The Direct Project's Progress with Health Information Exchange

Kachina Shaw

During the month of May, IT Business Edge is taking a closer look at the state of health care IT. One approach to the transfer of health information among health information service providers, service providers, health information exchanges (HIEs), government agencies and patients incorporates the three-year-old Direct Project, which has the goal of specifying "a simple, secure, scalable, standards-based way for participants to send authenticated, encrypted health information directly to known, trusted recipients over the Internet."

Andrew Nieto, health IT strategist for DataMotion, a secure data delivery provider and health information service provider (HISP), offering secure data delivery services, explained to me how far along the Direct Project's pilot programs have gotten, and what comes next.

Why is the Direct Project the answer to the sharing of health information and where does it stand in regards to participation and achieving its goals?

"The keys to broader adoption will be seamless integration into the providers' workflow, universal standards for HISP-to-HISP communication, as well as a national provider directory (possibly tied to NPI numbers)."
-- Andrew Nieto, DataMotion Health
IT Strategist

Health care is in the midst of the most aggressive and significant technology ramp-up in human history. It was not uncommon just two years ago for a provider’s office to have a computer only on the biller’s desk; everything else on paper. As this ramp-up has progressed, the technologies which are being most readily adopted are the ones that are familiar. Email has been a familiar technology for more than 20 years. It makes sense, then, that the Direct Project, which is built on email, would be a logical tool to enable the sharing of health information. Combined with advanced encryption and security, the Direct Project has all of the ingredients to be the long-term solution for the exchange of health information. 

The Office of the National Coordinator for Health IT (ONC) made Direct Project capabilities a key requirement for Meaningful Use Stage 2 EHR certification. Participation, it follows, will build upon the workflow of the integrated Direct Project components within the provider's electronic health record (EHR). Coupled with this, the Direct Trust, a non-profit organization dedicated to facilitating standards of communication across health information service providers (HISPs), is making strides toward ensuring vendor neutrality of the message delivery services.

It is important to note that the U.S. Department of Veterans Affairs (VA) is leveraging Direct Messaging as the preferred secure messaging tool for outside referrals. A regional group in KS and NE has also created a Direct Project program for data sharing focused on patient outcomes. There are many such projects actively working and being built on Direct Project tools. The future of health care is in improving health and outcomes and this can only be achieved with the sharing of information. The work today by ONC, EHR vendors, the DirectTrust and HISPs around the country is laying the foundation for ubiquitous adoption and participation.

Which benefits, among convenience, cost savings, simplicity, and speed, are showing the greatest gains in pilot programs? Which do you think will resonate best and bring more participants onboard? 

Ease-of-use and trust in the technology seem to be the greatest drivers of use of the Direct Project. This is due to the simplicity and familiarity of the email-like interface. The greatest gain in pilot programs seems to be requirements of use. The VA external referral requirement for Direct, for example, now requires the referral recipient to receive and communicate findings via Direct. In my opinion, the keys to broader adoption will be seamless integration into the providers’ workflow, universal standards for HISP-to-HISP communication, as well as a national provider directory (possibly tied to National Provider Identifier, or NPI, numbers).

Where are the pain points for health providers and other participants when incorporating Direct Project standards and protocols? 


There is a very low pain point for providers as long as the EHR vendor has made the messaging interface part of the workflow. This is a challenge due to the diversity of EHRs and interfaces available. Providers will also have the challenge of managing multiple direct addresses as health information exchanges (HIEs), health systems and practices all have the option of offering addresses.

What is the Office of the National Coordinator for Health IT doing to help providers make significant progress toward compliance with its EHR criteria? 

Under the HITECH components of the ARRA, providers adopting and using certified EHRs can receive stimulus money. This is commonly referred to as Meaningful Use. This two-step approach to push the building of compliant EHRs for certification and stimulus monies for provider attestation is effectively fueling this rapid technology adoption. In the near future, providers with non-compliant EHRs, or those not willing to attest to Meaningful Use, may see reimbursement penalties. 



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