Connected Systems Beyond E-Prescribing | Frank Harvey & Andrew Mellin, Surescripts

This transcript was generated automatically. Its accuracy may vary.

[00:00:12] Mike: And Frank, for those who haven't come across you online, introduce yourself and tell our listeners what we're talking about today.

[00:00:20] Frank: I'm Frank Harvey. I'm chief executive officer for Surescripts. I've been with Surescripts for about a little over a year now. Healthcare for 40 years. Started out as a practicing community pharmacist in a small independent and had an opportunity to work in the chain drugstore industry, a little bit in hospital.

But again, my whole 40 years of professional career has been in healthcare. 

[00:00:43] Andrew: I'm Andrew Mellin, the Chief Medical Information Officer here at Surescripts . I've been here for about five years. My background, I'm trained in internal medicine. I worked part time as a hospitalist for about 15 years, but full time I've been in health IT. 

 Excited today to talk about how we can improve collaboration between pharmacists in the community and the providers.

 We have made huge progress, not only for e prescribing, but that whole life cycle of the prescription. of informing the provider about better costs of care, informing the pharmacist around how to improve medication affordability. 

[00:01:18] Frank: A lot of times we forget just how far we've come. Unfortunately, the past week I had a pretty big reminder. My wife was hospitalized for 10 days with pneumonia in Ireland. In one of the best hospitals in all of Ireland. And there was no electronic record. There was no connection between pharmacy and physicians other than paper written records.

[00:01:40] Mike: I think pharmacies were a little bit before their time. Frank, you started an independent pharmacy independent pharmacists, back in like the early eighties we were Already we're doing a lot of computer stuff.

 Did you see any part of the industry that was slower to come on to digital communication versus other ones? Some doctors get I guess a stereotype of, they want to have those big, huge files and they want to write stuff in their scratch still and all that kind of stuff. 

[00:02:13] Frank: First of all, I would say the thing that really helped move the industry forward was when the federal government stepped up and provided a lot of fundings for health systems and for individual physicians to put in computer systems. That really helped move the industry forward a great deal. These aren't inexpensive investments. When a physician's office, a physician's practice, or a health system puts in a computer system, it is very expensive. And particularly since If you've seen one, you've seen one. They aren't all the same. When you have physicians move between health systems, if you will, a lot of times they may be moving from an Oracle system to an Epic system to, to one of the smaller EHRs. A lot of times it's getting used to those systems. Again, as we move towards more interoperability between all the systems, I think you're going to see us take a next step, but I wouldn't say there was any one health professional or one area that sort of slowed it down.

I think it was just based on where the investment was able to come in and when people were able to engage. I know that physicians certainly want as much information as they can get to help treat a patient successfully. They also, I believe, want that information to really boil down so they see the critical things that they're dealing with at the moment.

A patient's record could be two, three, four hundred pages at times. And no one has enough time to go back and review all of that, right? And what our technology helps to do is boil that down into digestible clinical records to allow the physician or pharmacist to make the right treating decisions.

[00:03:44] Mike: My dad when he had dyna cancer and sometimes he wouldn't be thinking straight, but the one party I always thought straight on is when the nurses would come in and the doctors and every one of them would ask the same questions over and over. And my dad was so pissed at that. they weren't testing him to make sure he was thinking straight. It was just stuff like, what's your address? What's this? What's that? So I think Frank, that's probably a big part of it is clearing some of that away and just having a real structure of not asking it again, but then when you get it, putting it where it should be.

So it doesn't get lost in quotes, so it doesn't get lost in the computer kind of thing.

[00:04:25] Frank: No, I agree. And making it so that everyone can see it so you don't get that redundancy of questions. First of all, it takes up administrative time for the healthcare professional. Secondly the patient is not in a state of mind in general where they want to have to go back and regurgitate that over and over again. 

So as the systems improve, that's getting better.

Really is. And again, sometimes we see it at a moment in time and forget the progress that we've made up

to 

this point. 

[00:04:52] Mike: All right, guys. So who are the players in this? I know it's pharmacists. I know it's physicians. Am I missing anybody? That's part of the network.

[00:05:03] Andrew: Yeah.

[00:05:03] Frank: If you think of the SureSkips Network Alliance, it's EHRs, it's PBMs, it's it's pharmacies, independents, chains, and it's all of the practitioners, whether it's a physician or a nurse practitioner, a physician's assistant, or pharmacist, there are a lot of healthcare professionals that are in involved there, and that's Just with e prescribing, when you start to look at stuff like medication history, where it's impacted and being looked at by a number of the allied health professionals or the administrative staff of physicians as well, there's a lot of that information that's being utilized and accessed by a number of folks across the healthcare spectrum.

[00:05:40] Mike: One of our guests was talking one time about how it would be. Cool for pharmacists to even know something as simple as someone's blood pressure history. It's taken by a technician in the doctor's office. And this pharmacist, I think he actually found it, in one of your like you know how Programs have stuff on the people side that's all prettied up, but I know there's a ton of information in the background and he was able to sort around and find the blood pressure and things.

Is that part of this new wave of pharmacists having more of that stuff?

[00:06:18] Andrew: Yeah, we are not in a place where technology is a limitation anymore. We think about how to engage the pharmacists more in the care team globally, whereas blood pressure is a part of it, right? In one place where I think they play a critical role of supporting that, being a core part of that care team.

So it's not just the technology of getting it there, it's the payment models of

Milenovic. I see. Wait, it says Milenovic. To part click through Okay. What's great about this is that we can go over it with you. I'm seeing people like Em, given the space required by the language of post and enrollment to advance the care team and to bring the pharmacist into the fold.

We are at the ready and working in some small areas to bring that information to pharmacists. And again I think pharmacists are critical as we think about the provider shortage, as we think about the increased burdens on providers to help expand that care team and be a core part of that patient's team.

[00:07:19] Frank: Just to expand a little bit on what Andrew said, one of our latest studies we did, we looked at every zip code in the United States and in almost half of those zip codes, there's fewer than one primary care provider and that's an internist, PCP, nurse practitioner, physician's assistant, less than one for every 1, 500 patients.

An individual, a physician or an NP cannot see that many patients effectively. So the good news is in almost 50% of those zip codes, there's an abundance of pharmacists that can step up and be an active member of that care team. It's really important that as we evolve care and listen, the shortage of physicians or primary care physicians is getting worse by 20%.

It's estimated 130, 000 primary care physicians shortage. And the only healthcare professional that has the bandwidth, the desire, and the scope of training to step in and help be a larger member of that care team is the pharmacist.

[00:08:19] Mike: A lot of the listeners to this are pharmacists, so they know Surescripts Ipts as far as the prescriptions coming in and things like that.

Paint a picture of where you see this going. Let's say it's three years out or 10 years out. Paint a picture of what we'll see coming down the pike of the interoperable relationship between the professions and so on.

[00:08:46] Andrew: Think there's a few aspects that are really exciting to think about now. One is just pure interoperability. Today we have the ability to find patient records across the country and extract from most EHRs to bring it to the point of care. We do that across and between EHRs today.

We do that to specialty pharmacies today. We'd love to expand that. to retail pharmacies in a more direct way. One of the challenges with that information overload is information overload, three, four hundred pages of someone's chart when you're looking for one question.

So as you look to the future, certainly what we're seeing with artificial intelligence, chat, GPT the ability to summarize information, answer questions out of the chart, I think is going to be a game changer, not just for the pharmacist, but for providers to not just be faced with this overwhelming set of information, but to address. I think that's one core part. I think the other thing that I would encourage your listeners and the people listening today is, the way we're going to get there is for everyone to take advantage of the interoperability. One thing that we see and we manage is the growth of different kinds of ways for the stakeholder network to communicate things that pharmacists I'm sure are familiar with cancel our X and our exchange medication history. What we see and I think some of the places that we wish it would go faster is getting everyone online with that. It's really hard for the providers and pharmacists when only half the network or some people use it. And I understand the constraints of technology upgrades and other things, but the faster people can take advantage of these standards that...

Whether it's ANSI PDP or ONC or other places have put in place, the faster we'll get to that place where we have, where everyone's integrating that care team. Again, just encouragement that there's a lot of technologies today, things that half our network's using, that we would love to see, and our providers and pharmacists would love to see all the network using.

It eliminates the fax, it makes it faster and more efficient for everyone.

[00:11:00] Frank: Hey, Mike, if I were to paint a picture of you of what the practice of pharmacy, in a lot of cases, will look like in three to five years, I think you'll see reimbursement structures in place that are reimbursing pharmacy to do a lot of those sort of lower level of primary care, if you will. The blood presSurescriptseenings, tests to treat immunizations, a lot of the things that COVID and the pandemic helped...

push forward, I think you'll see those things put in place. We'll also see, legislatively, state by state, start to empower pharmacists to, to operate more across the scope of their training. And thirdly, the technology will be there to help hone down the right information that a pharmacist needs at that point of care.

They don't need, as Andrew said, all 300 to 400 pages. They need, what is that paragraph of information the pharmacist needs to know immediately when it's dealing with, let's say insulin dose escalation based on the latest HbA1c's. Those sort of things. That's what the future practice will be.

Community based clinical pharmacy. If pharmacists want to go there, if a pharmacy wants to go there. It doesn't say they have to go there, but the opportunity for pharmacy to practice community based clinical pharmacy is going to be much more available, three to five years in the future.

[00:12:13] Mike: And this might already be in place. Like I mentioned the blood pressure thing. It seems like right now, like I say, you guys might already do this. It seems now that when we get information, it's more of a, this is coming from the doctor through Surescripts Ipts, here it is there is going to be a point where a pharmacist would be able to get.

To that database and so on to, not just wait for this news to come to us and then have to do something with,

[00:12:41] Frank: Absolutely. As a part of the evolving care team, as pharmacists are being expected and compensated for doing more primary care, they will have the ability through interoperability, if you will, to reach out, look at a patient's record, have the right information that they need to make those clinical decisions available to them.

So it's going to be more of a two way street rather than the pharmacist waiting on a physician to push something to them.

[00:13:06] Mike: We don't want to focus on the negative, but when you look at this process coming through, where are any bottlenecks? Is it just time? I know it's not computing power. I know it's probably not programming and things like that. Is it just time for adoption?

[00:13:23] Frank: Yeah, the two biggest that I see, and Andrew, I appreciate your insights on this as well afterwards. The two biggest I see is, one, legislatively, having the states recognize a pharmacist's ability and the scope of their practice, and legislating at a state level, because it is a state level legislating their ability to do that.

Secondly, it's ensuring that we've got the reimbursement structures in place. Both at CMS and in the health plans to compensate pharmacists for this activity. Listen, pharmacists, I would have loved to have been able, when I was practicing, to be able to practice at this higher level.

Pharmacists want to take this activity on. They want to be a more integral, more important part of the overall health care team, but they've got to be compensated for that. We can't do that for free because you substitute some sort of time between where you were for And you'll be working more directly with the patient and you need to be compensated for that work.

So those are the two things, the reimbursement structure and the legislation that needs to move forward and that's what's holding us back. We'll take care of the technology. Surescripts will make sure that pharmacists have the technology they need to participate at that level. 

[00:14:32] Andrew: And I'd also just extend that one of the things pharmacies can do today, and I'm sure many do in the small communities, is building those bridges and relationships with the providers. You don't have to start in a big, huge, every single patient kind of thing, but what we are seeing are pilots or small groups or a payer in a community is building these collaborative care models.

So I think as Frank said, to see it at scale. We need some of those changes, but it doesn't mean you can't start. And we are seeing people start today in certain communities. So just continue to build those relationships with their providers and demonstrate how they can collaborate efficiently.

[00:15:13] Mike: Frank, when you touched on the payment and so on, as far as I know right now, from what I know about Surescripts is we see the prescriptions come in on it. Is that something that you guys will just be helping to be the transmitters of this stuff? Or does Surescripts ever get into the payment transfers and things like

[00:15:36] Frank: Yeah, if you think about how a prescription works today, it comes in, it gets adjudicated, the payment goes out. We expect the exact same thing around these clinical practices. Not that we're going to be a payment processor, but we will make sure the network that sort of payment process takes place so a pharmacist can get paid.

The way medical reimbursement works, right? The physician may get a little upfront. They may have to send out a bill in the future. We don't believe, we don't believe pharmacists can operate that way. We believe that that pharmacy is going to need it much more like it is on the prescription side where it's adjudicated, during that or after that process with the patient.

It's a much more direct payment. methodology. And there are already some examples of this in place. Thrifty White is a great example, a small regional chain up in the North Dakota, Minnesota area. And they have already directly contracted with some health plans to do some of these first levels of primary care.

And they have the processes going back and forth. They're getting paid for providing what are really important primary care services. That's what the picture is going to be like nationwide.

[00:16:44] Mike: I think of Surescripts as being the information coming in on the prescription and the pharmacies getting the information and then off to a different area for the billing and things like that. Would you say now Surescripts is involved in any billing and maybe we don't see and will that be more so or the same for the pharmacy services?

[00:17:07] Frank: Let me step back before I address that directly and say it's really, it's much broader than just e prescriptions. 

[00:17:14] Mike: Give me an example of 

that first. 

[00:17:17] Frank: great example. Medication history. A patient checks into a health system. Before they can start to work on that patient, the health system needs to understand what medications the patient is on.

Utilizing our medication history for reconciliation products, it shows a complete record. Or let's say if a pharmacist wants to communicate back something like, I gave this immunization to this patient. through clinical direct messaging. They can install that information. It goes into the patient's chart.

Record locator and exchange, another product where if they need to understand what's going on, with the patient's medical records, we can reach out and pull that information in. Real time prescription benefit, where, the most, one of the most important things is ensuring patients are on Prescriptions are medications that are affordable and that work and so with our real time prescription benefit product making sure that information is available to the Physician, so when they write a prescription, it's one that they know the patient is going to pick up at the pharmacy Rather than patient gets written something they get to the pharmacy and get shocked by the price of it So it's all of those clinical interventions all of that information that we're moving around what i'll say is that we are we're not going to be The, the one handling the checks, sending the checks back and forth.

We're going to make sure across our network, all of that takes place. That becomes very streamlined. It happens. It gets taken care of. We're not going to sort of be the bank in the middle, if you will. That's not not our focus as a company and not a place we would go. I would say that we're involved to the extent that we move that information back and forth. We're not adjusting the price

or have any impact on that. 

[00:18:52] Mike: you're... helping with that information going there and stuff. I didn't know that because I knew it was always like somehow we were talking to those guys and so you help be the telephone lines 

for them to happen. 

[00:19:02] Frank: We're the information highway across all of that information flows. Another great example is prior authorization. We have a prospective prior authorization tool. So say a physician writes a medication that would otherwise require prior authorization. With our tool, it can get cleared before it ever gets to the pharmacy.

rather than waiting till it gets to the pharmacy having to call back the doctor, making sure the prioritization is taken care of. So again, relieving the administrative burden from the system, whether it's at the pharmacy, pharmacist level, physician level, or administrative staff inside of the health plan, that's a big focus for

[00:19:38] Andrew: Yeah, I think the way I would just extend that the way I think about it is our goal is when you drop that claim. You know that test claim or your real claim. It's clean, it's a covered medication. The prior auth is already done. It's the right place on the formulary while we're, as Frank said, we're not doing the actual billing itself.

All the work that goes into making sure that patient has a great experience when they show up to the pharmacy and they, their meds ready, it's available to them. That's our job. Bringing that information to the prescriber and to the pharmacist where appropriate to help make that a great experience both for the patient and for your economics to bill it. 

[00:20:21] Mike: I know that Google tried to do this and stuff like that, but is there actually One database of what this person's blood pressure was, or are you guys more like pinging out this information to get stuff?

[00:20:33] Frank: it could be across multiple databases. If a patient has been in multiple different health systems that use different electronic medical records, they could, there could be information in a lot of places. Now we paint, we go out and pull that together in record locator exchange and we create that bundle of clinical information that's utilized by the clinicians.

[00:20:53] Mike: Is there ever a database and let's say it's maybe even blockchain, is there ever going to be a database of this one thing that has all this information on me? Or will it always be in the cloud, just like the internet is now, basically?

[00:21:07] Andrew: I don't think we're ever going to see a single national database of someone's patient records. And in fact, what the government is proposing and establishing under TEFCA are this concept of QHINs, these Qualified Health Information Networks, which are Different entities that essentially reach out, find patients records, and bring them together.

And then there will be intelligence, we call it clinical intelligence, in taking data from multiple sources and cleaning it up and creating that one piece of information that you need. But I don't think we'll ever see a single national database of patient information.

[00:21:48] Mike: I don't think anybody would probably allow it. All right, guys, listen, here's a free one for you. Now I know that this isn't probably up your alley, but let me tell you this idea I had, and think every pharmacist can appreciate this. Right now there's a shortage of the Wigovy and the Adderalls.

And then there's always a shortage of something. And it's a lot of time on the phone. We probably get it. I don't know. A fifth of our calls are like, do you guys have this in stock? So I thought I was trying to think of, all right, people say to build a business first, you think of a problem before you come up with this big product.

So I'm thinking, all right, that's obviously a problem for people. They don't know where they're going to get their next thing. And I thought, You can't really have a database because what pharmacy would want to go on there and they say, we're the leader in Adderall for the area. We always have it in stock kind of thing, but I thought it would be a cool thing to have something like Priceline where, you know, on Priceline, at least I used to do this where you'd say, I'll take any flight on this three days and you don't know what it is till you say we do it.

But I thought it'd be cool to have some system where somebody could say, what is Govi or this pain medicine, is it available? And this system would say, yes, it's available in this area. And maybe always make the area have five pharmacies. This would be in an urban, a city area, not out in the country.

And then say, yes, it's there, and then the prescription would go to one of them, and then finally it would tell them. Only then, so it's not like in the front page of the paper, who's got all the Adderall. Only then it would say, alright, pick your prescription up at so and so place. Guys, that's just a free one.

[00:23:37] Andrew: I think there's actually a whole bunch of ideas to unpack in that scenario you created. And I'll just pick up on two of them. I think one is the concept of consumerism and allowing patients to have more insights into their different options and make choices, whether it's based on price or relationship or whatever it is.

And, here at Surescripts, it's always a patient's choice of pharmacy and we will always and forever support that. Right now they choose that at the moment with their doctor and we anticipate having, giving ways for the patients to get more involved in the process over time.

Whether it's Priceline or something, who knows, but it always has to remain the patient's choice of where they go. I think that just the second thing and this drug shortage is something my physician community talks a lot about is we are a standards based organization and it's not just the technology on top of it.

But it's knowing that the pharmacy, what they have in stock, so this is something I just encourage , your constituents to work with the NCPDP and their organizations to help establish those standards and, those are, that's the exact kind of thing that we would pick up on and find ways to incorporate into the EHRs, into the prescribers and other places where appropriate.

[00:24:51] Mike: Am I hearing you right? That would be something that maybe it's not there yet, but eventually this would be information, not all my dreams about how it would happen, but this would be information to start to say, Hey, before a doctor takes somebody who's, got a migraine and sends them all over the city, they're going to have a little bit of input on maybe who has what that kind of thing.

[00:25:13] Andrew: I think we need standards in the industry to be able to know what the inventory is in the pharmacy. So I think that's the first step in that process. And again, that's where the NCPDP plays the critical role of establishing those industry standards.

[00:25:27] Mike: Standards not as far as what pharmacy should have what but how it's counted and how it's labeled and that kind of

[00:25:34] Frank: And how it's, how it's put into the database so you really know it. Now, I can tell you days of old, 40 years ago practicing pharmacy in Richmond, Virginia, we always knew there was that one independent pharmacist. A pharmacy that carries everything under the sun. Westbury Pharmacy.

And if no one else had it, we would always go to Westbury because they always had it. That's how it used to be done. There was always one independent that decided, I'm going to carry everything ever made. And they had a supply of it. But again, tech, technologically, it's possible to do that once it's incorporated into the standards to Andrew's perspective.

[00:26:09] Mike: Taking the model of Surescripts, are there any other professions that have as many things going on? Car parts with all the tools and dead people , all this, is it worse for the medical?

Or do you think that every profession has similar challenges with this interoperability and so on?

[00:26:32] Frank: I think interoperability across a lot of industries can be an issue. I'll say it's more important in health care because we're dealing with somebody's life. And their life affects their entire family and their friend group. And so while there may be similar types of interoperable challenges across a lot of different, and you can look just at the supply chain in general, you look at the automotive supply chain now and.

People have been waiting for new Ford F 250s for over a year and a half because of the supply chain. So sure, they're out there, they're just not as impactful, as important as what you get in health care.

[00:27:06] Mike: My sister in law passed away a couple weeks ago and I thought 

to myself, what a terrible time to think of all the stuff that goes on you're dealing with insurance stuff. You're dealing with transferring titles over in this.

You're dealing with the funeral home and all that. And then on top of that, the person you loved has just died. 

And I think pharmacies are the same way for someone, like I mentioned, a migraine or something, for them to go around and try to find this and then not know the price and all that kind of stuff.

And I know your guy's stuff with the pricing and stuff, I think that's going to help some of that. So people don't have to make decisions. In the pharmacy after they've waited for an hour somewhere, they maybe already know before they even leave the doctor's office, like how all this is going to transpire,

[00:27:54] Andrew: Yeah, we talk a lot about moments that matter here. In healthcare, we are privileged as physicians and pharmacists to be working with people and the people that love them in those critical moments that matter. And if you think about it as a physician, you're sitting in the exam room, you have a conversation with the patient, you've thought about their diagnostic process, you've chosen a therapy and then that patient goes to their pharmacy and they find out it's unaffordable.

It's so frustrating. And, so then what does that start? Either the patient's not going to pick it up, they're going to make a really hard choice between that med and maybe their food or their kids present for the day. The pharmacist is going to have to make a call back to the provider and do rework, which none of those are great outcomes for the patient or the provider or the pharmacist.

In those moments that matter, what we're trying to do and what we're succeeding in doing is getting that information. That provider has a price they can combine to make the best clinical and economic decision for the patient. They do it. The patient knows what they're going to pay when they show up at the pharmacy And there's no surprises and it's interesting when we've studied this now for the people that use that tool for real time prescription benefits. Those pickup rates were 3.

2 percent That's pretty remarkable to think about, those prescriptions that were abandoned, because it was unaffordable to the patient. We're seeing people save 61 on average per prescription. When the provider makes that switch I think it's for us. It's those moments that matter informing that provider or the pharmacist to have that information.

They need to make that best decision and make that process. The patient already has so much on their mind. They're thinking of their disease or illness. They're thinking about their path to healing. The last thing they want to do is find out they got to call the doctor. They have to rework things and start all over.

[00:29:53] Mike: I have a lot of stories I make up in my head and they've become true just because I've told myself them so many times, but once in a while we'll get some weird stuff in on the prescription. It's like, all right, I know what happened. And this is more like 15 years ago. I think attrition has helped a lot with this, but I'm thinking that Doctors are back there and they want to rush off to their golf game, you know, and they're 63 years old. And so they send it to Tiffany, who is their 17 year old girlfriend of their sons, who's in the front office.

And she just picks stuff, and I would tell my staff like, oh, that's Tiffany again, or something up there. Or just, throwing darts. I'm sure some of that was there, but I know now that the younger physicians or those who are not about to retire, it's better.

They got better monitors now that's easier systems and all that kind of stuff is some of that going on. And, attrition has taken care of a lot of that crossing over from people that were afraid to touch a computer to people that grew up with computers.

[00:30:59] Andrew: I think your scenario may still play out in some places. I've seen a lot but I will say, what you're talking about and what the way we talk about here is prescription quality. We think a lot about how to communicate that intent to the provider safely, effectively, efficiently, and cleanly to the pharmacist.

And at the same time, I would say that maybe. Some people have retired. Meds have also gotten a lot more complicated. You have starter dose maintenance doses. You've got creams and you've now the doctors have to be more precise with their quantity unit measures and what size tube to do.

 At the same time, I think. Let's just put aside the people. Things have certainly gotten more complicated. We've been on a journey for many years now of working with our EHR partners and our pharmacy partners to improve that process to make it cleaner to look at every aspect of that prescription and how do we make sure that EHRs are transmitting it.

Clearly and cleanly. The part we're really focused on now is the patient instructions. And I was just on with some pharmacists this morning and they were talking about how, as a provider, expanding the SIG length with the new standard to 1,000 characters is really useful. I think what I heard from the pharmacy side is That created a lot more room for weird prescriptions.

And we are very focused on this concept of rare signs, of, how do you get rid of the weight, those kind of really unusual ways to express things, or when things get into patient instructions that shouldn't be there. We're focused on putting things in a more structured and codified way.

So it is a journey we've been on and we've made a huge amount of progress towards it. But again, like the journey we talked about before, we have several ways to go to make it better.

[00:32:46] Frank: Think about it, you're practicing as a pharmacist. All of a sudden you get in this dissertation and then you have to decide how you are going to include those instructions on a prescription label or on a supplementary label.

So the structured and codified SIGs where we try to. You know, there's some drugs that there may be seven, I think was it Andrews 7, 000 different ways to express the same sort of instructions. And so just trying to simplify that, bring it down to a way that you're not going to get rid of, all of those, but bring it down to a manageable number that then is clear when it comes across to the pharmacy.

So the intent that the physician has is actually Implemented by the pharmacist because the instructions are clear.

[00:33:26] Mike: It's interesting what you said, Andrew, about doctors not having that many things before. I think now when we started in the mid 80s with our computer system, I told my team we did a lot more prescriptions but you didn't get any rejects. You had no PARs.

It was just, you just throw right in there with a crayon basically in the computer and it would go through. But the point of doctors is they have a lot more choices where before they might've had 10 or 15 drugs they liked, and now it's sky's the limit.

[00:33:59] Andrew: I remember writing paper prescriptions, it was like seven words on a piece of paper. I felt bad for the pharmacist who couldn't interpret my handwriting, but, but now if you Google the search for an EHR prescribing screen it's complex and everything on there is there for a reason.

It's to help inform the prescriber, help them make better decisions, but there's a lot more to consider now than there used to be in the past.

[00:34:24] Mike: You get some people that like vinyl records. I guess they like repeats and scratch sounds, pops and all that stuff. I think it's a fad. Is there anything that was lost with doctors writing in their... 12 inch high book or pharmacist, getting written things.

Is there anything other than nostalgia there that was better than electronic stuff? I doubt it. But is there 

Anything I'm missing? 

[00:34:54] Frank: yeah, I'll give you a great example of something that is missing that we used to have before. And again, it's much more advantageous to have electronic prescribing.

But a lot of times a physician used to call me when I was practicing and have that conversation. We would have a conversation. What do you think?

This is what I'm seeing. What do you think? And I would be included as a pharmacist in sort of some of those medication decisions. I think electronics took away a bit of those conversations. So now you may not even know your local Physicians that are writing to you unless you're in a small town now that we lost and that we've got to get back And as the care team is expanded and we're becoming more integrated across the care team that will reappear But that's that is something we lost absolutely something that's been lost over that time it's nostalgia that we need to get back to in some way.

And again, you can have the same communications now electronically where with, clinical direct messaging, we 

can share those sorts of conversations.

[00:35:58] Mike: You're right, Frank, because I think some doctors, some old timers would call me and while you're talking to them, you're writing the prescription down. You're talking together about what you're going to give and when you're off the phone, you already have it.

And now even if you have those conversations, it's a full extra step because then the doctor's got to go back to their system and redo this. They got to pick something out and things like that. Obviously things have to move on. It's like Blockbuster didn't want to go online because they thought people like to go down there with their kids and walk around for a half hour and try to decide what movie to get.

 there's something there, but I'd rather just sit on my ass and use my thumb, to do it. 

[00:36:37] Frank: Netflix started out doing the same thing. They were mailing it to your

home, but they have evolved with the time. So it's important that, while one thing may work well today, you have to evolve with the time. 

[00:36:49] Mike: Yeah, Netflix just sent out their last DVD, I think, last week or something like that. Do you see that, Andrew?

[00:36:55] Andrew: I did see

that. Yeah, 

[00:36:56] Mike: their last DVD out.

[00:36:58] Andrew: It's a lot of DVDs I got to get rid of.

[00:37:01] Mike: That's right. That's right. 

[00:37:02] Frank: All right guys, so you have a week at the shop And you're putting a lot of hours in, what is personally your worst hour of the week?

[00:37:13] Mike: Now we have to be careful. We don't want to say it's talking to Helen the administrative assistant, we got to be careful of what we say here. I know you love your job. I know you love the future and what you've done, but what's a pain in the ass for like an hour a week in your position?

Yeah.

[00:37:29] Frank: for me it's when you're sitting in Charlotte or Atlanta and the next leg of your flight gets canceled. That's the pain. Because I tell you, I am so blessed to work with such a talented team at Surescripts. I literally love my job. I love the people I work with. I love the things we're doing to help healthcare heal itself.

 And it's not the ticket agent's fault, right? It's not the weatherman's fault. But your flight gets canceled. You have to spend another night in some other city. That's the most frustrating thing for me.

[00:37:58] Mike: Do you do a lot of traveling, Frank, on the job?

[00:38:00] Frank: Probably three weeks out of the month I am because our team is spread around and then members of the Surescripts Network Alliance, our customers, our partners are all over the country.

So it's really important to spend time with them. And then there are a number of really important healthcare conferences that take place across the country and spending time there because being at that cutting edge of things, make it being the ones that are taking the industry forward.

It's important that we spend time out there among the rest of the industry helping take healthcare forward.

[00:38:30] Mike: How about you, Andrew? 

[00:38:32] Andrew: Yeah, I don't have like really hard hours in terms of being negative, but what's hard for me is saying no to things when I really want to say yes, there are so many ideas and so many places We can make health care better. I hear it as SurescriptsAnd we've got to think hard about where we 're gonna have the biggest impact, so there's so many great ideas. We hear so many Opportunities to help health care heroes heal itself as Frank was saying But we have to pick and choose like any technology company and so I think saying no or deferring a really great and important idea is really painful because I want to make life better for the providers and the patients and the network.

[00:39:19] Mike: Yeah, you get a lot of those, I'm sure. Like my price line thing, you probably have a lot of entrepreneurs that would like to hear some of those things that people have come to you with that they're trying to solve a problem, but agreed, it's just gotta be hard to pass up those things, both As a corporation, but also kind of like, Oh, that's, that's a neat idea.

You know, Personally as a business guy. So it's gotta be hard to see those go by the wayside. You know, They have to, you have to focus.

[00:39:48] Frank: That's part of the collaboration we do across the healthcare system as well. Surescripts Network Alliance, we have EHR vendors, healthcare technology companies focused on there. When those great ideas come up, we don't feel like we have to do it all. We've got great partners in that Surescripts Network Alliance that can take some of these things and run with it.

[00:40:07] Andrew: I'd say we also don't feel like it's all our decision. We go to our network and we ask them to help us figure out where we should put our energy.

So, you know, It's we're in this together and it's not just what your scripts want. It's how together 

we can make the best decisions.

[00:40:24] Mike: And I imagine, Frank, when you say you're traveling to those things, how do I want to say that instead of going to a healthcare service, you might be going to the association to see what people like that need.

Is that fair?

[00:40:41] Frank: Association or like conferences like health that bring together so many different type of health technology vendors that are focused and the great thing about a lot of the entrepreneurial companies, they have come about because their founder dealt with a certain health situation and found that there was a gap

in the healthcare system.

So they wanted to step in. So there are thousands of those companies out there. Going to those conferences is really important for us to interact with those individuals, to take their ideas and say, how do we solve some of those problems hand in hand, partnering with, working together with those companies.

[00:41:17] Andrew: have a saying here. It's actually used across all of technology, industry, or product management called NAHIDO. Nothing interesting happens in the office. And we can come up with lots of ideas, but the best ideas come with being behind the counter at a pharmacy, shadowing at a provider office, sitting next to the person making the phone calls to the payer.

So we try to spend a lot of time at the executive level. And also at the end user level, understanding what they're doing and bringing those ideas back to our organization.

[00:41:50] Frank: That's a great point. Andrew and his team, we embedded some individuals in a doctor's office to go through sort of the process and what the pains were for the provider. They spent a month there learning, helping out, and it helps make our products better as they, they bring those 

learning back in the office.

[00:42:10] Mike: I've always said that with all the damn time people spend in pharmacy school and physician school and dental and all that, if a pharmacist could spend a few hours in the ER, a few hours in the, primary care, a few hours, this, and then doctors would spend a.

Half a day on a chain pharmacy, a half a day down in the actual pharmacy of the hospital. And then a half a day with this or that, there'd be a lot more openness or at least cooperation, or at least what's the word I'm looking for? At least empathy, for kind of what's going on with things.

[00:42:43] Frank: I couldn't agree more. 

[00:42:45] Mike: Frank and Andrew, boy, thanks for joining us today. Besides all the cool technology stuff you guys have, anytime we think of pharmacists.

That's our focus. Pharmacists getting more involved in the healthcare team. That's a good thing. So thank you for all you're doing to unite all of those professions and not just in a fluffy way, but actually in a very Hands on physical way to help us all work together.

[00:43:15] Frank: Mike, it's been a real pleasure spending time with you this afternoon as one pharmacist to another. The one thing I've always said about pharmacists, we're people that care about people. We went into this profession to help people, to help families, because we could see it in our own families needing that.

It's been a real pleasure to spend time with you.

[00:43:34] Andrew: Yeah, and thank you too as we were just ending up talking about one of the great parts of my job here as a physician, I have now been behind a retail pharmacy counter. I've been in specialty pharmacies, I've been at payers, I have actually had the chance to see the other sides of the network and create that empathy and help bring our groups together.

So thank you for the opportunity to speak here as a physician to your pharmacist community.

[00:43:58] Mike: Thank you so much for your time guys. I look forward to keeping in touch.

[00:44:02] Frank: Great.