Monday, July 7, 2008

The Surescripts/RxHub merger

Last week, I spoke with the Associated Press and Wall Street Journal about the recent merger of Surescripts and Rxhub.

My basic message was:

"The merger of Surescripts and RxHub provides a single medication data stream, supporting medication safety. It also provides an easy e-prescribing implementation path for electronic health record vendors and an enhanced medication workflow for clinicians nationwide."

Here's the reason I made these comments. In the world of e-Prescribing, the stakeholders are

- the patient
- the physician writing the prescription
- the retail pharmacy or mail order pharmacy
- the payer
- the pharmacy benefit manager (PBM), which acts on behalf of the payer to adjudicate claims
- RxHub: the connection to most PBMs
- SureScripts: the connection to most retail pharmacies

Here's the data flow:

1. A clinician begins to e-Prescribe and electronically queries for the patient's insurance eligibility and the appropriate payer's formulary. Before the merger, both RxHub and SureScripts had eligibility services but RxHub processed the majority of these transactions.

2. The clinician queries for medication history to check for drug/drug interactions. RxHub has medication history based upon claims data and SureScripts has the actual dispensed information from the pharmacies (which includes cash, third party claims and $4 generic programs). Before the merger, the clinician's EHR would have to issue separate queries via two separate interfaces to get a complete history.

3. The physician completes the prescription. Retail pharmacy transactions are transmitted to SureScripts for delivery to community pharmacies and smaller mail order firms. Mail order transactions served by one of the 3 large PBMs are transmitted to RxHub for fulfillment. Again, two separate interfaces were required.

As SureScripts-RxHub integrates its services, there will no longer be a need to send out 2 queries for eligibility/formulary, medication history or routing. Also, the two sources of medication history data will be de-duplicated, providing an accurate and usable medication data flow to all stakeholders.

In addition to the Surescripts-RxHub merger, two other important events will accelerate e-Prescribing in 2009.

1. Regulatory changes proposed by the Drug Enforcement Agency will enable electronic prescribing of scheduled/controlled medications. Having separate workflows for controlled medications verses all others has been a real barrier to process change in many medical care settings. I look forward to the regulatory change.

2. Incentives to adopt and use e-Precribing via the Medicare Electronic Medication Safety Protection Act of 2007. Clinicians have been reluctant to adopt electronic prescribing because of the investment and time commitment to change change their workflow. Currently only 4% of the clinicians in the country e-prescribe (although Massachusetts is at 13% and BIDMC is at 50%). A one time payment when e-prescribing is implemented helps a physician acquire the technology. An ongoing incentive ensures they continue to use it.

Let's hope 2009 is the year of e-prescribing. Everyone wins through reduced cost, enhanced quality and better workflow.


Richard Dale said...

John... E-prescribing stakeholders: great list ... except where is the patient! I know you well enough to be sure that you place the patient at the center of the healthcare world. I take this as commentary on the e-prescribing transaction itself, and not a reductionist view of health-care!
Based on your previous comments, and talks I have heard you deliver, I understand e-prescribing is about better patient care at lower cost.
Amen to that.

John Halamka said...

Absolutely! I'll add patients to the stakeholders list. I have spoken with Surescripts/Rxhub leadership about ensuring patients have access to all their own data.

willrice said...

How are you measuring BIDMC eRx rate (50%)? Writing the prescription electronically is only half of the transaction. It must be received by the pharmacy electronically (not e-fax, not viewed in one system and typed into another system). How do you measure the true eRx rate at 50%?

Usman said...

Hi John. I'm one of your students from the Healthcare Quality course this year (Dr. Leape). The workflow you described looked like this to me:

Clinician begins e-prescribe --> Query to insurance --> if eligible --> Query drug hx for interactions --> if no interaction then transmit transaction to pharmacy.

I assumed this part:
If some interaction found --> re-prescribe alternative --> repeat.

I was wondering why the interaction query doesn't come before the query to insurance company?

John Halamka said...

Responding to Willrice's question - 95% of the pharmacies in Massachusetts are electronically (not fax) connected to Surescripts, so we're in good shape. Our BIDMC EMR does not have a fax option, just an NCPDP Script 8.1 electronic routing option.

Responding to Usman's question - the insurance query leads us to the formulary, which specifies the list of prescribing possibilities. The clinician chooses medications from the list and if there is a conflict, formulary alternatives are shown which are safe.

Anonymous said...

wholesale jewelry
handmade jewelry
jewelry wholesale
fashion jewelry
costume jewelry

Anonymous said...

看房子,買房子,建商自售,自售,台北新成屋,台北豪宅,新成屋,豪宅,美髮儀器,美髮,儀器,髮型,EMBA,MBA,學位,EMBA,專業認證,認證課程,博士學位,DBA,PHD,在職進修,碩士學位,推廣教育,DBA,進修課程,碩士學位,網路廣告,關鍵字廣告,關鍵字,課程介紹,學分班,文憑,牛樟芝,段木,牛樟菇,日式料理, 台北居酒屋,日本料理,結婚,婚宴場地,推車飲茶,港式點心,尾牙春酒,台北住宿,國內訂房,台北HOTEL,台北婚宴,飯店優惠,台北結婚,場地,住宿,訂房,HOTEL,飯店,造型系列,學位,牛樟芝,腦磷脂,磷脂絲胺酸,SEO,婚宴,捷運,學區,美髮,儀器,髮型,牛樟芝,腦磷脂,磷脂絲胺酸,看房子,買房子,建商自售,自售,房子,捷運,學區,台北新成屋,台北豪宅,新成屋,豪宅,學位,碩士學位,進修,在職進修, 課程,教育,學位,證照,mba,文憑,學分班,網路廣告,關鍵字廣告,關鍵字,SEO,关键词,网络广告,关键词广告,SEO,关键词,网络广告,关键词广告,SEO,台北住宿,國內訂房,台北HOTEL,台北婚宴,飯店優惠,住宿,訂房,HOTEL,飯店,婚宴,台北住宿,國內訂房,台北HOTEL,台北婚宴,飯店優惠,住宿,訂房,HOTEL,飯店,婚宴,台北住宿,國內訂房,台北HOTEL,台北婚宴,飯店優惠,住宿,訂房,HOTEL,飯店,婚宴,結婚,婚宴場地,推車飲茶,港式點心,尾牙春酒,台北結婚,場地,結婚,場地,推車飲茶,港式點心,尾牙春酒,台北結婚,婚宴場地,結婚,婚宴場地,推車飲茶,港式點心,尾牙春酒,台北結婚,場地,居酒屋,燒烤,美髮,儀器,髮型,美髮,儀器,髮型,美髮,儀器,髮型,美髮,儀器,髮型,小套房,小套房,進修,在職進修,留學,證照,MBA,EMBA,留學,MBA,EMBA,留學,進修,在職進修,牛樟芝,段木,牛樟菇,關鍵字排名,網路行銷,关键词排名,网络营销,網路行銷,關鍵字排名,关键词排名,网络营销,PMP,在職專班,研究所在職專班,碩士在職專班,PMP,證照,在職專班,研究所在職專班,碩士在職專班,SEO,廣告,關鍵字,關鍵字排名,網路行銷,網頁設計,網站設計,網站排名,搜尋引擎,網路廣告,SEO,廣告,關鍵字,關鍵字排名,網路行銷,網頁設計,網站設計,網站排名,搜尋引擎,網路廣告,SEO,廣告,關鍵字,關鍵字排名,網路行銷,網頁設計,網站設計,網站排名,搜尋引擎,網路廣告,SEO,廣告,關鍵字,關鍵字排名,網路行銷,網頁設計,網站設計,網站排名,搜尋引擎,網路廣告,EMBA,MBA,PMP


Anonymous said...

I like play online game, I also buy ragnarok online zeny and ro zeny, the ragnarok zeny is very cheap, and use the iro zeny can buy many things, I like cheap zeny, thanks, it is very good.

I like play online game, I also buy rupees and rappelz rupees, the rappelz gold is very cheap, and use the rappelz money can buy many things, I like cheap rappelz rupees, thanks, it is very good.

Affordable Luxurious Wedding Dress Blog said...

cheap wedding gowns,
discount bridal gowns,
China wedding dresses,
discount designer wedding dresses,
China wedding online store,
plus size wedding dresses,
cheap informal wedding dresses,
junior bridesmaid dresses,
cheap bridesmaid dresses,
maternity bridesmaid dresses,
discount flower girl gowns,
cheap prom dresses,
party dresses,
evening dresses,
mother of the bride dresses,
special occasion dresses,
cheap quinceanera dresses,
hot red wedding dresses

Football Matches said...

How are you measuring BIDMC eRx rate (50%)? Writing the prescription electronically is only half of the transaction. It must be received by the pharmacy electronically (not e-fax, not viewed in one system and typed into another system). How do you measure the true eRx rate at 50%?

Recep Deniz MD