CIO Forum: Mattison elucidates role of NHIN Direct for HIEs
ORLANDO, Fla.--John E. Mattison, CMIO of Kaiser Permanente Southern California, answered questions about the current role of the Nationwide Health Information Network Direct Project, and how health information exchanges (HIE) could participate, during the town hall portion of the CIO Forum, which is hosted by the College of Healthcare Information Management Executives (CHIME), in conjunction with HIMSS11.
How should HIEs be viewing efforts on Exchange versus Direct?
Mattison: Direct was introduced to fill in a gap of information exchange for a couple of specific use cases, such as smaller providers that could not handle the Nationwide Health Information Network model and point-to-point push communication. In these challenging use cases, there is no doubt that they need to be resolved in a uniform fashion.
There are two ways of solving such use cases: one, a direct way or two, to ensure that there is no white space and all providers belong to a local, regional or state HIE for the exchange of health data.
Currently, we have 40 large exchange programs in the U.S., including state HIEs. The sooner the gap between these established programs and the challenging use cases can be resolved, and the sooner they can stand up on their own, [the] better.
Individual providers will have to decide whether they use Direct as a stepping stone or a comprehensive solution set. By definition at inception, the Direct Project was originally intended to create a secure transport layer via email, eliminating fax machines, and planned to address the trust considerations and the semantic payload considerations later.
I am concerned that it is very difficult to extricate the individual components of the HIE framework, whether it’s the trust, the semantic interoperability, the security or the transport layer. There are so many intricacies of design that is very difficult to extract an individual component in isolation.
There is a lot of repetition occurring with the Direct framework, which may make a lot of sense for those providers who don’t have the opportunity to become part of an HIE in the near future. It’s a difficult challenge, and there doesn’t seem to be a clear-cut solution right now.
Also, the creation of the Direct Project may ultimately confuse the overall goals or roadmap of the Nationwide Health Information Network.
If states are encouraging providers to engage in the Direct Project, is that a proper allocation of funds and efforts, in terms of HIE sustainability?
Mattison: From the perspective of my provider setting, Kaiser Permanente will not be pursuing engagement with the Direct Project. We’re determined and dedicated to make our exchange work for the long haul, along with a number of other very large institutions. We’re hoping and expecting that the white space issues be managed providers that use our model for HIE standards.
In the state of California, the predominant model is the Exchange model, but there are ongoing experiments with Direct as well.
How should HIEs be viewing efforts on Exchange versus Direct?
Mattison: Direct was introduced to fill in a gap of information exchange for a couple of specific use cases, such as smaller providers that could not handle the Nationwide Health Information Network model and point-to-point push communication. In these challenging use cases, there is no doubt that they need to be resolved in a uniform fashion.
There are two ways of solving such use cases: one, a direct way or two, to ensure that there is no white space and all providers belong to a local, regional or state HIE for the exchange of health data.
Currently, we have 40 large exchange programs in the U.S., including state HIEs. The sooner the gap between these established programs and the challenging use cases can be resolved, and the sooner they can stand up on their own, [the] better.
Individual providers will have to decide whether they use Direct as a stepping stone or a comprehensive solution set. By definition at inception, the Direct Project was originally intended to create a secure transport layer via email, eliminating fax machines, and planned to address the trust considerations and the semantic payload considerations later.
I am concerned that it is very difficult to extricate the individual components of the HIE framework, whether it’s the trust, the semantic interoperability, the security or the transport layer. There are so many intricacies of design that is very difficult to extract an individual component in isolation.
There is a lot of repetition occurring with the Direct framework, which may make a lot of sense for those providers who don’t have the opportunity to become part of an HIE in the near future. It’s a difficult challenge, and there doesn’t seem to be a clear-cut solution right now.
Also, the creation of the Direct Project may ultimately confuse the overall goals or roadmap of the Nationwide Health Information Network.
If states are encouraging providers to engage in the Direct Project, is that a proper allocation of funds and efforts, in terms of HIE sustainability?
Mattison: From the perspective of my provider setting, Kaiser Permanente will not be pursuing engagement with the Direct Project. We’re determined and dedicated to make our exchange work for the long haul, along with a number of other very large institutions. We’re hoping and expecting that the white space issues be managed providers that use our model for HIE standards.
In the state of California, the predominant model is the Exchange model, but there are ongoing experiments with Direct as well.