gabapentinoids-pregabalingabapentin-benzodiazepines-and-z-drugs [Accessed 21-06-2026]"},{"key":"R30","unstructured":"Review of risk minimisation for disabling and potentially long-lasting\/irreversible side effects associated with fluoroquinolone antibiotics. Medicines & Healthcare Products Regulatory Agency; 2025. URL: https:\/\/tinyurl.com\/56nxfvrm [Accessed 21-06-2026]"},{"issue":"3","key":"R31","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1136\/ejhpharm-2018-001613","article-title":"Medicines reconciliation in primary care: a study evaluating the quality of medication-related information provided on discharge from secondary care","volume":"27","author":"Shah","journal-title":"Eur J Hosp Pharm"},{"issue":"2","key":"R32","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1016\/j.sapharm.2013.06.009","article-title":"Custom and practice: a multi-center study of medicines reconciliation following admission in four acute hospitals in the UK","volume":"10","author":"Urban","journal-title":"Res Social Adm Pharm"}],"container-title":["JMIR Formative Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/formative.jmir.org\/2026\/1\/e81355","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T22:26:30Z","timestamp":1785536790000},"score":1,"resource":{"primary":{"URL":"https:\/\/formative.jmir.org\/2026\/1\/e81355"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,3]]},"references-count":32,"URL":"https:\/\/doi.org\/10.2196\/81355","relation":{},"ISSN":["2561-326X"],"issn-type":[{"value":"2561-326X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,3]]},"article-number":"v10i1e81355"}}