HIStalk Interviews Tom Skelton, CEO, Surescripts

Tom Skelton is CEO of Surescripts of Arlington, VA.

Tell me about yourself and the company.

I’ve been involved in healthcare and healthcare IT for a little over 30 years. The first 25-plus was on the provider side of automation – physicians, hospitals, home healthcare agencies, and the like. The last five years I’ve spent running a diagnostic imaging services firm, where I had the opportunity to, for the first time in my career, focus on running a care delivery organization. That was a great change and a great opportunity for me.

What was it like going back to the provider side after being a vendor?

It was a fantastic opportunity. It was really good to work in that environment again, side by side with the physicians working to do similar things. We’re trying to improve quality. We’re trying to increase efficiency. To be right there in the trenches with them was a great learning opportunity and I took away a lot, no question.

Is there anything left to accomplish with electronic prescribing other than getting everyone on board with the prescribing of controlled drugs?

We’ve asked the team to focus on three things. We’re trying to optimize every segment of the e-prescribing value chain. There’s a lot that still can be done in the areas of convenience, efficiency, and accuracy. We’ve got new modules for the prescribing offering that are designed to enhance those types of things. We can provide valuable information at the point of care and help make sure the patients are getting the best that the healthcare system has to offer.

The second we’re looking for is broadening the e-prescribing footprint. We still think there are some things to be done there. Electronic prescribing of controlled substances is a great example of that.

The last is enhancing clinical connectivity — attacking things in a much more general form. We think there are great opportunities there, leveraging assets and skills that we’ve developed over the years.

Let’s go back to that optimization of e-prescribing and touch on some of the keys there. One for us, certainly, is medication history. That’s a big one. You’ve got folks standing there at the point of care, if you’ve ever had to take a loved one to the hospital and had the nurse and the ED ask the question, "What prescriptions does your father take?" You just get this blank look, or at least I did. We’re in a fortunate position where we’ve got this type of history for three-quarters of the US population. It’s a great place to be, so we’ve productized that and are making that available.

The second one is electronic prior authorization. A physician’s office has to invest significant time to prescribe what the physician believes in. Then you’ve got patients waiting at the pharmacy. You’ve got pharmacists reaching back into the physician’s office. There’s a lot of waste and a lot of opportunity there. Our CompletEPA product is designed to help address that and to improve that level of efficiency and accuracy around authorizations.

The last area in optimization comes down to adherence. You’ve probably seen some of the same studies that we have that show that, particularly when it comes to chronic diseases and chronic care, this is a vital and costly component that needs to be addressed. People are getting the prescriptions, but they’re not getting them filled or they’re not taking them to conclusion. We’ve got some tools at the point of care that can inform the physicians exactly what’s going on in that area and help ensure they’re having the right dialogue with their patients when they are face to face.

How do manage the patient identification issue when creating a medication history from multiple care settings?

We’re in a pretty strong position there. We’ve got 270 million patients in our MPI that we can uniquely identify. The algorithms for this identification have been refined and honed over the years. There’s a lot of work and a lot of time and energy that’s gone into that. The MPI continues to grow as the number of folks that are covered by insurance across the country is growing. If you want to get deeper on the technology, frankly I’m not that guy, but I can help connect you to that guy if you want to know exactly what we’re doing.

If you have claims data that includes anyone who’s ever filed an insurance claim, you must have bigger data footprint than anyone.

We’ve got a tremendous footprint. If you look at the business, this is one of the most interesting parts of it. We’ve got 270 million folks in our MPI. We’ve got connectivity to 800,000 prescribers, primarily physicians, across the country. We’ve got strong connectivity to the pharmacies — virtually every pharmacy is connected to us. We’ve got connectivity to probably slightly less than half of the health systems in the country right now. 

We’ve got an awful lot of connectivity that we can bring to bear to help people move forward. While we’re very excited about optimizing e-prescribing as the first step, and secondarily moving on to broadening that footprint. We think there’s a lot to do in the world of clinical connectedness and interoperability that’s at the forefront of everybody’s mind. We think there’s some things we can do to help there.

Now that EHR penetration is high, how would you gauge interoperability progress and the opportunities for Surescripts now that the network is in place?

When we look at broadening our e-prescribing footprint, we are talking about two major thrusts. The first is the electronic prescribing for controlled substances. This is a big, big issue. We’re very excited to see movement at the state level. We’re participating. In fact, we just did a webinar on this and ended up with about 500 people, so there is an awful lot of interest here. 

There’s huge benefit to the system to getting these types of prescriptions digitized. This is very sensitive information, but on the other hand, it’s a situation where also there’s a lot of fraud and abuse and these types of things can be weeded out better in a digital environment than in a manual environment.

The second piece for us is long-term care. This is an area that didn’t get caught up in the first waves of e-prescribing. The hospitals and the ambulatory settings are very penetrative, with adoption rates of greater than 70 percent, but there’s a lot of work to be done in the long-term care arena. We feel very good about being able to do that.

Those are the two in terms of the e-prescribing footprint. When we move on to enhancing clinical connectivity, that comes down to leveraging the assets that we have.

We’ve created a pretty secure environment for these things. We’re one of only 105 firms in the country at this point in time that’s achieved ISO 27001. That’s something that we’re taking very, very seriously. It’s going to underpin two solid offerings that we’ve got here, the first being a a record locator service that I’ll explain on a personal level.

My in-laws live in Pennsylvania. They spend a chunk of the winter in Florida. They have very good friends in California. They’ve had healthcare events in all three environments. If my father-in-law were ever to be admitted to a quaternary facility or something like that, to pull all of his records in, it would be difficult for them to know where to go. We can give guidance on where these folks have been seen based on what we’ve seen in the prescribing patterns and allow them then to very quickly contact facilities to get the information they’d need to inform the care that my father-in-law should receive. We’ll be demoing it at the Connectathon at the HIMSS conference. I think the market is particularly interested in this as patients become more mobile and society becomes more mobile.

The other piece for us is clinical messaging. We’ve done an awful lot of work helping hospitals connect to physicians, payers connect to physicians and hospitals, and physicians to connect to other physicians. The directory that we talked about helped enable this and underlie this. We feel real good about the opportunity here and believe there’s huge value in allowing clinicians to exchange information electronically in a secure fashion.

When we look at expanding outside of the world of e-prescribing, these are the two core offerings that you’ll see most of.

People see big data pipes and worry about how the overseer of that information might be selling it in some fashion. Do people ask you about that?

I agree with you. The market is very, very concerned about that. We do not package or sell any data. That is not part of our business model.

Is CommonWell’s work complementary to what you do or are they a competitor?

When you look across the industry, any time you have a large number of stakeholders and a really big chunk of challenges, you’re going to get different types of alliances and approaches. I think there will be continuing effort to try and move interoperability forward more aggressively, things like CommonWell, DirectTrust, Healtheway, and Carequality. There’s a whole list of them. All of them serve a valuable role. They increase awareness. They drive focus. They bring energy behind the problems. Each will have their own aspects and approaches to trying to solve this.

What progress are you seeing in not just making external information passively viewable, but inserting it into the provider’s workflow?

You hit it right on the head. That was one of the keys to e-prescribing. I remember when folks were pushing handhelds for the docs to do e-prescribing and portals were the way of the world. If this stuff isn’t in a natural workflow for a physician, it’s going to be very, very difficult to get the uptake that you want.

My experiences over the last five years working with physicians reinforce that. These are busy people. They care an awful lot about what they’re trying to do. They love to delegate where they can. You’ve got to work with them and get it into a natural workflow.

We did it with e-prescribing. That’s at the core of everything that we’re doing around prior authorizations, that tight integration right into the workflow allows the physician’s office to really gain some tremendous efficiency in this area. I’s something we’re quite proud of and take seriously.

Where do you see the company going in the next five years?

We’ve got the three legs of the stool that we’re working on — optimizing e-prescribing, broadening the footprint, and enhancing clinical connectedness. A lot of what will transpire over the next few years is going to be linked to how quickly the demand for well-packaged information begins to match the supply.

What I mean by that is, to your point, there’s a lot of data out there. There’s a lot of people that want to push data at physicians and at caregivers, but the caregivers are trying to make sure they only get what they need when they need it. The industry has a huge opportunity here, but also a huge responsibility to get that right.

I think we’ll see some increases in adoption across the interoperability spectrum, and as we do with the impetus from Congress and everybody else, this thing will start to gain momentum pretty quickly. The fact that we’re starting slowly is very natural when you’re building a network. Over the course of the next five years, I would expect this type of messaging to become pretty much ubiquitous. It’s going to drive what we’re doing and really change healthcare. It will start to put us in a position where we can reap some of the benefits of the monies that have been invested in laying the EHR foundation.

Do you have any final thoughts?

We’ve been very fortunate and have had some great success. We consider ourselves a leader at a national level in the interoperability space, particularly as it relates to clinical transactions. I think it’s incumbent upon us as a leader to make sure that we’re extremely focused on our customers, our partners, and the stakeholders that have helped us be successful. 

As we continue to build out the portfolio, we’re certainly going to be keeping an eye on the market. I expect a lot of changes. I expect it to be very dynamic. We’ve got to be nimble enough to respond appropriately. That’s something that we’re looking forward to building into the Surescripts of tomorrow.