It’s said that change is the only constant, and in healthcare, that’s always been true. But in 2018, the pace of change in American healthcare felt almost unprecedented.

Drug pricing made headlines, and data confirmed that medications are taking up a greater share of budgets: Prescription drug spending was projected to rise faster than spending in any other major healthcare sector.¹ The impact was magnified for the growing share of Americans managing chronic conditions² and those taking expensive specialty medications, which are expected to surpass half of U.S. drug spending by 2022.³

To help manage rising costs, the market continued its shift toward value-based care. Healthcare providers, clinicians and pharmacists had to wield an increasing volume of complex data as rules tying government reimbursements to total cost of care kicked into effect,⁴ underscoring the need for interoperability and information exchange between organizations across the country.

Patients, too, sought ways to get the most out of their healthcare dollar, spurred partly by a surge in high-deductible health plans⁵ and partly by expectations set by an ever more connected and convenient consumer environment. The industry fielded patients’ demands for more options, more transparency and more portability of healthcare information.

Legislators and regulators had an eye on all of these developments, displaying extraordinary levels of activity and involvement. Now more than ever, what happens in healthcare happens on a national stage.

These changes have complicated decision-making at the point of care and heightened the need for collaboration among pharmacists, physicians, payers and patients. In 2018, the Surescripts Network Alliance™ rose to the challenge by forging stronger connections, deploying new innovations and exchanging an unprecedented volume of actionable intelligence.

This report examines a year’s worth of data to track our progress enhancing prescribing, informing care decisions and advancing healthcare across the nation.

The rapid growth we saw in 2018 was supported by high-availability operations and advances in the realms of security, data quality and standards development.

In 2018, we achieved:

• 99.9% Network Uptime
• Less than one second Average response time for aggregated patient data
• Hitrust CSF certified status for key platforms, placing surescripts in an elite group of organizations worldwide

We also continued to track and celebrate prescription accuracy, building on our Critical Performance Improvement program established in 2016 with input and feedback from across the Network Alliance. All prescriptions processed by Surescripts, except those for compounds and supplies, are analyzed by Surescripts Sentinel^®, which identifies opportunities for quality improvement.

Our Quality Index Score (QIS) is used to measure factors that could impact the prescribing process, including prescription accuracy, directory alignment and adoption of appropriate transactions. In 2018, Surescripts improved the accuracy of e-prescription transactions by 14%, meaning physicians and pharmacists spent less time exchanging phone calls and faxes to clarify prescriber intent.

We also recognized five EHR vendors with the 2018 White Coat Award for their achievements in prescription accuracy between August 2017 and August 2018:

In 2018, we convened the Network Alliance to support the industry's transition to the National Council for Prescription Drug Programs SCRIPT Standard v2017071, which has a regulatory effective date of January 1, 2020. The new standard will:

• MODERNIZE E-PRESCRIBING AND MEDICATION HISTORY TRANSACTIONS
• IMPROVE PATIENT SAFETY AND PRESCRIPTION ACCURACY
• MINIMIZE MANUAL PROCESSES THAT REQUIRE CARE PROVIDERS TO STEP OUT OF THEIR WORKFLOWS TO EXCHANGE CRITICAL PATIENT INFORMATION

We worked to build consensus around how to leverage the new standard and guide our partners through the migration process by engaging with thousands of participants during:

• 10 WEBINARS
• 5 CONFERENCE CALLS
• 5 INFORMATION SESSIONS AT INDUSTRY EVENTS
• OFFSITES
• ONE-ON-ONE LEARNING SESSIONS

At the end of 2018, 16 Network Alliance participants had joined our Wave 1 early adopter program and three were certified, including AIS Healthcare, DAW Systems (ScriptSure Cloud) and Kalos, Inc.

In 2018, Surescripts processed 5.24 million electronic prescriptions per day.

When a prescriber needs to cancel a prescription, time is of the essence. In 2018, the Surescripts Network Alliance vastly increased its use of the CancelRx transaction to resolve prescription accuracy and safety issues within the prescribing workflow before they could impact patients.

In 2018, state and federal legislators continued to recognize EPCS as an essential tool in combatting the opioid epidemic. Congress passed and President Trump signed into law H.R. 6, the Substance Use-Disorder Prevention That Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, which requires that controlled substance prescriptions covered under Medicare Part D be transmitted electronically as of January 1, 2021.

Eight states passed their own mandates in 2018, bringing the total number of states with legislation requiring e-prescribing for opioids, controlled substances or all prescriptions to 15. Mandates in Minnesota, New York, Maine and Connecticut had taken effect by January 2018, with the majority of the others set to take effect in 2020.

As overall opioid prescribing rates continued to decline across the U.S.,¹⁰ electronic prescriptions for opioids increased by nearly half in 2018—a big step forward for safety, with more prescribers utilizing this critical tool for opioid prescriptions. A nearly 90% increase in e-prescriptions of buprenorphine shows that clinicians also relied on e-prescribing to help treat opioid dependence and addiction.

In 2018, five opioids accounted for more than 87% of all opioid e-prescriptions:

The foundation for solutions including Real-Time Prescription Benefit and Electronic Prior Authorization, Eligibility & Formulary gives providers the ability to check a patient’s benefits. In 2018, it informed nearly every physician office visit and hospital outpatient visit in the nation.¹²

In 2018, the momentum behind prescription price transparency was stronger than ever, led by high demand from the nation’s prescribers. When we commissioned a survey of more than 500 U.S. healthcare professionals, 78% said they considered patients’ out-of-pocket costs very important and 69% considered information on lower-cost alternatives very important.¹³

Surescripts met that need with Real-Time Prescription Benefit, which displays patient-specific, formulary-based out-of-pocket cost information for the prescriber’s choice of drug and the patient’s choice of pharmacy—along with up to five therapeutic alternatives—in real time within the EHR workflow.

In addition to displaying cost information, Real-Time Prescription Benefit flags medications that require prior authorization. If a prescriber doesn’t choose an alternative medication, and they have access to Electronic Prior Authorization, they can move seamlessly into an integrated and dramatically faster prior authorization process.

In 2018, Surescripts Medication History solutions continued to give care teams a more complete and accurate picture of their patients’ medications. Medication History for Reconciliation in particular was enriched by the addition of several significant new PBM and pharmacy data sources, making the reconciliation process even more efficient.

Built using the Direct protocol, Clinical Direct Messaging connects clinicians, pharmacists and other healthcare professionals with secure, HIPAA-compliant exchange of protected health information. In 2018, hundreds of thousands of users relied on Clinical Direct Messaging to improve transitions of care, send immunization notifications, coordinate medication management efforts and achieve government incentives requiring the use of secure electronic messaging from within the EHR.

Surescripts researchers concluded that when disaster strikes, "access to e-prescribing and medication histories via EHRs could allow for the quicker recovery of essential medical services—but only with robust infrastructure in place to mitigate the impact of catastrophes and essential emergency preparedness policies and collaborative agreements between critical stakeholders."¹⁷