Next month, Kevin Hutchinson will be stepping down as chief executive officer of SureScripts, the for-profit prescription drug data exchange formed in 2001 by the two major drugstore trade associations.
Replacing him as CEO, at least in the interim, will be Rick Ratliff, chief operating officer of the Alexandria, Va.-based organization, who will serve as acting CEO.
Both Hutchinson and Ratliff were in Chicago last week for a meeting of the Center for Improving Medication Management, a healthcare information technology consortium. Their visit gave Health IT Strategist time to catch up with both the outgoing and the incoming SureScripts leaders over breakfast.
E-prescribing has been in the news a lot in recent weeks. Last month, at a meeting of the American Medical Informatics Association in Chicago, members of the American Health Information Community recommended that HHS mandate e-prescribing under Medicare. Hutchinson is a member of AHIC, representing prescription drug and laboratory sectors of the healthcare industry.
On Dec. 4, AHIC, a 17-member panel created by Leavitt in 2005 to advise him on healthcare IT policy, posted to the HHS Web site a more detailed list of steps Leavitt should take to promote e-prescribing use.
The following day, a host of legislators led by Sen. John Kerry (D-Mass), introduced the Medicare Electronic Medication and Safety Protection (E-MEDS) Act of 2007, a bill that supports e-prescribing technology, while that same day the Senate Judiciary Committee held hearings on the Drug Enforcement Administration's policies toward e-prescribing.
"I think the Kerry bill crafted what the AHIC wanted," Hutchinson said. The final AHIC recommendations contained seven elements that needed to be fulfilled as precursors before the final recommendation, which is requiring e-prescribing, could be implemented. "They're really trying to drive incentives," Hutchinson said. "They're not going to make it illegal to write a paper prescription."
The Kerry bill has carrots and sticks. It calls for increasing Medicare reimbursements of 1% for office visits in which an electronic prescription is written, Hutchinson said. It also calls for a 10% cut in reimbursements by 2011 for visits in which a prescription is written and not filed electronically.
Hutchinson said that he is hopeful the forces backing electronic prescribing are making progress with the DEA. Currently, the DEA requires prescriptions for scheduled drugs to be written on paper. At the Senate hearing, the DEA pledged within two months to come back with a timetable for a rulemaking on e-prescribing.
The DEA paper mandate has been a significant barrier to physician adoption of e-prescribing technology, according to Ratliff, in part because about 10% of all prescriptions are written for DEA controlled drugs and physicians see switching back and forth between electronic and paper systems as a nuisance.
"It definitely creates a fragmentation, a disconnect in the workflow," Ratliff said. "The mainstream users want a consistent style. It is possibly not the top barrier, but it is one of the top three."
Don't look for any immediate change, however. Even if the DEA amends its rules to allow for e-prescribing, some states also have laws with stringent reporting requirements for controlled substances that would have to be modified to allow e-prescribing, Ratliff said.
Cost remains a significant barrier to adoption of e-prescribing, as it does to adoption of full-fledged electronic health-record systems, but for e-prescribing, at least, cost is becoming a matter of perception in markets where health plans have agreed to subsidize the cost of implementing and maintaining e-prescribing systems. Plans have a financial incentive to promote e-prescribing in that the systems boost formulary compliance and generic substitution.
Most of the major drugstore chains such as Walgreens, Rite Aid and CVS have home-grown computer systems, while about 10 commercial IT systems vendors have about 70% of the market for systems used by regional drugstore chains and independent pharmacists, Ratliff said.
All of the chains have the SureScripts system for e-prescribing installed and running in their stores, Hutchinson said, though only about 25% of independent pharmacies have it.
For 2008, interoperability will be a key issue as retail pharmacies, particularly the chains, work on getting in-store clinics up and running, Ratliff said. Most have relationships with primary-care physicians and are looking to exchange information using the Continuity of Care Record, or CCR, he said. The CCR is a standard for sharing patient information summaries developed by ASTM International and the Massachusetts Medical Society. In addition, SureScripts has developed its own unique provider identifier, modeled after the national patient identifier required under the Health Insurance Portability and Accountability Act of 1996, but with the additional feature that it tags the prescriber to a specific practice location.
Hutchinson, who came to SureScripts in 2001 after serving as chief operating officer of EHR systems developer MedicaLogic/Medscape, said he was still exploring his options regarding what he'll do after leaving SureScripts in mid-January. He said he will continue to serve on AHIC, if Leavitt asks him to do so, but Leavitt had not yet talked with him about it.
"I like to build things," Hutchinson said, adding that SureScripts "is well-financed and growing," with the bulk of its revenue coming from participating pharmacies, which have pledged to contribute $180 per year, per store for five years. The consortium launched its exchange network in 2004 and will move 35 million transactions this year with 100 million projected for 2008. SureScripts has strong ties to major IT systems vendors. In 2003, pharmacy IT systems developer NDCHealth Corp., became a value-added reseller of SureScripts technology. NDCHealth was sold to Per Se Technologies in 2006, which in turn was purchased by McKesson Corp. last year.
McKesson's physician and patient portal, RelayHealth, is now a value-added reseller for SureScripts. Ratliff said SureScripts has the ability to move diagnosis codes with prescription drug information, but is not doing so at this time. It also has had talks with the Food and Drug Administration about using the system to dispatch drug alerts.
"I'm looking at several different things right now," Hutchinson said. "I think there is still a void in healthcare IT, especially on the physician side. There are other needs for the sharing of information. Labs is one example."
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