Last month, Surescripts, the Arlington, Va.-based operator of a national clinical electronic network, released its 2016 National Progress report, revealing several noteworthy findings as it relates to healthcare interoperability.
Perhaps the report’s biggest single takeaway was that 10.9 billion secure health transactions took place in 2016 via the Surescripts network—a 12-percent increase from 2015—including 1.6 billion e-prescriptions. What’s more, the network connected 1.3 million healthcare professionals—21.5 percent more than in 2015—with secure patient data for 230 million Americans, or 71 percent of the population. Also in 2016, more than 1.08 billion medication history transactions containing key patient data were made available to providers at the point of care, the report noted.
Indeed, Surescripts’ National Record Locator Service (NRLS) aims to give healthcare providers fast and easy access to clinical records and historical patient visit locations. Last year, Surescripts delivered more than 2.2 million documents summarizing where patients received care, including information from more than 43 million patient visits to more than 165,000 clinicians, according to the report.
Soon after the report dropped, Healthcare Informatics Managing Editor Rajiv Leventhal spoke with Micky Tripathi, Ph.D., president and CEO of the Massachusetts eHealth Collaborative, and one of the nation’s leading voices on health data exchange. Tripathi discussed the significance of the report as well as how the industry is progressing with interoperability. Below are excerpts of that interview. (Editor’s note: On that same call, Tripathi also was asked his thoughts on a recent CNBC report which revealed that Apple is looking to make the iPhone a centralized spot for patients’ medical data. Tripathi’s commentary on that topic can be read here).
Micky Tripathi, Ph.D.
What do you think people should take away from Surescripts’ National Progress report?
Overall, Surescripts and e-prescribing in general have been the single greatest success in interoperability since we the widespread adoption of EHRs [electronic health records]. They’ve been able to drive e-prescribing to be a real commodity type of function that everyone has available to them and that has penetrated widely in almost every part of the U.S. So that’s number one.
However, it also points out there are still challenges and that it’s hard to get 100 percent of anything. As the report shows, there are different areas where there are independent pharmacies, that aren’t fully connected. And in some cases, people are not adopting the technology quite as fully in certain pockets.
When you look at what Surescripts has been able to do with its National Record Locator Service NRLS, can this be applied to other types of interoperability?
I think there is something valuable about what they have been able to do with respect to building an NRLS from the information that one can glean from prescribing relationships and prescribing behaviors. So that’s certainly a benefit—to the extent that knowing that a patient has a relationship with a provider because that provider prescribed something to that patient, and now that the information becomes available to people, they don’t have to do any work to get access it. That’s very valuable and they have done a nice job in making that available.
I will say that you do start to get into some of the different gaps that any organization or any effort like this has when you start doing “secondary uses,” or using data for another purpose. So in this example, Surescripts is able to glean [information about] relationships based on prescribing behavior. So the data they have at first is primarily because Dr. Jones prescribed something to you. Well ok, they have that and that’s the primary motivator for the data they have, and then they are able to say that there are relationships you can show—relationships which suggest that there must be other information there beyond prescribing information. And that forms the basis of my NRLS.
But one of the problems with that is that there are gaps—not every relationship ends up in a prescription. So if I go see a provider and they didn’t prescribe me anything, that won’t show up in the Surescripts’ database. And it’s not Surescripts’ fault, but it’s just a natural implication of the fact that you were getting data for one purpose and now you are trying to use it for another purpose. And it fits maybe 70 percent of the time for that, but there are gaps because that’s not always primarily what the data was being collected for.
CommonWell, which also has a nationwide RLS, does it through a different angle, and that presents its own set of data gaps. They do it based on real relationships, and that’s what they’re documenting in the RLS. What the CommonWell RLS doesn’t have are all those relationships that exist outside of the vendors that are participating in it. So you’re deep with those that are participating but you don’t have visibility with the relationships with those that are outside of CommonWell. So what gaps can you tolerate? It is a balance. Ideally you would use both [RLS’s] and many others because each one has its own gaps.
As we stand today, what do you still see as core interoperability challenges? What’s the progress update on the recent CommonWell/Carequality collaboration announcement? (Editor’s note: Tripathi sits on the board of directors of The Sequoia Project, which operates Carequality, and also does project management work for CommonWell).
I am optimistic. The CommonWell/Carequality [collaboration] is in motion; it’s in implementation mode. Right now, CommonWell is an implementer of Carequality and it is a Carequality adopter—when you go on the website you see it listed there among the other Carequality adopters. Their current plan is to have that up and running by the end of the year.
The challenge is that CommonWell was architected to perform interoperability in a certain way, and that’s a little different from what Carequality-type interoperability means. So there is real design and implementation work that has technical implications with respect to the infrastructure, and which has policy implications, too. There are certain policies that are baked into their vendor contracts that [define] how to do interoperability with respect to an RLS that sits at center, and with patient matching and things like that. With Carequality, the [terms] are different, so you have to go back and say how does this change our contracts and what we are representing to our provider organizations? So there are all kinds of flow down effects that just take time to work through. But to me that’s just an implementation thing, and I am confident that in two years from now we will look back and forget about this implementation period even though it feels painful right now.