It all started when Surescripts acquired collaborative HIE messaging vendor Kryptiq in late August. This was quickly followed a week later with Surescripts’ announcement that it would become Epic’s vendor of choice for cross-EHR connectivity. It appears that Epic has finally succumbed to the inevitable; that it will need to open up its system (Epic’s purported Epic Elsewhere, to address cross EHR connectivity was in reality Epic Nowhere – just vaporware) to communicate in a heterogeneous EHR environment. The Surescripts Clinical Interoperability (CI) network solution will become an “Epic Unit” and on Epic’s price sheet. The details of this story were covered in our September Monthly Update for CAS subscribers.
What drove Epic to make such a drastic move? Pretty simple really, Stage Two meaningful use requirements which were released on August 23rd. Within those new requirements for certification, EHR vendors must demonstrate that they can send a message across EHR boundaries (outside their ecosystem). Epic really had no choice in the matter – they had to do something to address this requirement. Chilmark has also been hearing an ever louder drumbeat that Epic customers were also demanding that Epic do something to address messaging in a heterogeneous EHR environment. (Note: eClinicalWorks is another EHR vendor that was forced to open up their notoriously closed peer-to-peer networking service for clients, though eCW twisted it around to make it appear like an act of generosity.) Surescripts provided Epic an easy way out with a non-competing entity.
Last week, Surescripts announced that another major ambulatory EHR vendor would adopt the CI network, this time it was NextGen. Surescripts now has three of the top five ambulatory EHR vendors (Epic, GE, and NextGen) on its network. If one were to just look at the numbers, these three EHR vendors combined represent over 50% of practicing physicians in the US.
Surescripts is likely to add more EHR vendors in the coming months as these vendors look to grapple with the latest Stage 2 MU requirements for both Direct Secure Messaging (DSM) and cross EHR messaging. Adopting Surescripts CI network as a module into their existing EHR solves that issue in a non-competitive manner.
Surescripts’ intent is to leverage its core competency of providing lightweight, network services to reach beyond eRx to address basic clinical messaging. Some may argue that DSM accomplishes the same thing. Not really. The Kryptiq solution, upon which Surescripts’ CI network is built, provides collaborative, threaded messaging and not just the simple point-to-point messaging of DSM. Surescripts also brings to the table what is arguably the largest physician directory, that currently supports its eRx capabilities.
Surescripts jumping into the mix of HIE solution vendors will only complicate what is already becoming an increasingly competitive HIE market for services. In our 2012 HIE Market Trends Report we called such services as Surescripts’ CI a micro-HIE for they are self-forming, starting at the physician practice level, rather than being sponsored by some large entity, be it a public agency or larger hospital system. One of the findings of eHealth Initiative’s latest survey released last week is that HIEs are seeing increasing competition from other HIEs in their community. This competition will only increase with the advent of micro-HIEs.
Combining Surescripts’ existing national provider directory, its partnerships with three of the top five ambulatory EHRs and you have a truly, commercial NwHI – something that Healtheway wishes to become but has a long journey ahead to get there. This will likely force Healtheway to only tackle issues for its federal sponsors (Social Security Administration, Veteran’s Administration and to lesser extent Dept of Defense). Dreams beyond those limited confines will likely remain such if Surescripts is able to effectively execute on its own vision.
Right on the mark John! SureScripts is likely to become the defacto NHIN & replace many existing HealthIT corps. This is similar to the opportunity that ePocrates had to leverage its huge provider user base to become the defacto Provider digital solution of choice to address a wide range of needs (eRx, EHR, billing, appointments, patient engagement, etc). SureScripts team looks like it will leverage its user base to not miss this huge opportunity.
Paulo Machado
@pjmachado
Thanks Paulo. Let’s hope Surescripts does a better job of execution then ePocrates did on the EHR front.
The SureScripts network is proprietary and inaccessible to patients. It seems unlikely that a proprietary and closed network will matter in the coming years. Healtheway is not proprietary but it is inaccessible to patients. It will be interesting to see if they can compete with lightweight and patient-visible transports such as Direct and Automate Blue Button Initiative (ABBI).
Direct Project and ABBI do not suffer the privacy and scalability problems of the institutional networks. Their infrastructure supports rapid innovation, Internet-scale security and integration with non-healthcare technology for identity management, single-sign-on and authorization management (OAuth).
Most of all, SureScripts will be competing with state health information exchanges designed to support patient engagement, public health and global payment analytics. The thought that these activities will be outsourced to a proprietary SureScripts network seems far-fetched.
Adrian Gropper
@agropper
Adrian, as you know, I am also a strong advocate for patient rights/access to their records and it is an unfortunate reality that the rest of the industry seems to think of this as an afterthought. Was particularly disillusioned to see in ONC’s most recent MU attestation report that those menu items that are least likely to be chosen by physicians and hospitals are those that pertain to patient engagement. We have a long, long ways to go and we are still grappling with a less than engaged populace.
Ideally, ABBI would become so useful, so fundamental, so an integral part of the care delivery process that we could just say so long to these HIEs and have a self-forming, patient-led and driven HIE. That will remain, unfortunately, a dream for many years to come.
As to state HIEs, lets see how many of these actually survive. Failure rates for these HIEs will be extremely high as they have been typically built by orgs that do not have much business sense as to how to create and eliver a clear and compelling value proposition that stakeholders are willing to pay for.
“De facto”, perhaps not, but the positive development here is the continuing evolution of existing networks beyond their original intended purposes. (Or, in some cases, reaching their designed potential in a market that’s developing more slowly than expected.) For most providers, the business case for participating in exchange is not Meaningful Use, but reimbursement. Fee for service won’t get us there, but to share risk or expect payment for performance, clinical data must be exchanged.
The intersection of administrative, financial and clinical data exchange is where the action is, and relevant infrastructure has already been built by a variety of healthcare technology companies (Availity, Emdeon, NaviNet, SureScripts, et al.), not to mention private payers that have their own ideas and assets. Leveraging their established adoption/utilization remains a largely untapped opportunity in our industry. It’s an over-simplification to suggest these any one of these networks will dominate, or that the group will merely compete with those public exchanges which actually become viable.
The network of choice for a particular instance of exchange will be a function of the stakeholders communicating, related business and competitive considerations, the use case, the applications involved and the networks available for transmission. In most cases, there can and will be more than one exchange option available among a mix of public and private information exchanges.
By expanding its capabilities beyond eRx related exchange and signing some early relationships, SureScripts has a nice head start. For exchange to flourish, we should hope for many more announcements from them and others… but let’s save the fireworks for when the information and payment really start flowing in tandem service of patient-centered care delivery.
You make some good points Marshal and your best background/experience at NaviNet comes through.
You are correct in your thesis that there are likely to be more than one uber-exchange. But much like the Lord of the Rings, the question is: will there be “seven rings” and “one ring” to rule them all? One can envision at least 3-4 NwHINs addressing specific needs across the country, e.g. Healtheway for SSA, VA & DoD, Surescripts for lightweight clinical, maybe Emdeon, or even someone like NaviNet to address payment. However, I do not see anyone on the horizon, at least at this time that is looking to address both reimbursement, clinical, and patient-centric care delivery. Once I see that, let’s go to OH and buy us a truck load of fireworks!
Several are looking at synthesizing administrative/financial and clinical. They must — submission of a claim alone won’t be enough for payment anymore in some contexts, so if you’re delivering administrative/financial alone, you’re leaving a gap for someone else to fill. Can’t we find fireworks in New England? 😉
Marshall Votta
@ydeologi
Yes, quite a number of companies are now looking at synthesizing such capabilities. Just look at the recent acquisition of Certify Data Systems by Humana, who also happens to have a pretty large stake/interest in claims clearing house solution Availity. Couple Availity with Certify and viola! As to those fireworks, yes, there is always NH.
I agree with a lot of what is said here but these views are clearly US focused. The world is transient. It would be naive to think that global exchange is not important enough to include nor that it will take beyond our lifetime, i.e. 20+ years. Further disruption is likely needed. I would be interested to hear how this could play out globally.
Mike,
Unfortunately, the world is really not that transient, especially for the vast majority of the populace in any country. Doubt that we’ll see aggressive x-country boundary exchange anytime soon. Hopefully, by the time such need does arrive, we will all have far better tools to work with and it will at last be consumer-led and directed.