John’s Update: Check out the full series of Direct Project blog posts by Julie Maas:
The specialist down the street insists he wants to receive your primary care doctor’s referrals, but only if it’s digital: “Sure, I’ll take your paper file referral sent via fax. But the service will cost an extra $20, to pay the scribe to digitize the record so I can properly incorporate the medical history.”
Does it really sound that far off? Search your feelings, Luke…
Will getting medical treatment using paper records soon be like trying to find somewhere to play that old mix tape you only have on cassette? Sound crazy? Try taking an x-ray film to a modern radiology department, and see if they still have a functioning light box anywhere to look at it. It’s all digital now.
There are, of course, other factors.
Because nobody, and I mean no small company and no large company, wants to be referred to as a data silo anymore.
Direct Exchange is a way of sending and receiving encrypted healthcare data, and certified EHRs must be able to speak it, beginning this year. Adoption of Direct is increasing rapidly, and its secure transfer enables patient engagement as well as interoperability between systems that were previously dubbed silos. Here is a brief overview of where Direct is currently required in the context of MU2 (please refer to certification and attestation requirements directly, for full details):
Certified ambulatory and acute EHRs need to use Direct for Transitions of Care (170.314(b)(1) and (b)(2)). They have to be able to Create a valid CCDA and Transmit it using Direct, and they have to be able to use Direct to Receive, Display, and Incorporate a CCDA. In the proposed MU 2015, the Direct piece may be de-coupled from the CCDA piece and modularized for certification purposes, but the end to end requirement would remain the same.
EHRs or their patient portal partner additionally need to demonstrate during certification that patients can View, Download, and Transmit via Direct their CCDA or a human readable version of it. Yes, you heard correctly, I said patients. As in patient engagement.
So, how does a healthcare provider get Direct?
1. Get a Direct account through your Direct-enabled EHR vendor
One way HIT vendors offer Direct is through a partnership with one or more HISPs (OpenEMR, QRS, Greenway, and others). Others run their own HISPs (Cerner, athenahealth, and others).
2. Get a Direct account through an XD* HISP that’s connected to your EHR
HIT vendors alternatively enable access to Direct through an XD* plug-and-play (mostly) connector. These “HISP-agnostic” EHRs allow healthcare organizations a choice between multiple XD*-capable HISPs when meeting MU2 measures (MEDITECH, Epic, Quadramed, and other EHRs have implemented Direct this way). EMR Direct, MaxMD, Inpriva, and a few other HISPs offer XD* HISP services; not every HISP offers XD* service at this time. Of course, there is a trade-off between this flexibility and the extra legwork required of the practice or hospital in setting up Direct.
3. Get a web-based or email client-based Direct account not tethered to an EHR or Personal Health Record (PHR)
Direct doesn’t have to be integrated into an EHR to transfer information digitally. Non-tethered accounts cannot attest to the sending side of (b)(2) nor the receiving side of (b)(1) on their own, but they can be Direct senders and receivers nonetheless, participating in Transitions of Care or data transfer for other purposes. They may also be used to exchange health data with patients, billing companies, pharmacies, or other healthcare entities who are Direct-enabled. In fact, some very compelling use cases involve systems who may not have their own EHR, but want to receive digital transitions of care—one such example is skilled nursing facilities.
By the way, patients are also an integral part of the Direct ecosystem. Several PHRs are already Direct-enabled, and more are on the way.
So, go digital and get your Direct address, and begin interoperating in the modern age!