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Direct Project Should Reach Most US States By Summer

Posted on June 25, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

It’s looking like a victory for the Direct Project, the clinical messaging protocol designed to make information sharing easier for providers. ONC reports that state HIE grantees in almost 30 states are using the Direct Project protocol, with a dozen more planning to kick off Direct within the next month or two.

As many readers may know, providers can send Direct Project messages using traditional e-mail.  Messages are packaged using MIME extensions, protected by S/MIME encryption and signatures.  Messages are authenticated on both ends using X.509 digital signatures.  All told, it’s not only a “direct” way of sharing information, it’s a relatively simple one too.

How are providers using Direct?  Here’s a few examples, courtesy of FierceHealthIT:

  • In Florida, hospitals are using Direct to send newborn hearing screening test results to a state agency, which sends back confirmation of the state-mandated screening tests by the same route.
  • In California, Redwood MedNet, an HIE in northern California, and St. Joseph Health System in Orange County are collaborating on a project to use Direct to improve care coordination for newborns
  • In Guam, the Guam HIE and the Department of Veterans Affairs are employing Direct to refer patients to providers for mammograms and are looking to expand the use of the protocol to all referrals.

Enthusiasm for Direct seems to vary across different parts of the country. For example, none of the northeastern states have gone live on Direct yet, while Wisconsin, Delaware, Arkansas Illinois, California, Florida and West Virginia have already signed up 300 or more providers, FHIT notes.

Don’t know about you folks, but I’m excited by this news. I think we’re seeing the beginnings of some really significant change. Yes, like most of us, I’d like to see full-scale, enterprise-class data sharing, but billions of bucks and years of development lay between us in that goal in many cases.  Let’s appreciate what we’ve got, eh?

HIMSS EHR Association Offers HIE Strategy, World…Yawns?

Posted on June 29, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

In my naivete, I thought the following might be a serious milestone, or at least a thought-provoking read.  Consider the serious tone of this announcement:

The HIMSS Electronic Health Record Association (EHR Association), a collaboration of 46 EHR supplier companies, announced today the availability of a major new white paper “Supporting a Robust Health Information Exchange Strategy with a Pragmatic Transport Framework”.  The focused recommendations in the white paper, aimed at key health IT stakeholders, are based on proven standards and successful health information exchange (HIE) implementations around the world.

Then I took a few spoonfuls of my cereal, drank some coffee and my mind woke up. Oh yes, right, an announcement and a white paper will power the languishing HIE market into action. Right, and President Obama will show up next week and do my laundry.

Honestly, folks, I’m an analyst with health IT background, not a developer or CIO type — so I’m not qualified to say exactly what technologies will work. But I do know posturing when I see it, and that HIMSS press release is rife with quasi-visionary statements. More pointedly, the paper does little more than point to some successful projects and say “See, aren’t they great?”

In any event, I have little confidence in any announcement that proposes to offer the solution, or even the outline of the solution, to any of life’s big problems:  say, the national debt, the struggle for world peace or linking a bunch of fragmented, siloed regional clinical data-sharing projects into a workable whole.

Lest you think I’m a lone cynic, ponder this reaction from an EMR industry insider who preferred to remain anonymous:

“Just about all of this white paper beyond the Direct Project stage is pure B.S. Bits and pieces can be demonstrated at Connectathons, etc. but it will be impossible in the real world to have generalized usefulness with all this overly complicated garbage. It is almost as if the EHRA is conspiring to thwart real interoperability progress.

Look for the push methodologies/capabilities arising out of the initial Direct Project pilots to expand to provide the functionalities this report claims are not possible. This will happen and just supersede all this proposed nonsense because it will simply, incrementally work.”

Now *that* analysis makes tremendous sense to me. If The Direct Project — or other efforts to follow — can foster the growth of sensible data-sharing schemes, we might just get our national HIE. If not, well, don’t look to announcements like these for answers.