Webinar: Direct projects will have more company soon
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In an overview of the Direct Project and where the national interoperability agenda is going, Arien Malec, coordinator of the Direct Project and of the Standards & Interoperability Framework for the Office of the National Coordinator for Health IT, said he expects 2011 to be a year of Direct Project pilots “rippling” outward toward wide-scale implementation and adoption in 2012.
Currently, there are three live Direct Project pilots, two production systems that are currently implementing the Direct Project as part of their released products and “a whole set” of implementation pilots that are set to go live this month and next, said Malec.
Direct Project implementations to date include examples of communication that supports meaningful use—for example, discharge instructions and clinical summaries to patients, transitioning immunization data to registries and transitioning clinical information, lab information and referrals between providers and other authorized entities in support of patient care.
The Direct Project is designed to provide low-cost, simple messaging, but not to replace other ways information is being exchange electronically, said Malec.
The Hudson Valley Direct Project for care coordination was based on a question: “How do we significantly improve patient care?” said Rich Elmore, vice president of strategic initiatives at Allscripts and leader of the Communication Workgroup for the Direct Project. “Direct is targeted to meet providers where they are today.”
The Hudson Valley Direct Project pilot is under way, targeting care coordination, and Direct can move with providers as they implement EHRs and additional health IT “so that when they have that kind of capability implemented, they can leverage IHE [Integrating the Healthcare Enterprise] profiles of Direct messaging,” Elmore said.
Hudson Valley’s Direct Project uses the specifications for sending referrals and discharge instructions. “The CCD [Continuity of Care Document] is the vehicle for accomplishing that,” said Elmore.
The Hudson Valley system is no different from any other setting in the country, in that there are many different organizations with different EHR systems, he said. “The goal is to find [a way] to allow physicians to, in a timely fashion, send the information necessary for a referral to better assist in coordination of care. It’s not the only tool, but it is way of being able to send that Direct message from one stakeholder to another.”
MedAllies, New York’s state pilot Health Information Service Provider (HISP), plays a hub role and handles message routing among stakeholders, Elmore said. The Hudson Valley Direct Project pushes critical clinical information across EHR systems to support care coordination and transitions of care, consistent with clinicians’ EHR workflows. The project has focused on care transitions when patients are discharged from the hospital back to their primary care physician (PCP); and on a PCP’s consultation request to a specialist, then the clinical consultation from the specialist back to the PCP.
In this second scenario, the PCP sends a message to a specialist using a CCD as a refrerral document, which is picked up by the specialist—all on different EHR platforms, he said. At the conclusion of the consult, the specialist can send that CCD back to the PCP, closing that loop and ensuring that the coordinator for the patient is able to access that patient’s information in a timely manner.
‘Wouldn’t it be great …’
“In Rhode Island, we started with the premise of ‘wouldn’t it be great if doctors routinely shared their records as part of caring for a patient?’ Also, ‘it would be great if doctors knew when patients were discharged from hospitals and automatically would follow up,’ ” said Gary Christensen, chief operating officer and CIO of the Rhode Island Quality Institute (RIQI). “We thought Direct could help in both cases.”
Information exchange between physicians is a three-step process, he said:
1. The PCP exports data from the EHR—in CCD, PDF or other form;
2. He or she composes a Direct Project message;
3. The clinician logs in to the HISP, puts in the message with the attachment, and sends it.
The second use case that RIQI is piloting—exchanging information between an EHR and currentcare, the state’s HIE—is a one-step process but it’s more complex, he said. One reason is that most data are now sitting in doctors’ offices in EHRs. “We must have 65 different platforms and thousands of providers out there. And if you’re going to get out of all of those individual practices into your EHR or HIE through custom interfaces, you’re just not going to get there from here," Christensen said. "It’s beyond the scope that the state can afford to run.”
For the Direct Project-based EHR-HIE exchange, a physician updates the patient’s clinical record, then the EHR, based on an internal trigger, generates a standard c-32 v2.5 CCD, calls a web service provided by the HISP, addresses a message to currentcare, attaches the CCD and sends it.
“None of those steps required the doctor to do anything other than their normal workflow,” Christensen said.
When currentcare receives the message, it uses alogorithms to match that CCD with a known patient, and absorb the data on that CCD into the database. “Our HIE decomposes CCD into individual data elements. New data elements are built into the longitudinal record for that patient, he said.
The Hudson Valley and RIQI Direct pilots will have company soon, according to Malec. “We expect over the course of 2011 to see products that support Direct Project. … We envision a rippling support of Direct Project to occur throughout 2011, leading to universal address and universal transport by 2012,” followed by widespread adoption, said Malec.
Click here for more about Rhode Island's currentcare HIE project.