On the Road to Interoperability, Industry Collaboration Drivers Wanted

The following is a guest blog post from Tom Skelton, CEO, Surescripts.     I've asked the leaders of number of health information exchange organizations to write guests posts to inform us about their plans for the next year.  These posts will appear over the next few weeks.

"As exemplified already by these first few weeks of 2016, health IT leaders certainly have a lot on their plates this year. Regulations and standards are changing, value trumps volume, the market is evolving, and the patient is moving to the center. Care providers and technology providers are both trying to keep pace with impending changes to the meaningful use program, as announced in early January, as well as the continued impact of MACRA—the Medicare Access and CHIP Reauthorization Act of 2015--which focuses on cost, quality and clinical improvement as the basis for Medicare reimbursements.

But keep in mind, these regulatory updates must not deter the use nor the development of technology solutions that both meet changing federal objectives and enable quality-driven care management despite them.

Luckily, we can tap into past successes to ensure these patient-centric, value-based priorities become a reality. Consider the evolution of e-prescribing, one of the most successful examples of technology implementation and widespread interoperability to date. In 2004, just four percent of physicians were sending prescriptions electronically. Then came MIPPA and HITECH, in 2008 and 2009 respectively, which incentivized electronic information exchange and introduced penalties for not using technology like e-prescribing. From 2010 to 2012, e-prescribing took off, with the number of transactions doubling in two years and continuing to increase dramatically since then. In 2015, we’re on track to process more than 1.5 billion electronic prescriptions on our nationwide health information network.

Now more than ever, collaboration is arguably one of the most important drivers of market progress. The industry’s use of technical standards such as Fast Healthcare Interoperability Resources (FHIR), rooted in the use of open APIs and Internet-based information exchange frameworks, has helped improve data exchange and interoperability. But standards and innovation only work when strategy, business models, and mission are aligned. Therefore, it’s critical that we not place all of our bets on a single approach.

Looking back at how far we’ve come, technology providers must apply lessons learned and remain diligent about expanding and improving capabilities going forward. As we continue to find ways to create value, decrease costs, and improve care quality, there are a number of critical areas in which we feel the industry must focus in 2016 and beyond:

Increasing Medication Adherence and Combating Formulary Inefficiencies: Nearly one third of all prescriptions are left unfilled at the pharmacy – many times due to long waits from prior authorization requirements or unforeseen, costly co-pays. But co-pays aren’t the only cost factor. The World Health Organization estimates that 50 percent of patients do not fully adhere to their medication treatment, causing as many as 125,000 premature deaths and billions of dollars in preventable costs.

But when caregivers have digital access to patient-specific cost and coverage information at the point of care, they are able to improve medication adherence and combat issues stemming from inefficient, ineffective formulary and benefits processes. Together with many of our partners, we have convened multiple cross-industry collaborations to improve patient care and experience while driving quality and value into the system from a formulary and benefits perspective. This includes working with our EHR partners, to deliver health-plan generated, patient specific insights directly into provider workflows so that patients have the medication they need, when they need it.

Combating Prescription Fraud and Abuse: In the United States, there are 16,000 deaths from prescription painkillers each year, or nearly 44 each day. By digitizing the prescribing process for controlled substances, prescribers and pharmacists can use technology to combat drug diversion and improve patient safety. And with Vermont becoming the 50th state to legally allow electronic prescribing of controlled substances (EPCS) for all scheduled drugs, prescribers across the nation can now use e-prescribing technology to stomp out fraud and decrease abuse of these highly addictive medications.

Improving Access to Patient Records: Enabling access to patient information in real-time is one of the most important ways that technology can improve care quality and add value. Without this information, providers are essentially jumping into care delivery blindfolded, with patients being the ones who suffer. When providers have electronic access to a patient’s records at the point of care, including critical information like medication history, outcomes are improved and safety is increased. Today, nearly half of all hospitals in the country depend on real-time access to patient medication history data, ultimately saving large 1,000 bed hospitals more than $1 million each year through decreased adverse drug events, prevented patient readmissions, and reduced staff time.

The benefits of digital records access become even greater when solutions are integrated into existing workflows and technologies, and when we can foster collaboration and connectivity where there previously wasn’t any. With EHRs, PBMs, and providers working together to implement solutions like our National Record Locator Service, clinicians can have a fast, easy way to locate patient records, regardless of geography or EHR system, saving time and reducing unnecessary and costly tests or procedures.

Enabling Accountable Care: With knowledge comes power, and the more relevant and actionable the information is, the more accurate and targeted providers can be with their treatment. This knowledge becomes even more urgent when considering changing reimbursement landscape and quality-focused benchmarks of the not-so-distant future, with 30 percent of traditional Medicare payments set to be tied to alternative payment models by the end of 2016 and increasing to 50 percent by the end of 2018.

By combining data from an array of healthcare participants, including pharmacies and PBMs, accountable care entities can reach their quality benchmarks and ensure their providers are operating with the timeliest, most meaningful information possible. This information, when delivered electronically, is ultimately improving population health and helping accountable entities better track and care for their patients.

The key takeaway? Interoperability is a reality for many in health IT today, and quality, efficient patient care is the end goal. We must apply the lessons learned in e-prescribing to broader health information exchange for value-driven care with technology as its foundation. We’ve been committed to connecting healthcare for over a decade, and remain focused on continuing to reduce prices to move critical health information affordably and securely, for the benefit of all who are connected.

By continuing to partner with doctors, pharmacists, software vendors, PBMs and others connected through our nationwide network, we are able to add value that could only otherwise be realized through connections with dozens or hundreds of separate organizations. Collaboration-enabling technologies made possible by a nationwide health information network have a direct impact on patients, by saving lives and improving quality on a massive scale each and every day – all while reducing costs and keeping information exchange private and secure. "