HIT Perspectives – September 2016
Surescripts Issues: Its 2015 Progress Report
By Tony Schueth, Editor-in-Chief
Surescripts recently released its 2015 National Progress Report. It further documents the industry’s herculean efforts in the past decade to eliminate the paper prescription pad (for all intents) and deliver essential data to prescribers.
For starters, some 10 billion transactions flowed just through the Surescripts network in 2015. These included 1.4 billion electronic prescriptions for noncontrolled substances — almost a modest 10% increase. Even so, that translates to an average of 3.8 million electronic prescriptions in the US each day, which is more than the 1.4 million Amazon packages shipped daily and Uber’s 2 million rides worldwide.
The numbers are indicative of the ubiquity of electronic prescribing (ePrescribing) so far. That said, the last mile will be harder as we begin to address ePrescriptions from the “laggards” — those slow to adopt this not-so-new technology – and dental care, discharge medications, long-term and post-acute care, specialty medications and controlled substances (EPCS).
EPCS was cited in the reportas documenting huge growth. Specifically, there was a 667% uptick in EPCS transactions — 12.8 million in 2015 compared with 1.67 million in 2014. Most of that was due to New York’s EPCS mandate, which demonstrates that prescribers need a legislative push to move them toward widespread adoption.
The level of success of the Empire State’s ePrescribing mandate has emboldened other states to adopt similar legislation; there already are a growing number of state laws and regulations that will require use of EPCS. In addition, the nationwide opioid epidemic is creating interest at the federal and state levels in tools, like EPCS, that can be used to stop overdosing and doctor shopping. (To keep current with these laws and regulations, Point-of-Care Partners offers its ePrescribing Law Review, which is the most succinct yet comprehensive analysis of federal and state rules, regulations and statutes governing electronic prescriptions in all states and the District of Columbia).
In addition, Surescripts routed 1.05 billion medication history transactions, which represents three times the population of the United States. Some 15.28 million clinical messages flowed through the network in 2015. The latter is an example of newer transactions in the Surescripts portfolio.
Despite the progress made so far, opportunities exist in the ePrescribing work flow on which we can capitalize. Take medication reconciliation, for example. As Surescripts highlighted in its report, nonadherence to prescription medication costs the US health care system close to $300 billion per year. Work can be done to promote, streamline and enhance this transaction to encourage wider utilization. Reconciling a patient’s medication history is becoming more automated due to requirements under meaningful use. Surescripts announced in early September the launch of a new medication history service to support population health management. The underpinnings of the new solution, prescription data from pharmacy benefit managers/payers and pharmacies, previously existed but have now been consolidated into a single data feed that presents a more cohesive picture of a patient’s medication history and adherence to prescribed therapies. It’s not necessarily a complete view of a patient’s medication history as it is subject to pharmacy and payer participation and typically doesn’t include cash pay, but it is an improvement over the claims- or pharmacy-only data.
Looking at complementary transactions and supporting data, we were again surprised to see several others that didn’t make the cut. There was no information about the formulary and benefit (F&B) file, which has been provided by Surescripts since back in the day. 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 benefit 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 high out-of-pocket costs to be a main reason why patients abandon prescriptions.
Specialty pharmacy also was not included but is an area of huge growth potential, even if the transactions will be minimal. The first reason is because specialty medications are the fastest growing sector in the American health care 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 work flows. These deal almost exclusively with controlled substances and prior authorizations, so EPCS and electronic prior authorization are definitely in their future once specialty pharmacies migrate away from the current paper-phone-fax environment.
All in all, the report highlights the industry’s success with ePrescribing, paints a picture of what’s still to be done and highlights how related transactions can translate to other areas of health information technology and patient care. Let Point-of-Care Partners help you interpret the data in the report and build it into your work flow and business plan.