Q&A: What’s next for e-prescribing; SureScripts’ Hutchinson, Ratliff discuss outlook

BY Jim Frederick

ALEXANDRIA, Va. With much of the groundwork laid for the rapid national expansion of electronic prescribing and more doctors embracing paperless prescriptions and the benefits of health information technology, Kevin Hutchinson announced in December his plan to retire as president and chief executive officer of SureScripts.

Hutchinson led the pharmacy-sanctioned e-prescribing platform provider since its launch by the National Association of Chain Drug Stores and the National Community Pharmacists Association in August, 2002. His acting replacement as chief executive officer is SureScripts chief operating officer Rick Ratliff.

A week before his departure, Hutchinson, along with Ratliff, participated in a lengthy interview with Drug Store News to discuss his future plans, the current state of e-prescribing in the U.S., and the outlook for 2008 and beyond. Here are portions of that interview:

Drug Store News: Kevin, the obvious question is, why leave now? As you’ve said yourself, e-prescribing is headed for what could be a watershed year, with a huge transition possible in 2008. After all the groundwork you’ve helped lay, why pick this particular time to move on?

Hutchinson: I think what’s going on now is we’re shifting to the physician space. We have the chain pharmacies on line, and now we’re seeing the major growth among the independent pharmacies. The network’s live and running. The standards have been implemented in the physician software products. And we’re really starting to see now a big push on the physician side to drive that adoption.

But as a company, the network is enormously successful; it’s well funded, and it’s well supported by the pharmacy industry. And there’s just so much other work to be done outside of SureScripts to drive physician adoption. I came from the physician software and electronic medical records world … and it just seems to me that we still have a lot of work to do to get physicians to adopt electronic prescribing.

The reality is we have a fabulous team at SS, and Rick is ready to take the helm. There’s a lot of work still to do, but it’s work that can be done by the team that’s here today.

DrSN: It sounds like you’ll stay in health IT in one form or another.

Hutchinson: Yes, I would imagine. I started my career at IBM, and then went to Oracle … then got focused on health care in the ‘90s. So I think I’ll probably stay in health care throughout the remainder of my career.

I think it’s a good time to be in health IT. We’re obviously seeing a demand for it from a consumer perspective, and even from a patient-safety and quality of care perspective.

DrSN: Looking back, what are you most proud of in your time at SureScripts?

Hutchinson: There are a lot of dedicated people at SureScripts, so I think from an internal perspective, I’m most proud of the team we’ve hired and the culture we’ve built to really solve this problem. We have been fortunate to hire some outstanding individuals … who really have a passion to improve the health care system.

Outside of the organization, the thing I’m most proud of is that SureScripts has played such a key role in driving momentum and demand for electronic prescribing, and driving standards and regulation changes at the federal and state level.

Obviously, we’ve had a lot of support from the pharmacy industry, from physician vendors and others. But we’ve played a key coordination role in driving demand and acceptance of the need for electronic prescriptions.

DrSN: Will this be the year that a lot of the remaining barriers to paperless prescriptions are swept away?

Hutchinson: I think so. I think you’ll see the DEA [Drug Enforcement Administration] regulations [forbidding e-prescribing of controlled substances] overturned. You see a lot of pressure being applied by several senators. And there’s a high demand for it, both at the state level—where they want to track the use of controlled substances—as well as at the federal level. That will help tremendously.

It’s a roadblock for us today, because physicians have to think about when to write scripts electronically, and when to pick up the paper pad.

DrSN: What about continued resistance from doctors themselves?

Hutchinson: Physicians who have been using e-prescribing applications … are starting to see the huge benefit from a time-saving and hassle-reducing perspective—as well as better patient care, of course, in getting access to patients’ medication histories, and being able to do a more thorough drug interaction check.

Up to this point, it’s been all about getting the pharmacies connected, getting the network operational, getting physicians’ software products implemented with the accepted standards, and getting them deployed. We saw a lot of that starting to happen in ‘07 on the physician side, and it does look like it’s going to explode in ‘08.

DrSN: Turning to you, Rick: what do you see as your primary role as you come into the top management role at this stage of the e-prescribing movement? What happens now?

Ratliff: As Kevin said, we’ve done a lot of work in the last few years to get the framework in place, and we have significant momentum going into this year. We did more electronic prescription transaction volume in 2007 than we did in the first three years of the network. We’re projecting we’ll generate about 100 million electronic prescription transactions in the network. That is triple the volume from 2007.

We’ve got to stay focused on improving the prescribing process, while helping the constituents who are part of that process to optimize overall e-prescribing. What that means is we have to work with the vendors on the physician side, for example, to ensure that their software is such that as we start to get into mainstream users of e-prescribing, that the workflow is optimal for writing and transmitting prescriptions electronically.

So we’re going to focus a lot of effort with the physician technology vendors to help ensure that their current installed bases are getting connected to our network, and that the experience from an end-user perspective is as high-quality as we can get it.

Overall, we need to move from what today is about 2 percent of prescriptions going electronically to about 7 to 8 percent by the end of the year. That’s another core focus.

DrSN: Why 8 percent?

Ratliff: That 8 percent represents about 100 million prescriptions, which shows good growth and continued momentum. It’s a reasonable number, given the growth we’ve seen and some of the market drivers Kevin described. If we can eliminate the DEA issues that prevent us from transmitting prescriptions for controlled substances, then we should easily be able to get to that number.

DrSN: Anything else SureScripts can do to move the needle?

Ratliff: There’s a visibility component to this. So we’ll be working with the community pharmacies in the first quarter and going into the second quarter of this year to create consumer awareness of the value proposition around electronic prescribing. It’s very similar to what you see if you go into a Starbuck’s or other coffee shop, and signs tell you it’s a WiFi-enabled hotspot. There’ll be consistent signage representing that these pharmacies accept electronic prescriptions.

DrSN: That’s a good idea.

DrSN: How’s your relationship with the technology vendors? Are they pretty much on board with SureScripts’ vision, and is there coordination between what they’re trying to do to get physicians connected, and what your team envisions as the optimum network?

Ratliff: The vendors are used to selling software into these practices, and not necessarily looking at the workflow in combination with the connectivity. So as Kevin mentioned, part of the leadership role we help to play in the market this year will be to help the software vendors optimize their products so they can deploy these products, implement and train their users, connect them to the network, support the connectivity—those types of things.

DrSN: The push by the Bush administration for health information technology nationwide by 2014—is that helping to push that effort along?

Ratliff: It’s interesting, because when you think about universal health IT, and look at what is happening from a federal and state perspective, the health information exchanges are in many cases being put in place to share information between the different health constituents on behalf of the patient.

Interestingly enough, Surescripts’ Pharmacy Health Information Exchange is a national health information exchange. We are sharing clinical information between physicians providing care to patients and the pharmacies, and it is a step toward allowing individual patients to start to have a better view to at least the medication component of their health care. So I would say it’s definitely a catalyst to move the industry in that direction.

Medication Therapy Management also tends to be a key component of the plan to move toward that universal health record.

DrSN: What will the pharmacy industry see this year from SureScripts in terms the organization’s public face and public efforts to drive e-prescribing?

Ratliff: I think the most important aspect of this company is the pharmacy stakeholder investment and support. In 2008, what the industry should see is that we’re continuing to build on the momentum from 2007, and really making real this full end-to-end e-prescribing process.

Number two, because of the infrastructure we’ve put in place, and the fact that we know inside of our network who is connected and using the network, we have an opportunity to allow for that network infrastructure to connect the pharmacies’ in-store clinics to community physicians.

Part of our role is to facilitate this change of pharmacies to become more health care service providers. And as they do that, they are very interested in ensuring that they’re connected in an efficient way with the community. We can use our network to connect that in-store clinic to that community physician, so that when the patient goes into the clinic and goes through an exam and leaves with some form of patient summary, we can actually send that electronically through the network. Today that summary is often just mailed or faxed to the primary care physician.

So the two key messages are, we’re going to continue to build on the momentum and deliver on the value proposition of electronic prescribing. And we’re going to leverage the network infrastructure we’ve put in place to help drive interoperability between the physicians and the pharmacies.

DrSN: How do you see the patients themselves participating in the recordkeeping for their own prescription records, clinical records, etc.? Will it be through the Internet?

Ratliff: That’s a very good question. We’re in conversations, as are many pharmacies, with multiple organizations to try to find ways to deliver services to consumers—whether they do that through personal health records delivered through the Internet, or through services you might install on your desktop computer at home.


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FDA to closer scrutinize consumer drug advertisements

BY Drew Buono

WASHINGTON The Food and Drug Administration’s current budget for reviewing consumer drug advertisements is larger this year than the previous five years combined, according to USA TODAY.

The FDA received $6.1 million for the current fiscal year to check the fairness and accuracy of consumer drug ads. That’s up from $2.2 million the previous year and $1 million the year before.

The FDA says it plans to hire more people so it can review more ads. It has 13 workers devoted to policing direct-to-consumer ad materials, six of which are primary reviewers. Last year, the FDA received 12,616 drug ad materials.

The FDA has been so overwhelmed by drug industry ad materials that only a “small portion” is reviewed, the Government Accountability Office said in a 2006 report. The FDA often didn’t declare consumer ads false or misleading until after ad campaigns were over, the GAO said.

President Bush’s proposed 2009 budget calls for $14 million from user fees to fund 27 FDA positions devoted to the consumer-ad-review program. In exchange, the FDA would review TV drug ads within 45 days of getting them from drugmakers — which is faster than many reviews occur now — and before the ads are seen by millions of viewers.


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BY Drew Buono

HOUSTON The Professional Compounding Centers of America has named John Herr its recipient of the Dr. M. George Webber Compounding Pharmacist of the Year, an award that is presented annually to an independent pharmacist who has demonstrated service excellence to patients, healthcare providers and pharmacy colleagues.

L. David Sparks, PCCA’s president/chief executive officer, presented the award to Herr during the company’s International Seminar held in Houston in January 2008. “This year, we recognize a pharmacist who has become one of our profession’s most respected compounders,” Sparks declared. “His colleagues appreciate his generosity and willingness to share and network with them. His pharmacy staff respects his dedication to compounding, compassion for patients and concern for their own well being as his employees. His patients and prescribers appreciate his ability to solve specific medication needs in a high-quality manner.”

Herr has been a registered pharmacist for more than 20 years, and has been an owner of Town & Country Pharmacy since 1999. He is the recipient of several recognition awards for his outstanding service in his practice of the art and science of pharmacy compounding, including the New Jersey Hospice and Palliative Care Organization’s 1998 Hospice Team Award for outstanding leadership as a Hospice Pharmacist.


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Which area of the industry do you think Amazon's entry would shake up the most?