NwHIN, Direct and Connect Provide On-Ramp to Information Superhighway
The Direct Project, a federal healthcare initiative for secure clinical direct messaging, is well on its way to achieving its objective of becoming an on-ramp to the nationwide exchange of health information—the health information superhighway. The Direct Project is part of the Nationwide Health Information Network (NwHIN), a set of standards and policies for exchanging information securely over the internet, coupled with the Connect project, a software application for exchanging information.
Jitin Asnaani, MBA, the coordinator of Standards and Interoperability Framework with ONC, says the Direct Project is "starting to see a number of pilots not only being demonstrated, but also becoming operational as they expand beyond their current geographies."
With more than 200 active participants from more than 50 organizations, the Direct Project has evolved into a community where participants share challenges and lessons learned.
Direct focuses on the technical standards needed to push content from a sender to a recipient in a secure message. For example, a primary care physician (PCP) referring a patient to a specialist can use Direct messaging to provide a clinical summary to the specialist and receive a summary of the consultation.
ONC put together other pieces to catalyze information exchange, says Douglas Fridsma, MD, PhD, director at the Office of Interoperability & Standards at ONC. "The Direct Project is the transport mechanism. Direct is about the transportation elements, and using standardized vocabularies to exchange data," he says.
Pilots are underway in Connecticut, Texas, Missouri, California, Minnesota, Oregon and New York. Several of the initiatives' executives spoke with CMIO to discuss their Direct Project work.
Minneapolis-based ABILITY Network serves as a health information services provider (HISP) which connects HCMC with the MDH. In its role as a HISP (because not all vendors in the Direct Project are designed to deliver HISP capabilities), ABILITY expands the pilot to additional providers as well as some outside of Minnesota, including the Oklahoma Department of Health.
"We focused on utilization and forming public-private partnerships," says Mark Briggs, CEO of ABILITY Network. ABILITY's work with Direct includes creating connection protocols for the exchange of information. "We are looking at ways to drive utilization through secure communications within the Direct community," Briggs says.
"For the first 10 months of the project, we participated in the work group, and one year later through Direct were able to exchange immunization information securely over the internet," he says.
The three initial use cases were PCPs referring patients to specialists, including summary care records; specialists sending summary care information back to the referring provider; and hospitals sending discharge information to providers.
MedAllies' Direct Project is a protocol and standards-based project, says John Blair, MD, CEO. "Direct is focusing our attention on EHRs and transitions of care, including reconciliation and medication lists so that patients have the necessary information before they are transferred off the hospital floor and discharged," he says.
Through its partnerships with vendors such as Allscripts, Epic and Cerner, MedAllies has completed regional activities on patient-centered care and pay-for-performance initiatives. "As this progresses, it can and will be a catalyst for other states, and may eventually be offered nationally," Blair says.
The program provides information and tools for practices to select and implement Direct messaging, including a vendor marketplace of vetted HISPs. The program not only helps practices implement Direct, but also encourages them to define their referral networks and assists the specialists and other providers to adopt Direct as well. RIQI also has established the Rhode Island Trust Community (RITC), a community of verified R.I. providers using Direct messaging.
In addition to the push for adoption for point-to-point communication, several statewide projects leverage Direct to improve information delivery:
Direct messaging is delivering real-time notifications to Primary Care Providers from currentcare, the R.I. Health Information Exchange, when a patient has a hospital encounter.
Direct is transporting data from practice EHRs into current care.
Direct Messaging has been used to exchange information between a practice and hospital emergency department prior to the patient being admitted to the hospital.
"Direct Messaging is a foundational component for helping improve and change healthcare," says Gary Christensen, COO and CIO at RIQI.
The pilot is focused on providing secure transport of health information to members and non-members based on existing referral patterns. It supports a PCP referring a patient to a specialist or hospital, including a summary care record, and addresses a specialist sending summary care information back to the referring physician or a hospital sending discharge information to the provider.
The HIE connects hospitals, federally qualified health clinics, PCPs, specialists, public health professionals and others, says Brian Ahier, president of GHC and operations supervisor for information systems at Mid-Columbia Medical Center in The Dalles, Ore.
"With all of the healthcare reform efforts underway, including accountable care organizations, there is going to be a need for effective health information exchange and an understanding of analytics tools," Ahier says. "HIE efforts are an integral piece to be thinking about for the future, and what needs to be in place for HIEs going forward."
Echoing the goals of the initiative to create on-ramps onto a superhighway to exchange health information, Ahier says NwHIN and Connect are "in the fastlanes, and Direct pilots are the on-ramps for those smaller physician practices who want to get onto the superhighway and begin transmitting data."
As the Direct Project evolves, other geographies will be added and some of the pilots will be expanded into production. Regardless of the location, the goal is secure exchange of health information.
Direct formation & participation
Based on recommendations from the NwHIN Work Group, the Direct Project was launched in March 2010 by the Office of National Coordinator for Health IT (ONC) for a secure, scalable and standards-based method of sending authenticated, encrypted health information to known and trusted recipients over the internet.Jitin Asnaani, MBA, the coordinator of Standards and Interoperability Framework with ONC, says the Direct Project is "starting to see a number of pilots not only being demonstrated, but also becoming operational as they expand beyond their current geographies."
With more than 200 active participants from more than 50 organizations, the Direct Project has evolved into a community where participants share challenges and lessons learned.
Direct focuses on the technical standards needed to push content from a sender to a recipient in a secure message. For example, a primary care physician (PCP) referring a patient to a specialist can use Direct messaging to provide a clinical summary to the specialist and receive a summary of the consultation.
ONC put together other pieces to catalyze information exchange, says Douglas Fridsma, MD, PhD, director at the Office of Interoperability & Standards at ONC. "The Direct Project is the transport mechanism. Direct is about the transportation elements, and using standardized vocabularies to exchange data," he says.
Pilots are underway in Connecticut, Texas, Missouri, California, Minnesota, Oregon and New York. Several of the initiatives' executives spoke with CMIO to discuss their Direct Project work.
Minnesota
Hennepin County Medical Center (HCMC), a Level 1 trauma center in Minneapolis, is sending immunization records to the Minnesota Department of Health (MDH). It is piloting a clinical exchange with the goal to improve care and public health, says James I. Golden, PhD, Minnesota's health IT coordinator.Minneapolis-based ABILITY Network serves as a health information services provider (HISP) which connects HCMC with the MDH. In its role as a HISP (because not all vendors in the Direct Project are designed to deliver HISP capabilities), ABILITY expands the pilot to additional providers as well as some outside of Minnesota, including the Oklahoma Department of Health.
"We focused on utilization and forming public-private partnerships," says Mark Briggs, CEO of ABILITY Network. ABILITY's work with Direct includes creating connection protocols for the exchange of information. "We are looking at ways to drive utilization through secure communications within the Direct community," Briggs says.
"For the first 10 months of the project, we participated in the work group, and one year later through Direct were able to exchange immunization information securely over the internet," he says.
New York
In Hudson Valley, New York, MedAllies operates differently than ABILITY. MedAllies is a HISP, which launched a Direct Project pilot to demonstrate how to deliver clinical information across transitions of care by "pushing" information that supports the physician's existing clinical workflows. MedAllies is implementing the Direct Project infrastructure, including the simple mail transfer protocol backbone, an internet standard used in email transmissions across internet protocol networks, as well as supporting the Cross-Enterprise Document Reliable Interchange standards protocol.The three initial use cases were PCPs referring patients to specialists, including summary care records; specialists sending summary care information back to the referring provider; and hospitals sending discharge information to providers.
MedAllies' Direct Project is a protocol and standards-based project, says John Blair, MD, CEO. "Direct is focusing our attention on EHRs and transitions of care, including reconciliation and medication lists so that patients have the necessary information before they are transferred off the hospital floor and discharged," he says.
Through its partnerships with vendors such as Allscripts, Epic and Cerner, MedAllies has completed regional activities on patient-centered care and pay-for-performance initiatives. "As this progresses, it can and will be a catalyst for other states, and may eventually be offered nationally," Blair says.
Rhode Island
The Rhode Island Quality Institute (RIQI) has launched the Direct Messaging Adoption program through the Rhode Island Regional Extension Center to encourage adoption of Direct throughout the broader community.The program provides information and tools for practices to select and implement Direct messaging, including a vendor marketplace of vetted HISPs. The program not only helps practices implement Direct, but also encourages them to define their referral networks and assists the specialists and other providers to adopt Direct as well. RIQI also has established the Rhode Island Trust Community (RITC), a community of verified R.I. providers using Direct messaging.
In addition to the push for adoption for point-to-point communication, several statewide projects leverage Direct to improve information delivery:
Direct messaging is delivering real-time notifications to Primary Care Providers from currentcare, the R.I. Health Information Exchange, when a patient has a hospital encounter.
Direct is transporting data from practice EHRs into current care.
Direct Messaging has been used to exchange information between a practice and hospital emergency department prior to the patient being admitted to the hospital.
"Direct Messaging is a foundational component for helping improve and change healthcare," says Gary Christensen, COO and CIO at RIQI.
Oregon
Gorge Health Connect (GHC), an HIE service provider in the Columbia River gorge region of Oregon, is working with Medicity and Krysora to launch a Direct pilot.The pilot is focused on providing secure transport of health information to members and non-members based on existing referral patterns. It supports a PCP referring a patient to a specialist or hospital, including a summary care record, and addresses a specialist sending summary care information back to the referring physician or a hospital sending discharge information to the provider.
The HIE connects hospitals, federally qualified health clinics, PCPs, specialists, public health professionals and others, says Brian Ahier, president of GHC and operations supervisor for information systems at Mid-Columbia Medical Center in The Dalles, Ore.
"With all of the healthcare reform efforts underway, including accountable care organizations, there is going to be a need for effective health information exchange and an understanding of analytics tools," Ahier says. "HIE efforts are an integral piece to be thinking about for the future, and what needs to be in place for HIEs going forward."
Echoing the goals of the initiative to create on-ramps onto a superhighway to exchange health information, Ahier says NwHIN and Connect are "in the fastlanes, and Direct pilots are the on-ramps for those smaller physician practices who want to get onto the superhighway and begin transmitting data."
As the Direct Project evolves, other geographies will be added and some of the pilots will be expanded into production. Regardless of the location, the goal is secure exchange of health information.
| Lessons Learned | ||
Douglas Fridsma, MD, PhD, director at the Office of Interoperability & Standards at the Office of the National Coordinator for Health IT “The Direct Project is engaging, and it is a remarkable thing to see the enthusiasm that has developed.” However, Direct is undergoing growing pains. “Moving forward, we need to address other parts of the ecosystem in terms of scalability and what each community has identified in terms of the privacy and security of patient information. One of the challenges is going to be the integration piece. Other pieces, such as certificates that ensure privacy and security, public-private keys encryption are going to be important. As we scale this out, being able to discover someone’s key in the near term and longer term needs to be properly authenticated.” Brian Ahier, president of Gorge Health Connect in Oregon Direct is not an easy process, he says. “The services and protocols are fairly simple, but that doesn’t mean it is easy to implement. You have to make sure you learn from your setbacks and your successes. Also, make sure to establish and maintain a good relationship with your vendors, and identify what everyone’s roles are going to be early in the process.” Gary Christensen, COO and CIO at Rhode Island Quality Institute “The adoption work can be difficult. Getting physician leaders to accept this and step into leadership roles also can be a challenge,” he says. “We need to operationalize things to show that Direct is an open architecture, and we need to have those operational elements in place to identify metric capabilities, and any workflow training that’s needed.” John Blair, CEO, MedAllies Direct is a simple way to connect EHR vendors, Blair says. “It’s very impressive what we have accomplished in connecting to Direct and with the CCD [clinical care document], and how that all occurs on edge systems. It’s not a point-to-point connection, but includes end users, clinician usability, edge systems and e-prescribing.” |
