Anyone working in health information technology knows: there's nothing simple about interoperability.

It's not just the massive coordination across the healthcare industry that makes things so complex. It's also the formidable infrastructure needed to deliver and protect health data across care settings—rapidly, at scale and often in high-stakes situations.

At Surescripts, we've spent nearly two decades, building and optimizing a nationwide health information network. In the process, we've learned a great deal about what it takes to engineer true healthcare interoperability. The resulting infrastructure is at the core of everything we do today—whether that’s ensuring the safe and secure delivery of opioid prescriptions, enabling care providers from across the country and across the street to share critical patient information, or providing access to patient-specific prescription price information, so prescribers can make the best care decisions for their patients.

Through a single connection to the Surescripts network, participants in the Surescripts Network Alliance are able to exchange actionable patient intelligence far more extensively, efficiently and effectively than they could if they had to rely on individual connections to all other organizations. Meanwhile, all Surescripts solutions—and all those who use them—benefit from the industry-leading reliability, security and scalability of the Surescripts network.

We represent our network with a set of core building blocks. These building blocks are deeply interconnected with each other and with our entire portfolio of solutions. But when we think about their overall function, we can stack them into four layers:

1. The Trust Fabric
2. The Transport Layer
3. The Usability Layer
4. The Optimization Layer

Within these layers are the technologies, standards and practices that make it possible to securely deliver actionable intelligence across the nation at great scale and speed, enhancing prescribing and informing care decisions for patients and the people who care for them.

The Trust Fabric: Creating Confidence Across the Network

Essential to any two-sided network, the trust fabric creates confidence in participants, the integrity of the system, and how shared data can and cannot be used.

Privacy    
Surescripts maintains the privacy of protected health information through administrative, technical and physical safeguards. We ensure HIPAA and HITECH compliance with continuous real-time monitoring and a security infrastructure designed for high-transaction-rate auditing. Fraud detection, data protections, audit storage, encryption best practices and risk mitigation are all built into the network.

Information Security    
Surescripts has achieved a number of certifications and accreditations to help ensure the security of our network. A few highlights:

• Key platforms within Surescripts Enhance Prescribing and Inform Care Decisions solution   
  structures hold HITRUST CSF Certified status, placing Surescripts in an elite group of organizations worldwide.
• Surescripts participates in the rigorous EHNAC accreditation program to demonstrate its commitment to quality in all aspects of its healthcare technology and show compliance with DirectTrust. EHNAC is an independent, federally recognized, standards development organization and non-profit accrediting body designed to improve transactional quality, operational efficiency and data security in healthcare. 
• Surescripts undergoes an annual Service Organization Control (SOC) 2 Type II examination conducted by an independent American Institute of Certified Public Accountants audit firm to thoroughly assess our service organization’s solutions, controls and compliance
• Webtrust certification demonstrates that Surescripts' digital certificates comply with internet standards of security.

Governance   
Our alliance is governed by contractual chains of trust, certification and implementation requirements, ongoing compliance and enforcement activities, and continued flexibility and responsiveness to industry needs. As a founding member of Carequality, a national interoperability framework for trusted exchange between and among health information networks, programs and services, our governance approach informed the approach used across the industry.    

Through the network governance we’ve established over the past two decades—and the thousands of legal agreements and partnerships we manage—we’re successfully enabling interoperability and high-quality communications across the Surescripts Network Alliance.

The Transport Layer: Enabling Exchange Across Healthcare

The transport layer makes it technologically possible to exchange electronic health information across multiple domains.

Provider Directories    
Our provider directory makes it possible to deliver actionable clinical intelligence to 1.61 million healthcare professionals within their electronic workflows, while our pharmacy directory connects clinicians with 98% of U.S. pharmacies.

Record Locating    
Our Record Locator & Exchange solution delivered 108 million links to clinical document sources and 99 million care location summaries in 2018, giving more than 100,000 clinicians from nearly 5,000 healthcare organizations access to nationwide health information exchange through a single connection at the point of care. Record Locator & Exchange transactions are exchanged according to the Carequality framework.

Transaction Standards    
Our transaction types are based on National Council of Prescription Drug Programs (NCPDP), Fast Healthcare Interoperability Resources (FHIR)  and other industry standards, and we actively engage with the standards bodies that develop them to ensure that updates effectively support real clinical use cases across the Surescripts Network Alliance.

Workflow Integration    
Surescripts has native integrations with virtually all electronic health record (EHR) systems and pharmacy technology platforms, enabling easy access for clinicians and pharmacists. Workflow tools also help our technology partners get valuable new features in front of end users sooner by plugging additional capabilities into existing interfaces—making for a nearly seamless user experience. Many of our workflow tools are built to FHIR standards and leverage the SMART protocol.

Patient Matching    
The Surescripts master patient index lets healthcare providers uniquely identify and securely access data for 258 million patients—encompassing 93% of insured patients in the U.S. On average, queries return aggregated patient data in less than one second.

Application Programming Interfaces (APIs)    
Surescripts works with other industry stakeholders to innovate by leveraging FHIR standards and open APIs as part of HL7’s Argonaut Project and Da Vinci Project.

The Usability Layer: Delivering Actionable Intelligence Where It's Needed Most

The usability layer enables delivery of actionable patient intelligence to the point of care within existing  clinical workflows.

Data Transformation    
Surescripts has the ability to transform data and translate between data standards to ensure messages can be used by the receiving system.

For instance, Surescripts translates from the HL7 Consolidated-Clinical Document Architecture (CCDA) standard to the FHIR standard in real time, enabling cross-enterprise transactions. We also help automate the prior authorization and specialty prescribing processes in part by transforming question and answer sets for communication between prescribers, pharmacies and specialty hubs.

Transaction Sequencing    
Surescripts orchestrates transaction steps to automate the exchange of healthcare information in an intelligent, secure, and orderly fashion.

For instance, in emergency departments using Surescripts Medication History for Reconciliation, intake staff can submit a simple query using their EHR and promptly receive the patient’s electronic medication history. Behind the scenes, the EHR submits a medication history request to Surescripts, which matches patient identifiers and routes the request to the appropriate pharmacy benefit manager (PBM) and pharmacy dispense history database, which return medication history response transactions to Surescripts, which then routes the information back to the EHR, which displays the information to the end user. All of this happens securely, while protecting patient privacy, in a matter of seconds.

The Optimization Layer: Constantly Improving Accuracy & Performance

Touching every transaction Surescripts handles, the optimization layer helps continuously improve network performance in order to deliver actionable patient intelligence as quickly and accurately as possible.

Data Quality    
Monitoring and continuously improving data quality is essential to ensuring that messages preserve the integrity of patient health information and providers’ intent.

Surescripts Sentinel® monitors the accuracy of all electronic prescriptions sent across the Surescripts network to pinpoint areas for data quality improvement and analyze electronic prescribing trends. We also regularly convene more than 100 industry leaders to address e-prescribing pain points through our Critical Performance Improvement program.

Thanks to these efforts, we improved the accuracy of e-prescription transactions by 64% between 2016 and 2018.

Measurement & Reporting    
We proactively monitor, analyze and report on network transactions to help spot trends and make performance improvements. Network Alliance partners often rely on our reporting to better understand usage of their own systems.

Technical Support    
A two-sided network environment with hundreds of different system connections, thousands of potential transaction routes and multiple potential failure points along each path needs robust support.  Surescripts technical support works to swiftly coordinate communication and resolution efforts among all Network Alliance participants.

Surescripts customers also have access to a secured admin environment where they can carry out a variety of testing, troubleshooting and maintenance activities.

Interoperability Isn't Simple. But the Outcome Is.    
The elements of healthcare interoperability are unavoidably complex. Fortunately, by connecting to Surescripts, healthcare organizations can sidestep much of that complexity in their day-to-day work.

As participants in the Surescripts Network Alliance, they can automatically access the benefits of interoperability and keep their focus where it belongs: delivering excellent patient care.