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.