The Interoperability Infrastructure Passed the COVID-19 Test

When a healthcare crisis hits, scientists try to figure out the what, why, and who of the crisis, and during COVID-19, that search coincided with significant disruption, according to Tom Skelton, chief executive officer of Surescripts.

“During the pandemic, we saw disruption to the roles that clinicians were playing,” Skelton said in an interview with EHRIntelligence. “We saw disruptions to the nature of the patient makeup that health systems were responsible for. We saw changes in care venues; offices were no longer able to see patients, so everything became telehealth. All of that together created a significant demand for information.”

Interoperability has always been a significant focus for the healthcare sector, and COVID-19 found a way to accelerate patient data exchange and interoperability. Whether it was at a major health system, a clinic, a field hospital, or in a special suite where clinicians provided telehealth, clinicians could access patient information.

“Interoperability took pressure off of patients to deliver some of that information,” Skelton added. “Overall, we saw some great stuff and it shows in some of the numbers that Surescripts reported. We saw an increase in the number of clinicians looking for patients records and we found 400 million links to clinical documents that were very important to the care cycle.”

Particularly, healthcare professionals needed interoperable patient data to deliver targeted care management. With patients visiting different providers than they typically do, it became essential for those providers to access patient information.

“The interoperability infrastructure that we've all been working on for years did a doggone good job and it served its purpose for the frontline clinicians,” Skelton reiterated.

Communication between providers is critical for patient data exchange, which is why providers across the country are steadily trying to boost provider-to-provider communication through clinical direct messaging.

The volume of clinical direct messaging transaction exchanges saw a 50 percent increase from 52.8 million in 2019 to 79.4 million in 2020. The number of individuals and healthcare organizations leveraging the platform also increased 15 percent from 648,500 in 2019 to 745,200 in 2020.

According to Skelton, this increase tied directly to COVID-19. Having the patient carry the message between clinicians did not work as effectively as Skelton said it had worked in the past. Clinical direct messaging allowed primary care providers to stay in touch with pharmacists and specialists.

Although public health reporting was a major COVID-19 obstacle, clinical direct messaging helped streamline that aspect of the pandemic because, without it, it would have been a manual, paper-based nightmare for providers, Skelton said.

“All of those things came together and generated a lot more activity in the world of clinical direct messaging and enabled health systems to report COVID-19 cases directly to the federal government in a way that otherwise would have required faxes and all kinds of manual interruptions,” Skelton said.

“This was a much more natural workflow, much less disruptive to the clinicians, and much more helpful to the federal government reporting. What we saw here was innovation based on repurposing existing technologies. We'll see more utility like that out of the interoperability infrastructure as we continue to grow and evolve here.”

The total number of ePrescriptions exceeded 1 million prescribers for the first time when the vendor added 63,000 prescribers and 1.91 billion ePrescriptions in 2020. The number of ePrescriptions for controlled substances increased 52 percent from 134.2 million in 2019 to 203.6 million in 2020.

While some experts might have attributed the ePrescribing increase to COVID-19, the Surescripts leader connected it to the natural growth in prescription medications.

“There's an underlying growth trend in the market, and our volumes indicate that over the last few years,” Skelton said.

“The other thing that contributes to this is, through the combination of the regulatory regime is the general education awareness of the impact of controlled substances on society,” he added. “We're seeing more and more prescribers prescribing controlled substances and opioids through electronic prescribing. The digitization process is good, and that also impacted the overall volumes that we saw this year.”

Over the last 14 months, Skelton said the pandemic highlighted the importance of thinking creatively. 

“When some type of crisis, such as the pandemic occurs, developers and vendors are looking at every tool they have in their toolkit,” Skelton said. “They’re saying, ‘is there another way to use this tool to help a patient, to help a provider, to help an agency that needs this information?’ That level of openness and creativity to change the underlying utilization of these new tools is important.”

Additionally, the pandemic reminded healthcare leaders how valuable it is to look at the “simple things” that healthcare professionals do every day, such as identifying who a patient is or ensuring clinicians have the most up-to-date patient information.

“If you think back to the early days of the pandemic, the top concerns that we all faced were where individuals could get tested and how individuals could get tested,” Skelton concluded.

“All of those types of things were important, and that supply chain aspect of this, it's almost been forgotten, but there was a big point in time when finding respirators was key. The fact that much of the system is now digitized gave us capabilities that we've never had in the past. It speaks well for the march that the entire healthcare system is on to digitize all of this information.”