RxHub Improves Patient Safety and Health Care with Initiate Patient

REVIEWER: JP Little, chief operating officer, RxHub.

BACKGROUND: RxHub was founded in 2001 to provide a nationwide, universal electronic information exchange to facilitate improvements in patient safety and health care delivery. Today the company provides access to more than 170 million patients covered through contracted pharmacy benefit managers (PBMs), roughly 90 percent of the commercial prescription market. RxHub provides a central resource for determining drug eligibility, formulary and benefits, and dispensed drug history. RxHub also routes new prescription and refill requests between physicians and pharmacies.

HARDWARE PLATFORMS: RedHat Linux, Dell/Intel servers, Java shop, Oracle RAC, JBoss application servers, Symphonia mapping, Hitachi SAN.

PROBLEM SOLVED: The need to address the inefficiencies and information gaps that jeopardize patient safety and create unnecessary costs for physicians, hospitals, pharmacies, benefit providers and patients was confirmed by 1999 Institute of Medicine findings: more than $77 billion spent yearly in drug-related morbidity and mortality costs; more than $1 billion wasted yearly on physician and hospital visits resulting from medication errors; $5.6 million estimated yearly, per hospital, for medication errors and adverse drug effects; and 10 to 14 percent estimated annual increase in pharmaceutical spending. Beyond dollars, the astronomical toll inflicted on patient health and safety due to medication errors and noncompliance is estimated at 770,000 injuries, disabilities or deaths for U.S. hospitals annually.

PRODUCT FUNCTIONALITY: RxHub selected Initiate Patient as the high-performance technology to meet its requirements and tackle the complexity of matching and linking more than 150 million records. This implementation would enable RxHub to dynamically link and match - on demand - hundreds of millions of customer records from constantly changing databases, avoiding the substantial costs associated with establishing and maintaining unique keys. Initiate software recognizes patients by name, not numbers, eliminating time spent searching for or entering customer data. Initiate’s algorithms for record linkage create a solid and predictable foundation for patient data integration as well as generate levels of speed and accuracy simply not found in other technology.

STRENGTHS: Initiate Patient’s main strength is the ability to dynamically link and match hundreds of millions of customer records from constantly shifting databases. The Initiate technology plays a large role in helping us achieve RxHub’s mission-critical objectives. One of Initiate Software’s many robust features is its ability to enroll and update records while other transactions are running without interruption. This advanced transaction switching capability is particularly critical during periods of open enrollment, enabling updates to the master person index for potentially millions of records per day with no downtime.

WEAKNESSES: RxHub has yet to scratch the surface of the 3.5 billion prescriptions that are being generated annually. The test will be in its ability to continue to scale.

SELECTION CRITERIA: Initiate outperformed all other vendors with the best matching rate and fastest loading and processing time.

DELIVERABLES: The Initiate solution improved operational capabilities in several areas. The major PBMs feed their membership rosters to RxHub on a daily basis. Through Initiate’s customized process, RxHub loads 50 million records in approximately two hours. The database searches, scores and links records for unique matches in 250 milliseconds (a quarter of a second) per record. During periods of open enrollment, RxHub processes as many as 3 million records per day per PBM in the span of an hour. Response time now averages less than two seconds from initial request until complete information is provided to a physician or certified staff member using the network to securely access prescription benefit information.

VENDOR SUPPORT: Initiate’s team was extremely helpful throughout the process. In particular, they helped us take advantage of the Initiate solution’s flexibility to deliver the type and quality of information we needed to make the program successful. The staff expertise from Initiate Systems, including its chief scientist, Dr. Scott Schumacher, was invaluable in building an optimal solution.