Two not-for-profit pharmacy trade groups and three for-profit pharmacy companies have joined with the American Medical Association to create a national database to give providers access to patients' drug histories during emergencies. The Web-based service could be activated by the groups and companies in the event of a natural disaster or other emergency, giving physicians and other providers access to the data.
ICERx, or In Case of Emergency Prescription Database, is an outgrowth of a 2005 collaboration by the same groups and companies in the wake of Hurricane Katrina. Their goal was to create a resource for physicians and other healthcare providers treating Gulf Coast patients whose medical records were destroyed or made inaccessible, an effort called KatrinaHealth.org.
In addition to the AMA, the partners in ICERx are: Informed Decisions, a data-miner and technology services provider that is a wholly owned subsidiary of Gold Standard, a provider of prescription drug information; RxHub, a provider of prescription claims information owned by two large pharmacy benefit managers, or PBM; SureScripts, a provider of electronic prescribing technology; and the two owners of SureScripts, the National Association of Chain Drug Stores and the National Community Pharmacists Association.
The formation of ICERx was first reported in April, but the official launch was timed last week to coincide with the start of hurricane season in the Gulf of Mexico.
Physicians and pharmacists are given access to the information after registering with ICERx. The American Medical Association will use its AMA Physician Masterfile database to assist in verifying the identities of licensed prescribers, while SureScripts will verify pharmacists. SureScripts will also provide prescription drug information from its own database as well as from the databases of pharmacies connected to its e-prescribing network.
RxHub will provide prescription information via its connection services to participating PBMs.
Informed Decisions will provide prescription data from its databases of Medicaid patients in Florida and Mississippi, where it provides e-prescribing services to those two state programs. The company will also provide the Web portal that providers will use to access ICERx. And Informed Decisions will also be responsible for approval and designation of organizations as official authentication authorities in the ICERx network.
According to officials of the companies involved in ICERx, a request to activate the network could be made by federal or state emergency officials, but an official government declaration would not be required.
"It will run similar to KatrinaHealth," said Kathy Mosbaugh, senior vice president of Informed Decisions, but, "what we're launching today is more complex." The Web-based system is aimed at the 80% or so of physicians who do not have an electronic medical-records system, she said. And while all the companies and groups in the ICERx coalition will continue to operate their various systems independently, the connections between them will not go live until the ICERx system is activated.
"No one can log in until it's activated," Mosbaugh said.
ICERx will be offered at no charge. "It's a public service," Mosbaugh said. "That came out of KatrinaHealth. We all enjoyed working together. Until there is systemic interoperability, we agreed to come back and provide what ICERx can do."
Rick Ratliff, chief operating officer for SureScripts, said the decision to activate the system would not be dependent on a government declaration.
We can get this rolling on our own, Ratliff said. Data could be flowing through ICERx within 24 to 48 hours of an incident and the circumstances need not rise to the level of a federal disaster declaration, he said. "The key, really, from our perspective, if there is a need for access to this information, we're not reacting in the same way we did with Katrina."
In 2002, HHS issued a revision to the privacy rule under the Health Insurance Portability and Accountability Act of 1996 giving providers, payers and claims clearinghouses authorization to exchange patients' protected healthcare information without the patient's consent for treatment, payment and a broad category of "other healthcare operations." But HHS did not change a HIPAA provision that also allows states to pass more-stringent privacy protections, and most states have done so for patients treated for HIV/AIDS, mental health issues and drug and alcohol abuse.
Ratliff and Mosbaugh said their systems will be able to accommodate those controls to some degree.
For an e-prescribing software system to receive SureScripts certification, it must display a message that it is a SureScripts requirement that patient consent has been obtained to use the network. In addition, Ratliff said a SureScripts committee decides what information can move across its network from RxHub and the PBMs.
"From payer information, we do filter information based on a committee made up of pharmacists from various organizations," he said. "We do have an ability to filter medications if there is a specific state requirement. In that case, we filter across all medications for all states," he said, so the SureScripts network will default to the highest state standards.
SureScripts will not flag the physician that something has not been disclosed, Ratliff said. "We just notify the physician that the patient has not been found." If there were both highly sensitive and more-routine prescription information, such as an antibiotic, in a patient's history, the antibiotics would be disclosed, "but the sensitive information would not, and it would not be provided to the physician that other information was available."
Mosbaugh said Informed Decisions would handle patient requests somewhat differently.
"If the patient called us and wanted to opt out, we would refer them to the data source," Mosbaugh said. "If it's RxHub, we would notify them that this patient wants out. We would make a note of it for us."
Still, Mosbaugh said, Informed Decisions is ready to move whichever way policy dictates.
"We have talked and are aware of opt-out for patients and what it might look like in the future," she said. "Technically, nothing is a problem. It really becomes more a question of policy and implementation."What do you think? Write us with your comments at [email protected]. Please include your name, title and hometown.