SureScripts, A Defacto NHIN

Yesterday in New Orleans, SureScripts announced a new line of business: Clinical Interoperability. Leveraging their existing ePrescribing solution platform, currently serving over 200K physicians nationwide, and combining it with the technology stack of messaging solution provider Kryptiq, SureScripts will offer providers, EHR vendors, HIEs and other stakeholders the opportunity to securely share clinical information across town, the state, a region and the country. In this combination, SureScripts will provide the rails and Kryptiq will address the last mile of connectivity. This announcement has some pretty big implications for the HIE market.  Chilmark was briefed prior to this announcement by both SureScripts and Kryptiq, following is what we learned.

SureScripts primary focus has been to provide the network that would support physicians transition to ePrescribing. Therefore, SureScripts has been focused on transmitting NDP data and not clinical notes. SureScripts got into the transmission of clinical summaries from one of its larger customers, MinuteClinic wanted to send clinical summaries of patient visits directly to primary care providers. In the past year SureScripts has facilitated the movement of over 0ne million patient summaries for MinuteClinic to primary care physicians using CCR. Seeing an opportunity, SureScripts sought a partner that could take this capability to the next level.

Kryptiq, a company profiled in Chilmark’s forthcoming HIE Market Trends Report due out next month, can be characterized as vendor of HIE capabilities that allow for the organic growth of an HIE without the overhead. Kryptiq has worked behind the scenes for a number of EHR companies to provide secure, structured messaging services within these EHRss ecosystems of customers connecting them to one another as well as to other systems, including SureScripts to facilitate care coordination.

SureScripts has made an equity investment in Kryptiq (undisclosed but likely in the range $7-9M over the next few years) to build-out Kryptiq’s technology stack for SureScripts. The Clinical Interoperability solution will combine SureScripts foundational technology (provider directory, security, authentication, master patient index, etc.) with Kryptiq’s connectivity toolset (interface technology to various EHRs), secure messaging framework and clinical portal.

SureScripts will release the first wave of Clinical Interoperability products in early December. Pricing will be subscription-based (monthly) and depend on the level of service a given practice desires.

SureScripts is the closest thing the US has to a de facto National Health Information Network (NHIN). With the rapid growth in ePrescribing (181% in 2009) representing over 600M prescriptions and now over 200K physicians connected to SureScripts, SureScripts has a network in place, particularly in the ambulatory sector, that few if any can boast of. Sure, Epic has its walled garden of Epic Everywhere and its future release of Epic Elsewhere will attempt to connect physicians using other EHRs, but the walled garden has not proven itself to be sustainable over time. Just look at AOL’s walled garden: fine in the early days of the Internet but was simply unable to innovate fast enough to satisfy market needs and wants.

As an EHR vendor neutral platform that actually puts EHR vendors through a rigorous process to provide them with SureScripts certification, SureScripts is not a threat. If anything, and this is highly dependent on what SureScripts may do in expanding its Clinical Interoperability product and services suite, SureScripts may provide a common foundational and commercial NHIN framework that will allow others, including EHR vendors to provide innovative solutions upon. This may lead to a Platform as a Service (PaaS) model facilitating the adoption of distinct modules that sit upon the SureScripts/Kryptiq communication network.

While both SureScripts and Kryptiq stated that they did not see themselves competing directly with HIE vendors, Chilmark sees quite the opposite. Through its ePrescribing services, SureScripts already has established data connections and relationships with a number of EHR vendors. Kryptiq, through its services, has the technology that provides the interfaces to a wide range of EHRs, many of them in the ambulatory sector where SureScripts is also strong. The combined SureScripts-Kryptiq solution suite will impact many an HIE vendor’s bottom-line for these HIE vendors generate a significant portion of revenue on EHR interfaces and their portal solutions. The SureScripts announcement is likely generating a significant number of internal meetings among HIE vendors as they assess what their game plan will be moving forward. If they are wise, they will seek out SureScripts and look at opportunities to collaborate, offering distinct value-added services on the SureScripts network.

While Chilmark was briefed prior to this announcement by both SureScripts and Kryptiq the briefing was short and details few. A more in-depth briefing will occur in the next week or two, including a deep dive into the technology stack. We’ll keep you posted.

John Moore is an IT Analyst at Chilmark Research, where this post was first published.

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10 replies »

  1. John,
    I always enjoy your thoughtful analysis.
    Why don’t you think the government can pull it off?? I think they can call it a success if they get the private sector to adopt their standards and protocols. I’ve read that the VA and DoD will exclusively expose their mountain of health data over these openly developed protocols. Doesn’t that trump SureScripts existing presence in physicians’ offices? After all, it’s about the patient, right?

  2. Couple of quick points for clarification:
    First, Vince, I did actually mean NHIN, yes in all caps for I remain unconvinced that the govt will be able to pull off a truly nationwide information network that will truly scale and be widely adopted. Now NHIN Direct and the fine work of many over the last several months to bring this capability to market will have a role to play, but that will be a limited one.
    And Margalit, looks like we agree once again as I also saw the NaviNet and RelayHealth announcements to also be quite interesting market moves.
    And as to all those regional and state HIEs for which the government is pouring hundreds of millions of dollars? Those that provide value to the market, be they public, private, regional or state will survive, those that do not will fade away. Yes, a lot of taxpayer dollars will likely go down the drain, but hey, it won’t be the first time (remember the bridge to nowhere in Alaska?) and likely not the last.

  3. This is the most amazing announcement. Surescripts is essentially a government sponsored monopoly in eRx. And they have charged HIEs and providers an arm and a leg for their “services”. Now they are going to “help” us in general clinical exchange? The government should put them back in their box and not allow them to leverage their government sponsored market position into making HIE into a pure commercial enterprise with little interest in health outcomes.
    Secondly, is anyone aware that Surescripts has an internal patient identifier for over 200 million people nationally? I thought that we were not supposed to have a national patient identifier in the US…
    John McNider

  4. So what does this mean for the hundreds of start-up community HIEs spawned by HITECH – all busied working on their strategic and operational plans, and trying to build value and sustainability?

  5. Margalit, it’s hard to debate counterfactuals, but I do think the government push towards data exchange and care coordination is a major factor on both the timeline and the content of these developments.
    Remember, we’ve been hearing forever that the business model isn’t there to support clinical data exchange. What hospital (paid episodically) would spend money to make it easier for potential patients to avoid visiting it, or avoid exams and tests that were recently done? In fact, I can remember on this very blog not too long ago people poo-pooing efforts to build RHIOs on these grounds, among others. And yes, I realize the three companies you mentioned are not RHIOs in the standard sense.
    What is changing now with ACOs, Medicare/Medicaid subsidies for EMRs, and other legislative developments, is that we know the next 4 years are going to be a time of rapid growth in EMRs and that these new EMRs will be interconnected sooner rather than later. As a business, you now know that there will be customers in 2-4 years rather than 10-20 if you can build a better data exchange platform.
    I do agree that what Surescripts, NaviNet and Relay are doing is encouraging and a natural move given their existing strengths and abilities, once it became clear that if you build it, they will come. Without that, we would still be in the land of endless pilots.

  6. jd,
    I’m sure HITECH accelerated this somewhat, but this development was pretty much inevitable for Surescripts and, as I pointed out here last week, the next “thing” to watch are the claim clearinghouses and the payer networks – all very well positioned for national information exchange.
    There are two recent developments pointing in that direction
    The NaviNet EHR – http://bit.ly/bvqu9B
    The RelayHealth ONC certification – http://bit.ly/9eEXTi

  7. John, Great write-up and analysis.
    One subtle but important point…
    You are correct that the Surescripts network becomes a “nationwide health information network” (nhin)
    but not the “Nationwide Health Information Network” (NHIN) — the envisioned network of health information exchange networks.
    Expect competing nhin’s. That said, I think Surescripts gains some important first mover advantages with their announcment.
    Overall, this is great news for advancing the vision of interoperable, modular, open health data exchange!