Q&A: Direct, Connect and interoperability at HIMSS11

HIMSS11’s Interoperability Showcase will feature more exhibitors and a larger federal presence than ever before. CMIO recently discussed Direct, Connect and the Nationwide Health Information Network (NHIN) with Doug Fridsma, MD, PhD, director of the Office of Interoperability and Standards at the Office of the National Coordinator for Health IT (ONC) and Arien Malec, ONC’s coordinator of the Direct Project.

The ONC’s presence at HIMSS11’s Interoperability Showcase has expanded to 5,000 square feet of space. Does this reflect a growth in Direct/Connect-based initiatives?
Fridsma: The simple answer is yes. It is a reflection of continued growth of the toolkit or resources that ONC is trying to provide that we hope will enable information to become electronic, to start moving, and then to start to be used for decision support and quality measures. Connect continues to grow, and Direct, which was announced at HIMSS 2010, has had tremendous support in the private sector as well.

What are some of the ONC’s highlights at the HIMSS11 Interoperability Showcase?
Fridsma: This is difficult to answer, as it’s like choosing your favorite child. There are a tremendous number of things that are going on within the Interoperability Showcase. People should be aware of some of the Direct demonstrations. [At HIMSS 2010], Arien and I announced the beginning of this project. At the time, it was essentially a website. Over the course of the last year, it has grown into a number of demonstrations [as well as] announcements of private sector support for Direct specifications.

What are the Direct Project pilots doing?
Fridsma: Certainly, the work of Hennepin County Medical Center [in Minn.] is one to look at. They were the first to demonstrate Direct specifications for exchanging immunization data.

The Virtual Lifetime Electronic Record project also continues to grow. We have had dramatic increases in participation, both with the Social Security Administration and the VA, to use the Nationwide Health Information Network and the Connect tool to help support veterans’ care.

There are also pilots looking at issues of privacy and security—key goals and areas of focus for ONC—looking at patient-centric access. [Pilots are] using the NHIN and trying to figure out how we can provide more granular access control for patients, trying to make patients the center and [with] ways of protecting their privacy. The VA is doing a demonstration around privacy and security for patients.

Population health is [another] critical priority within ONC. If we’re going to get this information flowing, it’s important that we measure the quality improvement and focus on core clinical improvements that we want the technology to enable.

Malec: One thing to highlight is how many of those demonstrations incorporate the individual as part of the workflow. One of the interesting things about Direct is that the transport standard is common, so it’s just as easy to send information to the individual as it is to send it to the clinician or to the immunization registry. Many of the pilots incorporate workflows sending the same information to clinical context and directly to the individual.

Fridsma: Direct has been a great leveler in terms of providing a simple, standardized way of moving information around, and that has opened up new opportunities for people to create innovative solutions that really do include the patient.

Is the ONC Standards and Interoperability Framework working on any initiatives specifically with ACOs in mind?
Fridsma: The fundamentals that we need for ACOs [are] getting data into electrons, figuring how to move that around and coordinate that so that there’s more data accessible, then standardizing that data so that we can take data from one organization and use it in another for quality reporting, patient safety and clinical decision support.

Malec: Medical home is often a key component either of quality improvement and payment reform or as a subcomponent of accountable care organizations (ACOs). A number of booths focus on the medical home and focus on the way data flows both to and from that medical home and between the medical home and the patient.

The challenge of our time is how to take some of the quality improvement that we see in large, fully integrated, fully employed health systems that are all on a common technology and apply those clinical improvements to the rest of the healthcare system that is incredibly heterogeneous, with multiple practices and multiple ownership environments. Information exchange and interoperability, both at a transport level and at a semantic level, are absolutely critical efforts for that: Everything at the Interoperability Showcase is applicable there.