Prescription Plumbing: Surescripts VP Andrew Mellin — Harlow On Healthcare

For this edition of Harlow on Healthcare, my guest is Andrew Mellin, Vice President of Medical Informatics at Surescripts. Andrew is a seasoned physician executive who brings multiple perspectives to the table and is working to improve the flow of information in the world of prescriptions in order to advance the Triple Aim. For starters, I asked Andrew to provide a thumbnail summary of what Surescripts is focused on these days. The high-level answer: “Surescripts has built an industrial strength health information network … to increase patient safety, lower the costs of health care and improve the quality of care.” In order to expand from prescribing to a broader approach to more informed care decisions, Surescripts has rolled out a network alliance with “virtually all” EHRs, PBMs, pharmacies, specialty pharmacies, clinicians and health plans. This Surescripts Network Alliance enables sending more than 85% of all US prescriptions electronically – which means that Surescripts processed over 17.7 billion healthcare transactions in 2018.

Over its 18-year history, Surescripts has been focused on electronic prescribing, including making eligibility and formulary information available to prescribers. Today, Surescripts also makes patient-specific longitudinal medication histories available to prescribing clinicians across provider organizations, and also assists in enabling EHR interoperability more broadly by identifying where around the country a particular patient may have had an encounter with another clinician.

Andrew shared an unusual example of how this sort of information sharing can be lifesaving:

One of the challenges in treating transplant patients is they often hide information they don’t want to tell an organization that’s going to do their transplant about some of their other conditions because they really want the transplant. They don’t want to give any reason to not get it done. So one health system was relaying this story to us where a patient came to them. The patient had a very serious hypercoagulation condition that had been treated out of state. So when the transplant team went into the EHR and uses\d our record locator service they saw that this person had a number of encounters in a distant state. They pulled up that information and they realized that she had she had a hypercoagulation condition. She was prone to getting blood clots. So they did go ahead with the transplant but with this knowledge they obviously had to do a number of additional things to prevent those clots from happening. So again this is a great example where that information led to a very significant change in care where a transplant likely would have failed or had significant complications if that provider organization wasn’t aware of that information.

Next, we spoke about ways in which Surescripts’ systems are helping to limit forged prescriptions for opioids (by enabling electronic transmission of prescriptions from prescribers’ EHRs directly to pharmacies), and are helping to limit the success of drug-seeking behaviors by making medication histories more easily accessible, in compliance with state prescription drug monitoring programs. Electronic prescribing of opioids is now mandated in fifteen states; as that number of grows, the medication history monitoring process can be more comprehensive.

When I asked Andrew about Surescripts status as a single source providing its services, he suggested that they see themselves as the “facilitator of a network alliance” rather than as a “standalone company.”

We serve more than 258 million patients and 1.6 million healthcare professionals. So the way that we operate is this network brings us key challenges and health care that they can’t solve alone. And all these challenges depend on two or even three different kinds of stakeholders collaborating together to improve the experience, cost, quality and safety for patients.

Andrew touted some capabilities of the Surescripts system, built in response to Network Alliance members’ requests, that enable real-time decision support capability that conducts benefit checks and out-of-pocket cost determinations, and offers the prescriber alternatives in the same therapeutic class that may be cheaper for the patient, and offers alternatives to retail pharmacies that may be cheaper for the specific patient (e.g., mail order). The process is triggered by a clinician entering a prescription in an EHR and the full process and response to the clinician generally “takes a second.” The adoption of this service? From zero at the beginning of 2018 when this was rolled out, to 140,000 providers today.

It’s a decision support tool that providers are really excited about. They’ve always known how important cost was because if they don’t get it right the patient’s not going to fill their drug or it’s going to cause rework on their side. Now they feel like they’re empowered to be a partner with the patient in that economic discussion. And it’s a win for everyone in that stakeholder network.

Given the high correlation between prescription drug affordability and adherence, this sort of technological fix is of great importance.

When I asked Andrew how he hoped the health care system would look different in five years, he said that “about half of providers feel like they’re burned out and this is due to administrative burdens, feelings of loss of autonomy and many, many other factors. And so really, in five years, I hope that’s burnout level is dramatically lower.” While he recognizes that there is no cure-all, he said:

The part of the solution that I’m focused on is using technologies like the EHR to decrease a lot of those administrative burdens …. [T]here’s a lot of administrative tasks like prior authorizations that we’re working hard to automate and make much less onerous so that information needed to complete those can be done with minimal interventions just by drawing out other information from the EHR. And I think there’ll be other technologies that continue to eliminate, remove, minimize a lot of the other non-clinical activities that just weigh on the shoulders of the providers and their staff and take a lot of their time now. I see the EHR as being a key factor in reducing that cognitive burden on providers. Today it’s just overwhelming for providers to assimilate and understand all the patient information, remain up-to-date and comply with all the relevant evidence-based guidelines and identify the critical elements out of all that to inform a diagnosis or change in therapy in fifteen minutes.

So what I’m starting to see and I’m excited about are some interesting solutions where all this information — the clinical information, critical insights through artificial intelligence and otherwise, decision support tools and knowledge from external sources — are all presented together in novel user experiences [to enable] providers to deliver high-quality and patient-centric care as efficiently as possible.

I spoke with Andrew as part of my ongoing series of fireside chats with healthcare innovation leaders – Harlow on Healthcare, on HealthcareNOW Radio. Listen to our radio station online, or say: “Alexa, play HealthcareNOW Radio.” You can catch me live weekdays at 8:30 am, 4:30 pm and 12:30 am ET. As each new show goes live, the last one joins the archive, available via SoundCloud or your favorite podcast app (iTunes, Stitcher, iHeartRadio). If you like what you hear, leave a review and tell your friends and neighbors. Your comments are welcome here. Join the conversation on Twitter at #HarlowOnHC.

David Harlow