Wednesday, May 18, 2011

The US Project Direct Seems To Be Making Some Headway. Keep An Eye on This!

The following appeared a few days ago

A New Path For Health Care

Elizabeth Gardner

Health Data Management Magazine, 05/01/2011

In Minnesota, Hennepin County Medical Center sends immunization records electronically to the state health department's registry, part of a test that will eventually allow all of the state's physicians to both submit that data securely and access complete immunization records on all their patients.

* In Rhode Island, some physicians who use EHRs can automatically upload a finished record to currentcare, the state's health information exchange, with the same keystrokes that saved it to the practice's database.

* In Tennessee, the VA Mountain Home Medical Center outsources its mammograms to local health systems. While almost all Veterans Affairs hospitals outsource their mammograms, Mountain Home is the only one sending its referrals and receiving reports back electronically.

* In New York, Albany Medical Center (AMC) has successfully tested a way to securely exchange electronic referrals and discharge summaries among primary care physicians, specialists, and the hospital, with data that flows seamlessly among systems from four different vendors. "It almost feels like they're all using the same EHR," says Albany's CIO George Hickman. The medical center is now exploring how to put the enhanced communications capability into daily use.

All of these information swaps, and several others now in pilot phases, are propelled by the Direct Project: secure electronic mail designed specifically for health care. The idea-simple to describe, less simple to execute, and potentially transformative-is to make HIPAA-compliant, one-to-one Internet-based communication as easy for providers, and as ubiquitous, as regular e-mail.

Using Direct Project protocols, providers could send clinical messages to one another, regardless of their location or institutional affiliation, without relying on fax machines and sneakernet (i.e., courier service). The information contained in the messages could, when appropriate and correctly formatted, slide directly into an electronic health record, a database, or any other digital receptacle without scanning or transcription.

"We've been toying with this for awhile, but we've been so busy getting EHRs to be something that's clinically usable," Hickman says. "For this to be meaningful, you have to have a critical mass of EHR users in a community. We have that critical mass and [Direct messaging] will be the next thing."

In Hickman's mind, the Albany pilot shows how seamlessly and inexpensively Direct messaging should work if it's executed correctly. "The vendors are the ones who have made the notable investment, because they had to make software changes," he says. "The investment we've made is one we had planned to make already, and it wasn't substantial. It's been mostly just smart people getting together, and doctors showing us what's clinically meaningful to them."


What's a HISP?

The Direct Project has spawned a new acronym: HISP, or health information service provider. A HISP is a switchboard for Direct messages. The switchboard made the telephone a winner for one-to-one communication, while walkie-talkies remain a niche technology, and HISPs may play a similar key role in pushing messages among multiple providers, especially small ones that can't afford the I.T. know-how to maintain their own servers for Direct messaging.

HISPs are often health information exchanges, though they don't have to be. However, Albany Medical Center CIO George Hickman points out that secure messaging is the biggest reliable revenue-generator for HIEs, and he expects most of them to adopt Direct protocols to insure their futures. Ultimately, though, the future may be less localized. "For the sake of the health care dollar, we'd like to see this evolve, and HISPs are scalable to a large geography," he says, observing that e-prescribing is handled almost entirely through a national network, Surescripts.

Check the growing list of HISPs at to see if any of your current business partners are listed in the HIE/HIO category, because they could potentially be your HISP. "You may have a HISP and not know it," says Kevin Larsen, M.D., chief medical information officer for Hennepin County (Minn.) Medical Center, which for its Direct Project pilot is contracting for HISP services from Ability (formerly VisionShare), the same company it uses for direct payments to Medicare.

What's the Story?

Though the Direct Project's objective is for anyone to be able to send any kind of message securely to anyone else, it has to start somewhere.

The Direct Project's starting points (many of them currently in pilot tests) are the specific communications listed below, which participants variously call "user stories" or "use cases."

They were selected because they're required capabilities under federal EHR meaningful use criteria and can't be easily met using existing solutions. The top dozen are:

* Primary care provider refers patient to specialist including summary care record

* Primary care provider refers patient to hospital including summary care record

* Specialist sends summary care information back to referring provider

* Hospital sends discharge information to referring provider

* Laboratory sends lab results to ordering provider

* Transaction sender receives delivery receipt

* Provider sends patient health information to the patient

* Hospital sends patient health information to the patient

* Provider sends a clinical summary of an office visit to the patient

* Hospital sends a clinical summary at discharge to the patient

* Provider sends reminder for preventive or follow-up care to the patient

* Primary care provider sends patient immunization data to public health

Various types of public health and quality reporting make up much of the second and third tier of use cases.

A heap more is found here:

A visit to the web-site and wiki will make it clear that this is a serious effort to get basic health information exchange running in a secure way using government resources and software while allowing the industry to provide and ultimately connect both with this stack and in the end the National Health Information Network.

Another effort that deserves close following!


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