• Background: SureScripts is the largest network provider of electronic prescribing services and operates the Pharmacy Health Information Exchange, enabling the electronic exchange of prescription information between pharmacists and physicians.
• Challenge: SureScripts needed to take medication history data feeds from multiple pharmacies and create an indexing structure that would link patient records from different pharmacies, enabling a single view of a patient’s history at the point of care.
• Solution: SureScripts chose Initiate® EMPI software to match and link patient medication histories, matching physician requests with the corresponding records across all connected pharmacies.
• Results: SureScripts’ high performance, dynamically linked environment delivers sub-second responses to physician requests for medication history for over 54 million lives.

SureScripts was founded in 2001 by the two associations that represent over 55,000 pharmacies in the United States - the National Association of Chain Drug Stores (NACDS) and the National Community Pharmacists Association (NCPA). SureScripts is the largest network provider of electronic prescribing services, and its mission is to improve the quality, safety and efficiency of the overall prescribing process.

At the core of this improvement effort is the Pharmacy Health Information Exchange (PHIE), a healthcare infrastructure that establishes electronic communications between pharmacists and physicians and enables the two-way electronic exchange of prescription information. SureScripts has signed agreements, tested and certified the software of pharmacies and pharmacy technology vendors, connecting more than 95 percent of U.S. retail pharmacies to PHIE.

Essentially, SureScripts provides the network that makes the two-way electronic exchange of new prescriptions and renewal information possible.

Challenge

SureScripts needed to take medication history data feeds from multiple pharmacies and create an indexing structure that would link patient records from different pharmacies, enabling a single view of a patient’s history at the point of care. At the same time, response times had to be fast – less than three seconds to find up to 300 records – and matching had to be done solely on patient demographic information. Since pharmacies use a plethora of different databases and systems, the solution had to transcend differences in data types and formats.

SureScripts came to Initiate Systems in 2005 with three specific initiatives in mind for facilitating patient identification, matching and searching in their Primary Health Information Exchange:

• Improve the accuracy of customer searches


• Speed time to market for data updates


• Create a more flexible, extensible application platform

Solution

SureScripts chose Initiate® software to provide physicians with a single view of a patient’s clinical information and medication history from pharmacies, regardless of retail brand or location. The matching, linking and searching functionality of the Initiate EMPI matches the physician requests for a patient’s medication history with the corresponding records across all connected pharmacies.

As David Yakimischak, chief technology officer at SureScripts explains, “Because we’ve linked records, we can see who has which patient records.” As a result, the actual patient data is kept securely behind the firewall of the source databases.

Besides medication history, SureScripts can now offer information on patient formulary/benefits and eligibility across the system to their partners. The SureScripts service uses Initiate software to make more eligibility and formulary information available at the point of care, in real time. A physician enters a patient query into the SureScripts interface, which passes the query via “web services” to Initiate. If Initiate finds records that match, it sends information that identifies those records back to SureScripts, which retrieves all the prescriptions for that patient and bundles the medication and patient information back in the response.

As a result, more “clean” prescriptions sent to pharmacies can help decrease follow-up phone calls from pharmacists and prescription benefit managers (PBMs).

Results

Since implementing Initiate software, SureScripts has developed a high performance, dynamically linked environment that delivers sub-second responses to physician requests for medication history. Today, through its participating pharmacies, SureScripts has access to medication information for over 54 million lives and growing as more pharmacies make this clinically important information available to healthcare providers. As a result, these physicians and their patients are better able to make more informed, safer and more effective prescribing choices.

The Initiate implementation has already been put to the test. SureScripts is a primary partner and sponsor of ICERx.org (In Case of Emergency Prescription History Service), a public-service resource developed to help ensure continuity of care for disaster victims. Created after Hurricane Katrina displaced thousands of people from their homes and medical histories, ICERx.org enables authenticated, licensed prescribers and pharmacists to securely access a patient’s medication history, providing caregivers with drug reference information and valuable tools, such as therapeutic duplication and interaction alerts.

During the San Diego fires in the fall of 2007, ICERx.org was activated when a state of emergency was declared. With the Initiate implementation in place, authorized users were able to access vital medication information, such as indications, dosages, quantities and interactions, for displaced people. As Yakimischak said, “Most people don’t know the names of the medications they’re on – they just know it’s a white pill or a blue pill.” By enabling data sharing in times of crisis, ICERx.org and its participating organizations help ensure continuity of care so that patients get the right dosage of the right medications.

Future

According to Bob Beckley, SVP Alliances & Product Strategy, SureScripts plans to leverage Initiate® software in a variety of new initiatives, including personal health records, patient rosters, medication reconciliation and pharmacist access. Personal health records would enable a patient’s data to be presented to them in a single view. Patient rosters are showing a lot of promise on the road to e-prescribing. Using Initiate software to match and link records across the numerous involved databases, patient rosters would populate a patient’s information – demographics, full history and related information – to enable electronic prescribing. Medication reconciliation will help hospitals meet JCAHO compliance. And pharmacist access will enable pharmacists to have this essential information right at their fingertips, while still being able to recognize privacy precautions.

As other healthcare organizations around the world look to promote interoperability and initiatives like e-prescribing, the example of leaders like SureScripts can provide valuable guidance.