Surescripts Unveils New Patient Record Locator Service


By Michael Burger, Senior Consultant

Patients typically get care and treatment from many doctors and in many places, including physicians’ offices, hospitals, pharmacies and urgent care clinics. Doctors wish they had this complete picture of patient data — or so-called longitudinal view — to make the most informed treatment choices as well as enable improved care quality and patient safety. This is closer to becoming a reality now that Surescripts has begun promoting its national record locator service (NRLS). The NRLS has the potential to be an industry game changer.

According to Surescripts’ press release, the new service will be offered without charge until 2019 to electronic health record system (EHR) vendors as a way to foster data exchange. Our understanding is that the NRLS is based on Surescripts’ existing methodology for identifying patients and matching them to their records, which is used extensively for electronic prescribing. The NRLS will operate within the nationwide Carequality Interoperability Framework, which “leverages a common set of legal, technical and policy rules for data sharing across technology platforms and networks.”

What does it mean? For the industry, the NRLS could be the start of something big.This is a national network offering free record locator services to EHR vendors. Epic, NextGen, Greenway Health, Aprima and eClinicalWorks already have signed up, representing 41% of all Meaningful Use-attesting EHR users.The NRLS could create competitive advantage for these major players, and perhaps create another challenge to the hundreds of smaller EHR vendors aspiring to compete with these big guns.The early adopter EHRs create a significant core user group, which we believe makes the infrastructure investment and NRLS launch a good investment on Surescripts’ part.

The availability of the new NRLS data adds to the existing medication history already available for multiple prescribers in the Surescripts medication history data feed. The value in the NRLS for doctors (outside of prescribing) is that they now have on-demand access to a range of data — such as lab results, vital signs, allergies and procedures — from the patient’s other health care providers. This is vital clinical information they have limited access to today, and often on paper. For patients, the NRLS is valuable because it gives their doctor a complete view of their records, regardless of where care was provided or by whom. As the number of EHR vendor participants of NRLS grows, we expect to see an increase in higher quality of care and a reduction in care-related expenditures by reducing duplicate testing.

What do we think? We think this is a good idea whose time has come, and we are encouraged by the number and scope of the EHRs which are participating. As mentioned previously, we think the NRLS has the potential to be a game changer. However, there are unanswered questions.

The first have to do with the business model. The NRLS is being offered free until 2019 to EHR vendors. What happens after that remains to be seen. Will there be charges for using the service? How much and under what circumstances? What about updates? Will there be costs to participants? Currently, pharmacies and payers support Surescripts’ electronic prescribing services. Who will pay the freight for the NRLS?

Another set of questions deals with physician adoption. The NRLS technically enables physicians to efficiently identify and share patient records within existing workflows. But now that Surescripts has built it, will physicians use it? Use of interoperable EHRs has been the major focus of the federal Meaningful Use EHR Incentive Program for several years. Despite the fact that interoperability is an MU requirement, actual data sharing has been sparse to date. There is no incentive program to promote adoption or payment-related incentives for using the NRLS, such as mandating its use as a quality measure. Such legislative and pay-for-performance requirements have historically been great motivators of physician adoption. Without such motivation, will doctors use the NRLS solely because it could help improve the quality and safety of patient care?


The Top 10 Takeaways from the Surescripts 2015 National Progress Report


By Tony Schueth

American healthcare continued to use technology at a record-breaking pace in 2015 to prescribe medications and improve patient care, according to Surescripts’ newly released 2015 National Progress Report. Here are our top 10 takeaways.

  1. ePrescribing adoption still grew in 2015. The Report indicates that regular electronic prescribing (ePrescribing) increased by roughly 10%, with 75% of non-controlled substance prescriptions being sent electronically. There were 1.41 billion such ePrescriptions routed through Surescripts in 2015.  In fact, these ePrescriptions nearly doubled since 2012 and increased 300% since 2010.
  2. Despite rumors to the contrary, ePrescribing is still alive. We think that the modest 2015 growth in ePrescribing is pretty good, especially since we are at the tail end of the ePrescribing adoption curve.  While the last mile may not be a cake walk, there are still many areas that can contribute to ePrescribing volume and adoption, such as prescriptions from laggards, dental care, discharge medications and long-term and post-acute care. Perhaps the biggest opportunities will come from increasing electronic prescriptions for controlled substances (EPCS) and specialty medications.
  3. EPCS adoption. EPCS grew substantially in 2015, fueled by the desire of all stakeholders to address the opioid epidemic and resulting state mandates. As a result, there was a 667% uptick in EPCS transactions—12.8 million in 2015, compared with 1.67 million in 2014. However, that growth was due mostly to New York’s I-STOP program, which mandates EPCS.
  4. EPCS Connectivity. About 80% of pharmacies (mostly chains) could receive ePrescriptions for controlled substances in 2015, which is slightly more than 2014. The number of providers who can electronically submit controlled substance prescriptions rose to 5.7% in 2015. While that’s a 359% increase over 2014, it’s still a disappointing overall connectivity rate. EPCS connectivity by pharmacies and physicians should rise as more states follow New York’s lead for mandatory EPCS. Legislation is a time-tested way to get folks off the starting blocks.
  5. Missing puzzle pieces. We were again surprised that we didn’t see anything about the formulary and benefit (F&B) file, which has been a major part of ePrescribing since back in the day and is critical for ePrior Authorization. There also was nothing about the real-time benefit check (RTBI). This up-and-coming transaction is a value add because of its potential for providing real-time, patient-specific formulary and benefits information at the point of care. Both the F&B and RTBI have implications for curbing costs and, arguably, improving health care by increasing formulary compliance and medication adherence. Research has shown that high out-of-pocket costs are a main reason why patients abandon prescriptions.
  6. Other transactions. In case you were unaware of what Surescripts has been up to, the Report highlights several newer products and services in the company’s portfolio. These include clinical messaging, electronic prior authorization (ePA) and medication history aimed at hospitals. Surescripts also is branching out into the realms of long-term and post-acute care (LTPAC). LTPAC is a huge growth area, which is ripe for ePrescribing and EPCS.
  7. Keep an eye out for specialty pharmacy. Specialty pharmacy was also missing. It’s important because specialty medications represent the fastest growing sector in the American healthcare system. Use of specialty medications is expected to jump by two-thirds in 2015 and account for half of all drug costs by 2016. Secondly, specialty pharmacies are just beginning to consider how to computerize their prescriptions and workflows.
  8. It’s a marketing brochure. The Report has evolved over the last decade or so from its humble beginnings as a yearly snapshot of ePrescribing adoption. Now it is slicker than ever. There are videos of providers, thought leaders and others, who comment on how Surescripts’ products improve patient care. There are interactive features, such as a return-on-investment calculator for physicians for ePA and an interactive map showing state rankings for EPCS enablement.
  9. The state ePrescribing adoption map isn’t quite what we expected. The Report contains a map indicating the estimated rate of ePrescribing use by state of medications in the five major therapeutic classes of drugs as defined by First DataBank. They are: heart and blood vessel, antibiotic and antiviral, brain and spinal cord, endocrine/hormonal and respiratory. This is a new approach that took us by surprise. If this format is kept, we hope other classes will be added.  Furthermore, the map could be done differently (or a second map added) to improve usability, for example by condition instead of therapeutic drug class.
  10. The presentation of data. The interactive map approach is easy on the eye and a pretty cool feature. It certainly is what many users expect in this digital age of data sound bites. However, this approach obscures how much information the Report really contains because the user must do a lot of digging and individual analysis to make meaningful comparisons across states and regions. Why? The user must click on each state, record data of interest, collate it and analyze it.  In the old days, much of this would be provided in chart form. Yes, charts are boring, but making users dig for the data could lead to less than fully optimal use of the Report.

NCPDP Action Group Focused on Biologics and Biosimilars


By Brian Bamberger, Practice Lead, Life Sciences

Biologics and biosimilars are starting to burst into the American market. Biosimilars are expected to quickly become mainstream in the near future because of their significant cost-savings and patient care implications. Recognizing their potential and patient safety implications, how can the unique challenges of biologics and biosimilars be addressed when folding them into the electronic health record landscape?

This was the focus of a July 21 Stakeholder Action Group (SAG) meeting of leaders of key industry stakeholders at the National Council for Prescription Drug Programs (NCPDP). Attendees included pharmacies, electronic health record (EHR) vendors, electronic prescribing infrastructure providers, pharmaceutical manufacturers, health care providers and other industry groups.

Unique challenges of biologics and biosimilars. Compared to traditional medications, biologics and biosimilars have unique properties—in terms of their manufacturing and the legal requirements related to their use. In addition, biologics and biosimilars are typically specialty medications, which as a whole still rely on antiquated phone-fax-paper methods for gaining payer approvals and engaging patients with specialty pharmacies.Those are among the reasons why changes will be needed when folding biologics and biosimilars information into the electronic health information ecosystem. The SAG discussed a number of these challenges, including:

  • Manufacturing variability. The composition of biologics and biosimilars vary among manufacturers and the lots they produce. This is important information that when captured in the electronic health record (EHR) may improve the reporting detail in adverse drug event (AE) reports.
  • Pharmacy substitution rules. States are leading the way in proposing and enacting substitution legislation for biosimilars. Most include a notification to the prescriber if an interchangeable biosimilar is available (even if there is no substitution). Not surprisingly, these requirements differ by state. How should these varying requirements be addressed in prescriber EHR systems to satisfy the needs of prescribers, pharmacies and states? The accuracy of the reported NDC numbers by pharmacies was also examined with an open question about NDC information in the EHR to identify drugs that were both prescribed and dispensed.
  • Adverse event reporting. Today, the Food and Drug Administration receives AE reports directly from healthcare professionals, consumers and manufacturers. Biologics and biosimilars are expected to generate a higher number of AE reports due to the complex conditions they treat. The reporting is typically based on the information a physician has available, which may be incomplete. For example, the EHR may contain information on which drug was prescribed, rather than the drug that actually was dispensed. As a result, the patient’s medication history may not be complete. This in turn causes the adverse event to be reported on the drug that was prescribed to the patent, rather than what was actually administered or dispensed.

Opportunities. The SAG discussed opportunities for reporting of biologics and biosimilar on current infrastructure and transactions. Two possibilities were identified for reporting administered or dispensed medications to patients. The first is RxFill, which is a Meaningful Use 3 requirement for EHR systems but isn’t used much today. The RxFill message tells the prescriber that the patient has picked up the medication from the pharmacy for each fill. The second is RxHistory, which also is available to the prescriber at the point of prescribing.  While very useful, the information may not be complete.

The SAG recommended that NCPDP convene a Task Group to develop use cases for biologics and biosimilars for both transactions. It also recommended the development of pilots to test the use of the transactions for biologics and biosimilars when an interchangeable biosimilar is available. A pilot can also be used to address the accuracy of NDC numbers in these messages.

Next steps.  The creation of the Task Group was just approved by NCPDP at the August Workgroup meetings.  Stay tuned for results of the Task Group’s deliberations and the development of pilots.