The ability to conduct electronic transactions and information sharing in health care is supposedly key to reducing administrative expenses and improving care coordination. The largest network in the nation for such purposes is actually run by SureScripts, which is owned by pharmacy associations and PBMs. SureScripts gives us an annual report on use of its network. (Surescripts Report) SureScripts’ predecessor organizations focused on allowing electronic prescribing and electronic billing and payment for prescriptions, as well as giving providers various alerts and facilitating access to a patient’s medication history. The network is so ubiquitous, however, that it could easily serve as the national data exchange for health care. 258 million patients are in the Surescripts database and the platform is connected with 1.61 million clinicians and almost every EHR. 17.7 billion transactions went through the network in 2018, an increase of 29% over the prior year.
These transactions include 1.91 billion e-prescriptions, 1.77 billion medication histories, and 31.44 direct clinical messages. 85% of all prescriptions were sent electronically, a number which is much higher, 96%, if only non-controlled substances are considered. 99% of pharmacies use the network, as do 73% of prescribers. One of the most important functions the system serves is avoidance of delays in patients getting drugs. To that end, there were 2.7 billion eligibility and formulary transactions. Many of these were real-time, allowing a physician to consider formulary status and patient cost-sharing at the time of the patient visit and before prescribing. According to SureScripts, this resulted in a large number of drug switches to avoid prior authorization and substantial savings to patients and payers. And where prior authorization is required, there was over a 170% increase in use of the system’s electronic PA capabilities. The prescription drug segment provides a good example of how IT can facilitate health care processes.
(A quick postscript. Since I wrote this post, the FDA has filed suit against SureScripts for supposedly attempting to monopolize the eprescribing market, apparently through use of exclusive agreements. Naughty, naughty, naughty.)