A Primer on Surescripts’ Nationwide Medication History Data

Different pieces of a patient’s medication history reside within electronic health record (EHR) systems maintained by various ambulatory care providers, hospitals, long-term care facilities, community pharmacies, pharmacy benefit managers (PBM), health plans, and with the individual patient. The fragmentation of medication history information across multiple providers, platforms and care settings presents a formidable challenge to providing high quality care including drug utilization review, care coordination, population health, medication therapy management and accurate and complete medication reconciliation. As hospital and community EHRs seek to improve the accuracy and completeness of patient medication histories they are increasingly integrating with health information networks like Surescripts. In 2015 alone, Surescripts delivered 1.05 billion comprehensive medication histories sourced from PBMs to care providers across the United States and another 700 million sourced from pharmacies. The information is delivered directly into the provider’s EHR system using the Meaningful Use 3 compliant NCPDP 10.6 standard and is helping to improve patient care at a lower cost and cement Surescripts’ place as the clear leader in facilitating health information interoperability.

The Surescripts Medication History feed contains two distinct data sets: PBM claims and Pharmacy Dispensed data feeds

Surescripts Medication History data includes prescription claim records adjudicated by connected PBMs and prescriptions dispensed from national and regional retail pharmacy chains and independent community pharmacies, including medications paid for in cash. Included are data from Medicare part D plans and state Medicaid plans, both fee-for-service and managed care.  The two data sets contain over one hundred discrete data points providing information such as dispensing pharmacy, quantity dispensed, days supply, date picked-up, SIG, etc. Additional characteristics of both data sets are listed below.

Nationwide Medication History data coverage ranges from 70-90%+ of the U.S. population

When combined, this data (i.e. PBM claims and pharmacy dispensed records) create a comprehensive national interoperability network of medication history information available to providers for treatment purposes. Depending on the location, data coverage (e.g. percentage of time a medication history is found for a patient) ranges from 70%-90%+.

How It Works: Patient Medication History

With appropriate patient consent, authorized users can request their patients’ medication histories from certified EHR systems in real-time. Surescripts employs a national Master Patient Index (MPI) containing over 240 million patient records to positively identify the patient based on the data in the incoming request. The Surescripts MPI utilizes a combination of the patient’s first name, last name, gender, date of birth, street address and Zip Code for accurate patient identification. Upon positive patient identification, all available PBM and Pharmacy patient medication history records for the past13 months are aggregated and returned directly into the clinical workflow using the Meaningful Use 3 compliant NCPDP 10.6 standard as a supplemental and comprehensive source of external patient information.

The Medication History data provided is near real-time. Participating retail and independent pharmacies send their dispensed prescription records to Surescripts on a nightly basis and connected PBMs provide their adjudicated prescription claims on a real-time basis.

Medication History Continuous Quality Improvement Program Initiative

To ensure care providers have the highest quality data available to them while treating patients, Surescripts has implemented a continuous quality improvement program to continuously enhance the quality of patient medication history data and further improve patient care and end user satisfaction. Surescripts is working with all stakeholder groups including EHRs, PBMs and pharmacies to measure and improve data content quality, eliminate errors, and disseminate industry-wide best practices to optimize end user satisfaction and usage. 

This article was originally posted on Surescripts.com