Opening Our Eyes to New Possibilities

Winston Churchill once said: "The pessimist sees difficulty in every opportunity. The optimist sees the opportunity in every difficulty."

While it may seem grossly insensitive to look for opportunity when the world is off kilter, in truth, there’s wisdom in Churchill’s oft-repeated maxim. Great crises can birth great changes.

We hope the changes born from this pandemic will be positive, for the betterment of all, though it may be too soon to tell with any certainty. But we do know that healthcare—really, the world—will be much different after COVID-19. (The tens of thousands of lives lost, and the tragedy of that loss, so keenly felt in homes and families and communities worldwide, have already shown us both the global and personal impact.)

We recently asked some of our resident experts to share their perspective on how the crisis is transforming healthcare. They shared some bright spots, opportunities and a few predictions on the future state of our industry.

Preserving High Quality Care and the Patient-Doctor Relationship

Andrew Mellin, MD, MBA, serves as Surescripts Chief Medical Information Officer, and works on improving the care experience, focusing on smart workflow solutions. Board Certified in Internal Medicine, Andrew was a hospitalist for 15 years.

“It’s been said a lot recently, but telemedicine is here to stay. And we know that younger generations embrace this technology. But let me share another perspective: my dad's a physician; he's near the end of his career. He has patients who’ve been with him forever and he's now managing them all via telemedicine and telephone. He is not technologically savvy, nor are his patients, yet they’ve found a way. On one hand, that's been really positive. On the other hand, I think my father feels that the more personal patient-doctor relationship, something that he savors, is losing out.

In this new world, how do we embrace the concept of telemedicine while at the same time ensuring that these powerful relationships don’t founder? These are not transactional relationships.

COVID-19 is also accentuating the need for digital transformation in healthcare. We’re no longer just talking about the inconvenience of antiquated models. We’re talking about keeping people safe, especially our most vulnerable populations. We need to ensure that, wherever and however a patient is seen, that information is fluid and essential care continues unimpeded. We need to embrace secure messaging, the digital delivery and exchange of clinical and medication histories, and electronic prescribing for all prescriptions, no matter the care setting. Let’s not have our elderly population waiting at pharmacies right now with paper prescriptions. Let’s not have them show up to a pharmacy only to be surprised by an unaffordable medication and have to return at a later date. While I hope patients can return to face-to-face visits with their physician and pharmacists in the near future, let’s continue to embrace the tools that are available today and that allow for a better, safer, more coordinated care experience for all."

Tapping Pharmacists’ Expertise in a Changing Culture of Care

Ken Whittemore, Jr., RPh, MBA, spent 16 years as a practicing pharmacist. In his role as Surescripts Vice President of Professional & Regulatory Affairs, he follows regulatory and legislative initiatives, and liaises with state and national pharmacy associations.

“The U.S. Department of Health and Human Services is allowing pharmacists to conduct COVID-19 testing. And when a vaccine becomes available, it’s highly likely that pharmacists will administer it, because there will be a need, in short order, to vaccinate a quarter to a third of the U.S. population. Leveraging pharmacists to deliver critical care: that’s a big win for patients, pharmacists and for an over-taxed healthcare system. Pharmacists and pharmacies have long been essential, and now they are receiving overdue recognition.

Another thing to note is the fact that the federal Drug Enforcement Administration (DEA) has temporarily waived the requirement for an in-person medical exam when e-prescribing controlled substances pursuant to a telemedicine encounter. So, we’re looking at how to help telemedicine vendors become enabled for electronic prescribing of controlled substances (EPCS). The DEA has also allowed practitioners to prescribe buprenorphine to patients with opioid-use disorder via telephone or telemedicine without an in-person evaluation. Buprenorphine is used in medication-assisted treatment (MAT) to help people reduce or quit their use of opioids. And they’ve waived the in-person exam for patients to access substance abuse treatment programs, as well. These exceptions will expire when the nationwide state of emergency lifts, but I think they could pave the way for future DEA rules that allow, for example, EPCS via telemedicine. And even if all measures are reversed, they have changed the culture of care, even momentarily, and opened our eyes to new possibilities.”

A Win for a Particularly Vulnerable Patient Population—and Those Who Care for Them

As Vice President for Policy and Federal Affairs, Mary Ann Chaffee leads Surescripts efforts to help inform federal healthcare policy. Mary Ann worked as committee staff and as legislative director in both the House and Senate, with a particular focus on public health policy.

“The CARES Act makes far-reaching changes to a statute governing the confidentiality of substance use disorder records, known as Part 2 records. It allows much greater sharing of these records in accordance with HIPAA. More importantly, the act allows that once a patient signs a written consent, their Part 2 records may be used for treatment, payment and health care, without the need for further consent.

Why is this important? Let me provide some context. When we helped advance the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act, we heard heart-wrenching testimony from families of young people who’d died because the providers who were caring for them couldn’t access the patient’s history of substance use disorder. So, they’d treat people who came in, who'd had a history of substance use disorder treatment, or were currently in treatment, with drugs that killed them. It wasn't the fault of the providers. They didn’t have any idea because of the Part 2 constraint, which was a vestige of the times when substance use illnesses were something to be hidden and could be used to deny coverage.

It was one of those things that made sense at the time but doesn't any longer. It took COVID-19 and the CARES Act to make the change, and it’s permanent. The ideal next step would be to fully align it with HIPAA. For all other treatments or diseases, you don't need a patient's consent for their data to be shared in the context of treatment; it’s not required under HIPAA. Substance use illnesses shouldn't be stigmatized or treated differently than other illnesses. That's the point.”

COVID-19 Has Underscored the Need for Information Sharing

Adnan Qadir is Surescripts Chief Strategy Officer. He leads efforts to build, execute strategies vital to the success of the company, taking into account market trends, key industry and regulatory drivers, competitive positioning and segment differentiation.

"COVID-19 has thrown into stark relief the importance of information sharing in healthcare. We have sick patients being treated in new care environments. We have patients who cannot access their normal healthcare facilities because hospitals are overwhelmed, or clinics are closed. We’re hearing about overtaxed providers who don’t have the time to spend to get on the phone to have someone send them a fax. They’re focused on managing finite resources or saving the lives of the patients before them—without a moment to spare.

Healthcare interoperability can have real impact in the initial triage of a patient. If a provider has never dealt with the patient before, sees them come in with an infection or breathing problems, but can easily pull that patient’s information—whether it’s a history of care encounters or medications—then that provider can more quickly determine the right course of care. When is a cough just a “cough” because this patient has a history of seasonal allergies? And when is there a need to escalate care because the patient has asthma or another condition that puts them at high-risk for severe illness from the coronavirus?

When the healthcare system is under such stress, access to quality patient information can mean the difference between life and death, literally. Our industry has made great strides to advance interoperability and health information exchange. What COVID-19 has shown us, when resources are scarce, when providers are triaging thousands of patients each day, is that interoperability isn’t just nice to have. It’s a must."