added 19 new participants to its clinical interoperability network, significantly increasing its national footprint as a health information service provider (HISP) that enables clinical messaging using the Direct secure messaging protocol. Most of the new members are statewide or regional health information exchanges (HIEs), but they also include a Tennessee HISP (Information Corp. of America), two EHR vendors (Cerner and Quest Diagnostics), and a big healthcare system (University of Pittsburgh Medical Center).
The Direct protocol, which must be embedded in EHRs certified for Meaningful Use Stage 2, allows providers to exchange messages that can include attachments such as clinical summaries, visit notes, and discharge summaries. HISPs are required to convey these messages securely between providers. These intermediaries include independent firms as well as HISPs created by EHR vendors and statewide HIEs. Surescripts, which is best known for linking providers to pharmacies for electronic prescribing, is in the process of building a national HISP.
Of the new participants in the Surescripts network, 15 are state or regional HIEs, including three in Michigan and three in upstate New York. By connecting these exchanges to the Surescripts network, the company makes it easier for members of the HIEs to communicate with other members of the community who may be using different mechanisms for Direct messaging, said Jeff Miller, senior VP/GM of clinical interoperability for Surescripts, in an interview with InformationWeek Healthcare.
Miller noted that already many of their [HIEs'] members can send messages to anybody in the Surescripts network. While there are no current plans to hook the HIEs themselves to each other via Direct, he said, Surescripts is looking into that possibility.
[ Will feds tie Medicare reimbursement to information exchange? Read Will Health Information Exchange Become Medicare Payment Criterion? ]
Miller emphasized that Surescripts is willing to connect to any other HISP, and is not trying to drive local vendors out of business. In fact, he noted, the more connectivity that Surescripts can offer in a community, the better the value for the end user.
In most markets, he added, providers use EHRs from 20-30 different vendors. "We have 60% of those users on our network, but the remaining 40% are not connected today, or they're connected to a regional HIE or a vendor HIE. So to facilitate the exchange in that community, we need to connect the networks together so there aren't any barriers to sharing information."
About 30-40 EHR vendors are currently linked to the Surescripts platform, according to Miller. Among these are Epic, Cerner, NextGen, GE, Greenway and SOAPware.
Surescripts will use its arrangements with HIEs to accelerate its enrollment of providers through those networks. "The other way we roll up large numbers of users is through our relationships with EHR vendors that offer Direct-based services to many of their customers," Miller explained.
Kryptiq, the secure messaging network that Surescripts acquired a year ago, provides the connectivity between these EHR vendors and Surescripts. Although none of Kryptiq's HIE clients are included among the 19 entities that just joined Surescripts, the company is working to convert them to the Direct messaging network. Miller noted that Kryptiq vendor customers like Vitera and GE are starting to offer Direct messaging to their provider clients.
Despite all of these efforts, Miller acknowledged that the number of physicians using Direct is still relatively low. But he believes that the requirements for information exchange in Meaningful Use Stage 2 will change that picture starting next year. "The key will come when the acute care segment begins to use Direct as a means of communicating transition of care documents. As that evolves, we'll see the use of Direct in the physician community increase dramatically."
Miller stressed the importance of EHR vendors integrating Direct into the clinical workflow rather than asking physicians to visit a separate Web portal. He pointed out that this lack of integration, which a number of vendors are now addressing, has hindered the growth of Direct messaging.
Besides Direct connectivity and e-prescribing, Miller said, Surescripts now offers links to 41 immunization registries. It provides doctors with immunization notices and sends them to state registries. It also enables retail clinics to send visit summaries to primary care physicians.
Surescripts is involved in a CDC pilot for reporting lab results to public health agencies, and it is looking into expanding into communicable disease reporting and syndromic surveillance. Today, the ability of HIEs and providers to connect with public health agencies is very limited, according to a recent study.