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Electronic Health Transaction Status Report

By June 18, 2015Commentary

Greater use of information technology is one prescription for lowering administrative costs and potentially health spending.  That prescription has historically been best exemplified in the pharmacy world, which managed to get itself using electronic transaction capabilities well ahead of the rest of health care.  SureScripts provides a great deal of the software for interaction among payers, PBMs, pharmacies, and providers and issues an annual report detailing use of these capabilities.   (SureScripts Report)   The SureScripts network is connected to a very high percent of participants in the health system:  3300 hospitals; 61,000 pharmacies; users of 700 different EHR applications; 32 state and regional health information exchange networks and a large number of physicians and health plans.  This network actually would likely be a cheaper and more efficient way to create a national health information exchange capability than the current approach.  1.2 billion prescriptions crossed this network, including 67% of all new prescriptions.  764 million medication histories were exchanged, which improves quality of care and reduces duplicate work.  The network originally started by routing prescriptions from providers to pharmacies, and allowing providers and pharmacies to see benefit levels and formulary status; it now also can do prior authorization, give medication histories and be used for clinical messaging.  Automating the prior authorization process has the potential to not only reduce costs and time spent, but removes a major aggravation to both physicians and patients.  The data in the SureScripts system can also be used to combat prescription fraud and abuse of prescribed painkillers.  As with any piece of software, there are undoubtedly problems with the electronic transaction capability offered by SureScripts, but the overall success in expanding the use of the functionality demonstrates a good value to the provider, health plan, pharmacy and PBM users.


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