By Michael Burger, Senior Consultant
Patients typically get care and treatment from many doctors and in many places, including physicians’ offices, hospitals, pharmacies and urgent care clinics. Doctors wish they had this complete picture of patient data — or so-called longitudinal view — to make the most informed treatment choices as well as enable improved care quality and patient safety. This is closer to becoming a reality now that Surescripts has begun promoting its national record locator service (NRLS). The NRLS has the potential to be an industry game changer.
According to Surescripts’ press release, the new service will be offered without charge until 2019 to electronic health record system (EHR) vendors as a way to foster data exchange. Our understanding is that the NRLS is based on Surescripts’ existing methodology for identifying patients and matching them to their records, which is used extensively for electronic prescribing. The NRLS will operate within the nationwide Carequality Interoperability Framework, which “leverages a common set of legal, technical and policy rules for data sharing across technology platforms and networks.”
What does it mean? For the industry, the NRLS could be the start of something big.This is a national network offering free record locator services to EHR vendors. Epic, NextGen, Greenway Health, Aprima and eClinicalWorks already have signed up, representing 41% of all Meaningful Use-attesting EHR users.The NRLS could create competitive advantage for these major players, and perhaps create another challenge to the hundreds of smaller EHR vendors aspiring to compete with these big guns.The early adopter EHRs create a significant core user group, which we believe makes the infrastructure investment and NRLS launch a good investment on Surescripts’ part.
The availability of the new NRLS data adds to the existing medication history already available for multiple prescribers in the Surescripts medication history data feed. The value in the NRLS for doctors (outside of prescribing) is that they now have on-demand access to a range of data — such as lab results, vital signs, allergies and procedures — from the patient’s other health care providers. This is vital clinical information they have limited access to today, and often on paper. For patients, the NRLS is valuable because it gives their doctor a complete view of their records, regardless of where care was provided or by whom. As the number of EHR vendor participants of NRLS grows, we expect to see an increase in higher quality of care and a reduction in care-related expenditures by reducing duplicate testing.
What do we think? We think this is a good idea whose time has come, and we are encouraged by the number and scope of the EHRs which are participating. As mentioned previously, we think the NRLS has the potential to be a game changer. However, there are unanswered questions.
The first have to do with the business model. The NRLS is being offered free until 2019 to EHR vendors. What happens after that remains to be seen. Will there be charges for using the service? How much and under what circumstances? What about updates? Will there be costs to participants? Currently, pharmacies and payers support Surescripts’ electronic prescribing services. Who will pay the freight for the NRLS?
Another set of questions deals with physician adoption. The NRLS technically enables physicians to efficiently identify and share patient records within existing workflows. But now that Surescripts has built it, will physicians use it? Use of interoperable EHRs has been the major focus of the federal Meaningful Use EHR Incentive Program for several years. Despite the fact that interoperability is an MU requirement, actual data sharing has been sparse to date. There is no incentive program to promote adoption or payment-related incentives for using the NRLS, such as mandating its use as a quality measure. Such legislative and pay-for-performance requirements have historically been great motivators of physician adoption. Without such motivation, will doctors use the NRLS solely because it could help improve the quality and safety of patient care?