Integrating Epic with SureScripts/RxHub

Since my last blog about MUSE/Epic integration, I have done a number of interfaces that I will be blogging about. The first one that I did like to talk about is Epic with SureScripts/RxHub; or some people might simply call this as enabling their CPOE with ePrescribing. I was part of a 4-person team on the west coast who went live with this integration. Much of this was done in getting in compliance with the CMS ruling of making sure all prescriptions are sent electronically vs. print or fax. (There is more to this ruling but I will keep it simple as my audience is primarily technical.)

The integration from an Epic standpoint involves the following interfaces

• Orders to SureScripts – This interface will be responsible for communicating all prescriptions to SureScripts network
• Provider add/updates to SureScripts – This interface does two things; (1) As a new provider is added at the medical care facility, he/she is automatically communicated to SureScripts (2) If a provider is updated (name, practice address), he/she is automatically communicated to SureScripts
• Pharmacy downloads from SureScripts – This will download all pharmacies from SureScripts and update the Epic database (specifically the PHR masterfile)
• Refills requests from SureScripts (as part of my project, we never went live with this)
• 270/271 RxHub eligibility request interfaces – This will be responsible for getting mail order benefits for a given patient
• RxHub medication history request/response interface – If the patient is found to have mail order benefits, he/she is then queried to determine if there are is any medication history available. (Do not worry, any history found is not downloaded directly to the patient record (EPT record), but is actually stored in a holding tank (DXR record))
• Orders to RxHub – This sends mail orders to RxHub
• Provider add/updates to RxHub – This is almost the same as SureScripts that is mentioned above
• Formulary, Coverage’s and Medication alternative downloads from RxHub – This interface download a few gigs of data from RxHub that was then tediously (did I say painfully) imported into Epic. The main masterfiles that are impacted are LCA, LCO, LMA, ALT

From a technical standpoint the information goes out of Epic via an intermediately server that is often known as Interconnect. Cache and Interconnect talk to each other via generic queues (ICOSYNC and ICOASYNC). This communication layer is very much proprietary to Epic. The Interconnect server has SSL certificates installed that enables it to be a trusted source for SureScripts/RxHub. Not only this, but SureScripts/RxHub will only accept connections from trusted IP addresses, and for this purpose the Interconnect server IP address needs to be communicated to them.

From a business sense, this was a bit of challenge. Some of the challenges that I noticed were

• Physicians were initially skeptical of using ePrescribing. The fact that for many years prescriptions have been faxed to pharmacies, or hand-written played a role in this. However, once they started to use it and noticed the low error rate, they gained confidence in the system.
• Sending mail orders to RxHub seemed picky or so we thought initially that was the case. Apparently, RxHub will return benefits for all PBM’s (Pharmacy Benefit Managers), however; they will only accept mail order prescriptions that are routed to PBM’s that have a mail order pharmacy defined. It was hard to understand which PBM’s had mail order pharmacy vs which one didn’t. The solution to this was that we turned off all PBM’s that did not have a mail order pharmacy defined. This resulted in lesser confidence in relying on patient mail order benefits., but nonetheless this feature continues to improve with time.
• Since SureScripts is really now the owner of your PHR masterfile (only for external pharmacies), any updates made to any PHR record are now over-written by SureScripts. Hence, if you want to change a phone /fax number, or address, you need to open a request with SureScripts to do that.
• Provider records that need to be communicated to SureScripts are now really picky. You cannot miss a provider address, phone number, fax number in their SER records.

Those were pretty much the highlight issues that came, there are definitely things that Epic and SureScirpts can improve, and I am hopeful they will improve the integration with time. At this time, this is a very much do-able implementation with a few kinks here and there. As always, please do not hesitate to leave me a comment if you have any questions.