“We’ve been doing pharmacy-to-doctor transactions, so the obvious conclusion was to support doctor-to-doctor communication,” says Cris Ross, executive vice president and general manager of Surescripts’ clinical interoperability business.
As simple as the software may seem—it’s not much more than secure e-mail—nothing like it is generally available to doctors, who still rely on fax machines or couriers. “Health care wants and loves this kind of exchange,” says Steven Waldren, director of the AAFP’s Center for Health IT. “The problem has been that there has been no one willing to pay to build the network, or pay for the transactions.”
Subscribing to the AAFP portal costs doctors $15 per month, a price Waldren thinks is low enough for his members to accept. “Our doctors run small businesses,” he says. “If it’s going to cost $5,000 for infrastructure and $500 a month, then they won’t do it. We really think there needs to be a very lightweight exchange, and that is what we are pushing.”
The government has been trying to coax its own data-exchange standards into existence through the Direct Project, an effort started in March 2009 to “specify a simple, secure, scalable, standards-based way” to send health information over the Internet. That effort involves a score of corporate players including Microsoft, Siemens, and Google.
Other efforts to create health information exchanges in the U.S. have occurred mostly at regional levels. One of them, the Indiana Health Information Exchange, includes 70 hospitals and around 19,000 physicians in that state and in Chicago. Waldren says the problem is that even such large networks are still too small to force insurance or lab testing companies to adopt their technology protocols. “No one in health care has had enough market share to drive standardization,” he says.
Some experts think Surescripts is big enough to do so, effectively overtaking the government standard-setting plan, at least for basic data transfers. Analysts at Chilmark Research, in Cambridge, Massachusetts, call Surescripts the “closest thing the U.S. has to a de facto national health information network.”
Surescripts says it supports government protocols and that more than 200 different programs for managing electronic patient records already interface with its e-prescribing network, and that regional data exchanges and large health-care companies will be able to use the network in the future. “We think we can simplify things,” Ross says. “The doc plugs into us once, and we plug into many health information exchanges. Our approach is to provide a commercially viable, low-cost implementation. We think we will dominate.”