Direct Project Specifications Achieving Widespread Adoption: Could Positively Impact Care Coordination Soon for Millions of Americans

By Doug Fridsma, ONC

As an internal medicine physician, I know how hard it was to coordinate patient care across diverse healthcare 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 healthcare 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 healthcare 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 healthcare 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.

Specifications and Compliance

Finally, the Direct Project announced the release two specifications and a draft compatibility statement that will help stakeholders create software that can speak with other Direct-enabled products and will help organizations deploy that software. The Direct Project specifications documents help define and shape the wider adoption of Direct Project technology by healthcare stakeholders. The Applicability Statement for Simple Health Transport outlines the core requirements for a system to declare itself a fully qualified and compliant Health Information Service Provider, or HISP. The Direct Project Compatibility Statement (in draft) addresses the universality of Direct Project messaging. It defines the conditions to participate in universal addressing and transport. The XDR and XDM for Direct Messaging Specification defines a specific gateway solution between the core Direct Project specification and senders and receivers who use IHE specifications.

We are finalizing the Direct Project specifications, engaging with the states, organizations and vendors, and coordinating with the IHE profiles to expand the applicability and value of the Direct Project specifications into a wide variety of use cases.

These developments will be discussed in more depth by Arien Malec, Direct Project coordinator, during a Webinar about the Direct Project on March 21 hosted by the National eHealth Collaborative. For more information, and to register for this webinar, please visit http://www.nationalehealth.org/NHIN301.aspx.

This has been an exciting year for the Direct Project, and I am encouraged by the quality and speed with which the Direct Project developed its work products and humbled by the community’s incredible work on the project. The Direct Project was started by ONC, but it has been made successful because of the active engagement and support of the Direct community. It is an excellent example of an open government initiative focusing on a specific challenge and working to resolve that challenge in an open and transparent process. If your organization would like more information on the Direct Project or would like to join the growing list of private, public, and government entities that are integrating Direct into their health IT systems, please visit http://directproject.org.