Surescripts is being considered as a hub for data exchange under QHIN

Surescripts' Director of Product Marketing Terry Douglas

Photo: Courtesy of Surescripts

Surescripts subsidiary Surescripts Health Information Network is seeking designation as a Qualified Health Information Network under the Trusted Exchange Framework and Common Agreement (TEFCA), according to the company's director of product marketing Terry Douglas.

Surescripts is being considered as a hub for data exchange by the Office of the National Coordinator . It would serve as a broker of sorts between providers, payers, pharmaceutical companies and others, to move forward the ONC's goal of interoperability. 

Surescripts Health Information Network recently advanced to the candidate phase in the process of becoming a QHIN.

QHINs make external data available to stakeholders. The data can come from providers, payers, pharma or elsewhere, but the information remains with the original source.  

What all of this means for payers and others was the question a panel addressed during AHIP's annual convention in Las Vegas last week. AHIP represents the health insurance industry.

The breakout session, "True Clinical Data & Interoperability – Shaping Member Experience and Outcomes," included panelists Douglas; Matt Hartzler, director of product commercialization for Surescripts; and Andrew Borgschulte, principal product marketing manager for Surescripts.

WHY THIS MATTERS

The panel focused on best practices in the areas of clinical data exchange and use. 

Having connectivity to QHINs allows people to query to see if certain clinical information exists and retrieve it, according to Douglas. Medical record information would be available across provider networks. A query could be made to determine what other types of care a patient has had.

There's also clinical data available around medications.

Payers are getting some of the information today as they have access to their own claims data. But if there's other stakeholders at the table, such as pharmacies, insurers will be able to get information beyond their own systems, Douglas said.

"With more information we'll have the ability to close the information gaps and close more of the care gaps, leading to savings and outcomes," Douglas said.

Many questions were around the voluntary nature of the data exchange, he said. There are givers and takers in information exchange, but someone can't be a data consumer without being a data giver.

The big takeaways are to understand the external data resources that are available that will help increase interoperability and for organizations to think about their internal systems and processing, especially if they're contributing data.

THE LARGER TREND

Last year, Surescripts, through its subsidiary Surescripts Health Information Network, applied to become a QHIN. 

In December 2023, the Department of Health and Human Services announced that eHealth Exchange, Epic Nexus, Health Gorilla, KONZA and MedAllies could immediately begin exchanging data under the Trusted Exchange Framework and Common Agreement's policies and technical requirements.

In February, HHS, through the Office of the National Coordinator for Health Information Technology (ONC), announced that two additional organizations – CommonWell Health Alliance and Kno2 – had been designated as Qualified Health Information Networks capable of nationwide health data exchange governed by TEFCA.

Email the writer: SMorse@himss.org