Getting DIRECTly to the Point: The Role of the Direct Project in Fast-Tracking Health IT Interoperability

 By Rich Elmore and Arien Malec

A patient’s health records are no longer confined to a doctor’s office, shelved inside a dusty file cabinet. With the advent of the Nationwide Health Information Network, a framework of standards, services and policies that allow health practitioners to securely exchange health data, medical records digitized to be easily shared between doctor’s offices, hospitals, benefit providers, government agencies and other health organizations, all across America.

This health information exchange is dramatically enhanced by the Direct Project. Launched in March 2010, the Direct Project was created to enable a simple, direct, secure and scalable way for participants to send authenticated, encrypted health information to known, trusted recipients over the Internet in support of Stage 1 Meaningful Use requirements. The Direct Project has more than 200 participants from over 60 different organizations. These participants include EHR and PHR vendors, medical organizations, systems integrators, integrated delivery networks, federal organizations, state and regional health information organizations, organizations that provide health information exchange capabilities, and health information technology vendors.

On February 1, the Department of Health and Human Services and the White House announced the first live, production uses of Direct for sending medical records securely among providers. Additionally, EHR and PHR vendors announced support for Direct, allowing many types of system-to-system messaging including sending health information to a patient’s PHR or sending a referral to a consulting physician.  These developments are an accelerator to achieving directed health messaging much faster than before predicted, using the Internet!

This month, at the Healthcare Information and Management Systems Society 2011 Conference (HIMSS 11) in Orlando, Fla., eight Direct Project pilots will be demonstrated and discussed. These projects include a collaboration with the Department of Veterans Affairs and a regional health information exchange network known as CareSpark; a demonstration that will explain how the Direct Project technical standards and services are being used to securely transport immunization data in Minnesota; and a project that shows how Albany Medical Center is able to send a closed-loop referral from primary care provider to specialist and back. 

These and additional projects are included below with a brief description of the work.

Care Collaboration: Connecting the Hospital, Physicians, and Patients

Medical Professional Services, Inc. (MPS)

This demonstration uses Direct Project protocols to connect and securely share clinical information among a hospital, patients and a diverse group of MPS physicians who have a heterogeneous set of health IT tools (ranging from e-mail only to fully functional EHRs), in support of Meaningful Use and improved collaboration and continuity of care.  This demonstration will track information as it follows the following flow: a primary care provider refers patient to specialist including summary care record; the specialist sends a response back to the referring provider; and the physician sends summary of care record to the patient.

Consultation, Referral and Result Exchange through Direct Messaging

Department of Veterans Affairs and CareSpark

This demonstration illustrates the feasibility of utilizing the Direct Project constructs to enable secure messaging between a federal agency (Veterans Affairs), and a regional health information exchange network (CareSpark). This demonstration shows the secure, standards-based transmission of a referral for mammography from a VA medical center to a private sector provider clinic, and the reply from the private sector provider clinic with a text-based report. VA and CareSpark are using two Health Information Service Providers (HISPs) based on the Direct Project Reference Implementations (Java and C#) that are publicly available from the Office of the National Coordinator for Health IT (ONC).

Direct Exchange Using Certificate Authority Supporting Medical Home

MedVirginia

This project demonstrates the electronic exchange of clinical information and patient summary record using the Direct Project compliant MEDfx LIFESCAPE provider portal. The demonstration will show the secure exchange of referrals from providers using LIFESCAPE to MedVirginia-based care managers using MEDfx's Medical Home Information System with a patient summary record to support the fulfillment of Stage 1 Meaningful Use criteria.  It will use both the Direct Project protocols and Nationwide Health Information Network/CONNECT for transport, integrated with the Verizon certificate authority and provider registry to define the circle of trust.

Hudson Valley Direct Project Supporting Care Coordination

Albany Medical Center, Asthma and Allergy Associates of Westchester, Community Care Physicians, Institute for Family Health, Scarsdale Medical Group, LLP

MedAllies, a Health Information Service Provider (HISP), has fully engaged clinicians throughout the Hudson Valley and their disparate EHR vendor partners to create a Direct Project that pushes critical clinical information across EHR systems to support care coordination and transitions of care, in a manner that is completely consistent with the clinicians' established EHR workflows. The project has focused on the common care transition episodes of patient discharge from hospital back to their primary care physician (PCP); and a consultation request from a PCP to a specialist, then the clinical consultation from the specialist back to the PCP. 

Immunization Submission

The Direct Project

This demonstration will explain how the Direct Project technical standards and services are being used today to securely transport immunization data from Hennepin County Medical Center to the Minnesota Department of Health. To show the flexibility and possibilities of the Direct Project, an immunization submission workflow will be shown along with an optional ability to easily and securely send a copy of the immunization to a patient's Direct-enabled personal health record.

Traveling Wilburys – Continuous Care DIRECT from Wine Country

HealthBridge

During this demonstration, HealthBridge and Redwood MedNet will show how continuity of care for patients can be enhanced using the Direct platform to share healthcare information between two operational health information exchanges. In this scenario, the Wilburys of Cincinnati go on vacation in the Wine Country of California. When the Wilburys have to visit a health care provider, Direct connectivity allows HealthBridge and Redwood MedNet to exchange health information seamlessly and securely between the treating physician in California and the primary care physician in Cincinnati.

Direct Project and CONNECT Working together In California HIE

Redwood MedNet

This demonstration will highlight the roles of the Direct Project and the CONNECT open source gateway as clinical messaging tools. Redwood MedNet will demonstrate how these solutions work within its operational health information exchange service in Northern California.

Wisconsin HIE Secure Messaging and Directory Services

Wisconsin Statewide Health Information Network (WISHIN), Inc., Wisconsin Health Information Exchange, and Wisconsin Department of Health Services

During this demonstration, participants will learn about Wisconsin's approach for supporting Stage 1 meaningful use HIE requirements using a Health Information Service Provider, the Direct secure messaging solution, and a provider directory developed by the Wisconsin Medical Society; and how Wisconsin's State HIE program, Medicaid, and Regional Extension Center will also use the directory for EHR and HIE adoption tracking, reporting, and outreach.

The Authors

Rich Elmore is the Direct Project Communication Workgroup leader and Vice President, Strategic Initiatives at Allscripts.  Arien Malec is ONC’s Coordinator, Direct Project and Coordinator, S&I Framework.