significantly expanded its clinical interoperability network by signing up hospital EHR vendor Meditech and ambulatory EHR/practice management system vendor Vitera. The network gives providers the ability to send and receive clinical messages securely using the Direct Project protocol.
With the addition of Meditech, which has health information systems in 1,400 U.S. hospitals, Surescripts says that participants in its network can potentially connect with more than 60% of hospitals. GE and Epic, the largest acute-care EHR vendor, are also members of the network. Besides Vitera, Surescripts' roster of ambulatory care vendors includes Greenway, Inofile, Medent, NewCrop, NextGen (which also sells some hospital products), SCI and SOAPware.
The ability to do Direct messaging is important because Meaningful Use Stage 2 requires providers to exchange data electronically at transitions of care. Moreover, the 2014 certification criteria for EHRs include Direct messaging capabilities.
Despite the expansion of Surescripts' network, relatively few of the hospitals that use EHRs from the participating vendors are exchanging Direct messages, according to Harry Totonis, president and CEO of Surescripts. But he expects this to change in the next few years, he told InformationWeek Healthcare.
[ Plenty of doctors agree: EHRs need to get a lot better. Read Why Doctors Hate EHR Software. ]
Surescripts, which is owned by pharmacy trade associations and pharmacy benefit management (PBM) firms, connects physician offices to drugstores for electronic prescribing. Just as with Direct messaging, few providers used its electronic prescribing network several years ago. But partly because of government policies, the number has dramatically risen to the point where more than 500,000 clinicians are now prescribing electronically.
Totonis predicted that the same will happen with Direct messaging, only more quickly. While Meaningful Use will be a major driver of Direct, he pointed out that when e-prescribing started, only a small percentage of physician offices were computerized. Now most of them have some kind of EHR and/or practice management system. So it should be easier for them to make the transition to Direct messaging than it was to adopt electronic prescribing.
Direct messaging requires health information service providers (HISPs) to connect hospitals, physicians and other healthcare entities. HISPs provide them with the same type of function that Internet services give consumers to allow them to connect to the Web.
Surescripts' interoperability network is, in essence, a large HISP that offers service to many providers across the country. But Totonis denied that the company seeks to become the sole national HISP, as it has effectively become the national network for e-prescribing connectivity. "Our goal is not to become this giant entity, but to facilitate the movement of critical information, just as we do with e-prescribing," he said.
Surescripts is not only acting as a HISP for individual providers, Totonis added, it is also providing connectivity for regional HISPs that have had difficulty communicating with one another across regions and states. Surescripts has also enrolled some health information exchanges. Both of those moves help increase its national coverage, he said.
"It's hard to be a network if you don't have a lot of coverage," Totonis explained. "We believe there will be multiple networks trying to do Direct messaging in this country. To be successful at it, you have to be one of a few in a combination of networks that cover 100% of providers. Otherwise, you'll be in the classic situation where you have a handset and there's nobody on the other end of the line to talk to."
Surescripts is not limiting the activities of its network to Direct messaging. "We'll support multiple standards and multiple types of messages," Totonis said. "We'll support a push and a pull and a publish format. Some of them may be Direct, some may be other types of messaging."
There are two other national exchanges for clinical interoperability: eHealth Exchange and CommonWell Health Alliance. While the latter has yet to become operational after making a big media splash last winter, eHealth Exchange, the public-private successor to the Nationwide Health Information Network, has gained traction over the past year. As of June, eHealth Exchange had 40 participants, including four federal agencies, six statewide HIEs, eight Beacon Communities, and more than a dozen health information organizations (HIOs) and healthcare systems, among them Kaiser Permanente.
Meanwhile, Healtheway, the not-for-profit entity that operates eHealth Exchange, and the EHR/HIE Interoperability Workgroup have been developing national standards to facilitate the exchange of data among disparate EHRs and HIEs.
Totonis said he doesn't view eHealth Exchange as a competitor of Surescripts' clinical network. Surescripts wants to accommodate "multiple formats and standards," he said. "No matter what ends up being the winning format, we'll be there."