SureScripts, A Defacto NHIN

Yesterday in New Orleans, SureScripts announced a new line of business: Clinical Interoperability. Leveraging their existing ePrescribing solution platform, currently serving over 200K physicians nationwide, and combining it with the technology stack of messaging solution provider Kryptiq, SureScripts will offer providers, EHR vendors, HIEs and other stakeholders the opportunity to securely share clinical information across town, the state, a region and the country. In this combination, SureScripts will provide the rails and Kryptiq will address the last mile of connectivity. This announcement has some pretty big implications for the HIE market.  Chilmark was briefed prior to this announcement by both SureScripts and Kryptiq, following is what we learned.

Details:
SureScripts primary focus has been to provide the network that would support physicians transition to ePrescribing. Therefore, SureScripts has been focused on transmitting NDP data and not clinical notes. SureScripts got into the transmission of clinical summaries from one of its larger customers, MinuteClinic wanted to send clinical summaries of patient visits directly to primary care providers. In the past year SureScripts has facilitated the movement of over 0ne million patient summaries for MinuteClinic to primary care physicians using CCR. Seeing an opportunity, SureScripts sought a partner that could take this capability to the next level.

Kryptiq, a company profiled in Chilmark’s forthcoming HIE Market Trends Report due out next month, can be characterized as vendor of HIE capabilities that allow for the organic growth of an HIE without the overhead. Kryptiq has worked behind the scenes for a number of EHR companies to provide secure, structured messaging services within these EHRss ecosystems of customers connecting them to one another as well as to other systems, including SureScripts to facilitate care coordination.

SureScripts has made an equity investment in Kryptiq (undisclosed but likely in the range $7-9M over the next few years) to build-out Kryptiq’s technology stack for SureScripts. The Clinical Interoperability solution will combine SureScripts foundational technology (provider directory, security, authentication, master patient index, etc.) with Kryptiq’s connectivity toolset (interface technology to various EHRs), secure messaging framework and clinical portal.

SureScripts will release the first wave of Clinical Interoperability products in early December. Pricing will be subscription-based (monthly) and depend on the level of service a given practice desires.

Implications:
SureScripts is the closest thing the US has to a de facto National Health Information Network (NHIN). With the rapid growth in ePrescribing (181% in 2009) representing over 600M prescriptions and now over 200K physicians connected to SureScripts, SureScripts has a network in place, particularly in the ambulatory sector, that few if any can boast of. Sure, Epic has its walled garden of Epic Everywhere and its future release of Epic Elsewhere will attempt to connect physicians using other EHRs, but the walled garden has not proven itself to be sustainable over time. Just look at AOL’s walled garden: fine in the early days of the Internet but was simply unable to innovate fast enough to satisfy market needs and wants.

As an EHR vendor neutral platform that actually puts EHR vendors through a rigorous process to provide them with SureScripts certification, SureScripts is not a threat. If anything, and this is highly dependent on what SureScripts may do in expanding its Clinical Interoperability product and services suite, SureScripts may provide a common foundational and commercial NHIN framework that will allow others, including EHR vendors to provide innovative solutions upon. This may lead to a Platform as a Service (PaaS) model facilitating the adoption of distinct modules that sit upon the SureScripts/Kryptiq communication network.

While both SureScripts and Kryptiq stated that they did not see themselves competing directly with HIE vendors, Chilmark sees quite the opposite. Through its ePrescribing services, SureScripts already has established data connections and relationships with a number of EHR vendors. Kryptiq, through its services, has the technology that provides the interfaces to a wide range of EHRs, many of them in the ambulatory sector where SureScripts is also strong. The combined SureScripts-Kryptiq solution suite will impact many an HIE vendor’s bottom-line for these HIE vendors generate a significant portion of revenue on EHR interfaces and their portal solutions. The SureScripts announcement is likely generating a significant number of internal meetings among HIE vendors as they assess what their game plan will be moving forward. If they are wise, they will seek out SureScripts and look at opportunities to collaborate, offering distinct value-added services on the SureScripts network.

While Chilmark was briefed prior to this announcement by both SureScripts and Kryptiq the briefing was short and details few. A more in-depth briefing will occur in the next week or two, including a deep dive into the technology stack. We’ll keep you posted.

Addendum:
John Halamka, CIO at BIDMC, was on the SureScripts panel yesterday at MGMA when this announcement was made. He provides his own perspective from the vantage point of one who is deeply involved in the Massachusetts HIE initiative.

Posted in CCD, Health Information Exchange, policy Tagged with: , ,
2 comments on “SureScripts, A Defacto NHIN
  1. Matt says:

    It seems like a bit of a stretch to state that a network that enables point to point connectivity meets the needs of provider networks leveraging DRR oriented HIEs.

    The future of care delivery is based upon access to complete clinical information at the point of care as well as the being able to see how the efficiency and quality of care delivered to an individual stack up against community metrics. (consider ACOs)

    It is my opinion that this will not be accomplished with a point to point network, but rather via community oriented EHR accessed directly via EMR or an ERM wrapped in a portal.

    It is likely that the creation of a vendor agnostic messaging service devalues the secure messaging network that Kryptiq has worked so hard over the years to create. Now a vendor with a very few connect physicians can offer the same robust network that Kryptiq can and rather than devoting effort to the building a network they can focus on building value added applications on top of that network.

    As for HIE vendors, yes today many generate a significant portion of revenue on EHR interfaces but this type of service is essentially a commodity piece of middle ware. Similar to my statement above, the next generation of HIE vendors will not be selling middle ware, but rather value added services that consume the data available on the network and generate meaningful, actionable information which can then be augmented through decision support tools.

    One unanswered question is why are we not relying on NIHN Direct and a simple national directory of connected providers? Additionally are we augmenting a standard prized for its lack of complexity?

  2. Matt –
    Thanks for your concern for Kryptiq. Speaking for Kryptiq, we believe this adds significant value for our existing customers. Kryptiq has always been a vendor-agnostic solution, and we offer numerous ways to access secure messaging depending on how a given vendor wants to work with us. Like ePrescribing, sustained high utilization occurs when the solution is deeply embedded in the workflow of the system-of-record, and hence we are most well known for the success enjoyed by our GE Healthcare and Sage Software customers, where we have the richest integration. Hence a core value of the Surescripts relationship is that any vendor, regardless of the size of their customer base, can now achieve that rich integration through the same implementation, certification, and deployment services that have powered the growth of ePrescribing over the last few years.

    We firmly believe the focus of EHR and other HIT vendors should be on increasing value of end-user applications, and not in having to spend precious resources on developing connectivity services that can readily be provided by a network. And Metcalfe’s Law applies here just as it does in telecoms – the value of the network to each participant grows exponentially with the number of participants. So we at Kryptiq are all for lowering any barriers to accessing the network – and increasing the value of participation. That’s how we can all help healthcare be better coordinated and more effectively delivered for the benefit of the physicians and the patients they serve.

    Malcolm Costello
    SVP Sales & Marketing
    Kryptiq Corp.
    http://www.kryptiq.com

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Chilmark Research is the only industry analyst firm focusing solely on health IT. We combine proven research methodologies with intelligence and insight to provide cogent analyses of the emerging technologies that have the greatest potential to improve healthcare. We do not shy away from making tough calls, and are respected in the industry for our direct and thoughtful commentary.