The following was published overnight.
Tuesday, March 22, 2011
The Direct Project: Accelerating Government Innovation in Health IT
In February 2011, two pilots of a new standard for sending health information securely over the Internet were launched. The pilots -- one in Minnesota and one in Rhode Island -- are the first tests of the Direct Project, an HHS initiative designed to simplify the exchange of information within the health care industry.
The most noteworthy aspect of this initiative is how quickly it happened. These initial pilots are taking place less than a year after the Direct Project was started.
The project represents an unusual experiment in accelerating the creation of the Nationwide Health Information Network. The project has demonstrated how rapidly a "lightweight" open process can yield useful results compared with typical government-sponsored IT development projects.
Development of NHIN began at HHS in 2005. It was intended to provide a robust, comprehensive electronic infrastructure for sharing health-related information among multiple agencies.
The NHIN project grew out of a realization that a great deal of time and effort had been invested in developing standards for the format and structure of medical information (such as the data in health records), but relatively little attention had been paid to how this information could be shared by different parties.
According to Brian Behlendorf -- who served as an adviser to HHS on the Direct Project (and now is the chief technology officer of the World Economic Forum) -- it was as if the creators of the Internet had focused all of their attention on deciding whether HTML or PDF was the best standard for presenting information online but neglected to establish a communications standard like the URL ("uniform resource locater"), the simple address scheme that is the key to allowing information to be easily found anywhere on the World Wide Web.
Development of NHIN was well funded, but it was carried out in a traditional governmental process -- specifications and parameters for the project were carefully defined in advance, a request for proposals was issued and a contractor was selected to carry out the work.
In an effort to increase the usefulness of NHIN, the government decided to use an open-source model for development of the software. This approach did expand participation in the project: an open-source community began to grow around the effort, and several private companies built applications to extend the functionality of NHIN. However, the effort also had significant limitations.
Development was done in Java, an open-source tool that is powerful but relatively difficult to learn. Some parties criticized the effort as being too broad and trying to accomplish too much at one time. Further, actually using NHIN Connect would require a relatively high degree of trust because (much like the Web) information placed in the system would be available to any other party who requested it, an arrangement that was potentially at odds with stringent HIPAA standards designed to protect the privacy of sensitive medical information.
Enter the Direct Project
In response to an HHS advisory panel recommendation, a decision was made in late 2009 to pursue an alternative approach that would be faster and less complicated to implement because it was more limited in scope. This new project, known initially as NHIN Direct, would be more like an e-mail service that allows two parties to directly exchange information between themselves (rather than making it publicly available), which simplified the issue of trust. In addition, the development process for this alternative would be much less structured.
HHS agreed to try using an "organic" process that involved inviting all interested parties to participate. The project leader agreed to serve as the "orchestrator" of an open development process ("air traffic controller"), rather than as a contractor responsible for writing the software. Since funding for the project would end in 2011, the goal was to have a working prototype completed by the end of 2010.
The Direct Project, as it came to be known, was built around:
- A wiki (http://wiki.directproject.org/) that could be accessed and edited by anyone;
- An open code repository (http://code.google.com/p/nhin-d); and
- A blog (http://nhindirect.typepad.com/nhin-direct) maintained by the project leader.
A weekly conference call open to all interested parties was set up to identify issues needing attention and keep everyone informed of the project's progress. Notes from the calls were published on the wiki, where a continuously updated list of current tasks and their status also was available.
When the project was officially launched in March 2010, the expectation was that it would attract perhaps a dozen outside participants. However, within a few months, more than 60 organizations -- including both major software and health care IT companies, as well as much smaller firms -- had gotten involved.
Over the next 11 months, the project progressed from initial discussion of the goals of the project to the development of a model to the creation of a set of prototypes to the launch of the first pilot implementations.
More here and lots of links:
What I hope people do is read here and then go on to the iHealthBeat site and read the rest of the article.
It is really hard to imagine a more different process of attempting to deliver Health IT than this when compared with the pathetic efforts of DoHA and NEHTA.
What this effort has is leadership, governance and purpose - all of which are lacking from the Australian efforts in my view.
What is being done in the US is almost certainly not perfect, but there are so many lessons about how to get things done and how to interact with experts and clinicians what is being done deserves careful study.
Enough said, go read and try and control the fury that reading will induce when you compare there with here! Chalk and cheese.
NEHTA and DoHA do not know what openness, consultation and transparency mean. Even worse they don’t get how important they are!
For those who want to follow up the technical details the following which also appeared overnight will help:
Direct Project Specifications Achieving Widespread Adoption: Could Positively Impact Care Coordination Soon for Millions of Americans
As an internal medicine physician, I know how hard it was to coordinate patient care across diverse health care systems. Primary care providers struggle to keep up with the flow of information coming in and going out of their offices on faxes, couriered documents, and hand carried patient notes. The Direct Project was created to address this problem head-on by creating a simple, secure way to send this information electronically, so that providers can concentrate on what counts: excellent patient care.
Today, The Direct Project announced that over 60 health care and health IT organizations , including many state based and private sector health information exchanges, leading IT vendors, and several leading integrated delivery systems, have planned support for the Direct Project. The broad reach of so many significant national players is helping the project reach its goal of providing health care stakeholders with universal addressing and universal access to secure direct messaging of health information across the U.S. This is quite an accomplishment, given that the Direct Project just started twelve months ago.
This broad swath of support for the Direct Project represents approximately 90% of market share covered by the participating health IT vendors. With over 20 states participating in the project, including many of the largest states in the country, nearly half of the total U.S. population can now benefit from the Direct Project’s growing integration into the national health IT ecosystem. Growing participation with the Direct Project will alleviate a health care system awash in a sea of paper and faxes.
The Office of the National Coordinator for Health Information Technology (ONC) convened the Direct Project to expand the existing specifications incorporated in the Nationwide Health Information Network to be as inclusive as possible for any caregiver regardless of their technology used or the size of the organization. The Direct Project is facilitating “direct” communication patterns, meeting the providers where they are today, with an eye toward approaching more advanced levels of interoperability as they invest in health IT systems.
The result of this groundbreaking public/private collaborative is a set of specifications for simple and directed messages among caregivers and to patients
Widespread Adoption – Up to 160 Million Americans May Soon be Positively Impacted
Many of the country’s largest health IT vendors, most populous states, and robust integrated delivery systems are incorporating Direct Project specifications into their health IT systems. What’s exciting about this growing list of organizations is that over half the country’s population could benefit from the availability of secure, directed health information messaging. The numbers are sure to continue growing in the coming months as more organizations support Direct Project specifications for health information exchange. A complete list of participating organizations, including states, health information exchanges, and health IT vendors, is available on the Direct Project website .
Transport of Coordination of Care Messages
The Direct Project also announced finalization of the Direct Project specifications, including the core Direct Project requirements and a specification which describes how EHRs and other health IT systems can leverage the Direct Project to securely exchange direct messages. Such communication is critical, especially when a primary care doctor in the U.S. on average has to coordinate care with 229 doctors across 117 different practices . The Direct Project helps address the technology interoperability challenge created by needing to coordinate with such a large group of diverse organizations. It does so by fulfilling the promise of a real-time secure electronic transport mechanism for referrals and clinical documentation, integrated into the health care workflows and systems across different settings of care. This has enormous impact on the provider’s ability to keep the patient at the center of care. The Direct Project meets providers where they are today and grows with them as they invest in electronic health records, enabling EHR to EHR direct message transport.
More details here:
Enjoy and reflect how much better this could be managed!