The purpose of this paper is to describe potential improvements in patient 
safety resulting from design decisions in the development of a computerized 
decision support system (DSS) for managing opioid therapy for chronic noncancer 
pain. ATHENA-DSS is an automated decision support system developed in a 
collaboration between Stanford University and the U.S. Department of Veterans 
Affairs (VA) to increase guideline-adherent prescribing and to change physician 
behavior. Based on data in patients’ computerized medical record and knowledge 
of the clinical domain encoded in a knowledge base, the system gives 
patient-specific recommendations to primary care providers at the point of care. 
ATHENA-Opioid Therapy is based on a previous system, ATHENA-Hypertension, and is 
designed to follow the VA/Department of Defense clinical practice guideline for 
the management of opioid therapy for chronic noncancer pain. We describe the 
rationale for development of decision support system elements and a graphical 
user interface to increase patient safety during primary care treatment for 
chronic pain. The ATHENA-Opioid Therapy system focuses on reducing patient risk 
in four main ways by: (1) identifying patients with comorbidities or concurrent 
prescriptions that raise risk for overdose and recommending more conservative 
dosing; (2) identifying patients with mental health problems that increase risk 
of medication abuse and recommending referral to psychiatric care and close 
monitoring; (3) assisting doctors with complex pharmacologic calculations to 
reduce the risk of mistakes when initiating, titrating, or switching 
medications; and (4) presenting relevant information to clinicians in an 
easy-to-use format. We describe a system evaluation plan that we believe is 
essential to ensure that deployment of ATHENA-Opioid Therapy leads to 
improvements in patient safety and increases in guideline-concordant 
prescribing, and we discuss the limitations of this system for patient safety 
efforts.