Direct Project Implementations Take Flight

The Direct Project has taken off, with the first-in-the-nation production use of the Direct Project for secure direct clinical messaging. Arien Malec, ONC’s Direct Project Coordinator, announced today that pilots in Minnesota and Rhode Island are now live with the Direct Project:

• VisionShare has enabled Hennepin County Medical Center to send immunization information to the Minnesota Department of Health. Testing of immunization (or syndromic surveillance) communication to a public health agency is a requirement for Meaningful Use incentives.
• Rhode Island Quality Institute has implemented provider-to-provider health information exchange supporting Meaningful Use objectives with Dr. Al Puerini and members of the Rhode Island Primary Care Physicians Corporation.

And innovative and high-value pilot projects in New York, Tennessee and California are scheduled to go live later this month. (Much more information about this below the fold)

Also announced:

• 29 Health IT Vendors now plan to connect using the Direct Project.
• A consensus-approved Direct Project Security Overview and Direct Project Overview Presentation have been published.
• A new look and logo for the Direct Project website ()

Hennepin County Medical Center (HCMC), Minnesota’s premier Level 1 Adult and Pediatric Trauma Center, has been successfully sending immunization records to the Minnesota Department of Health (MDH). "This first-in-the-nation Direct Project for clinical exchange is an important milestone for Minnesota and a key step toward the seamless electronic movement of information to improve care and public health," said James Golden PhD, Minnesota’s State Government HIT Coordinator. Recognizing Minnesota's leadership in delivering high-quality, cost-effective healthcare, U.S. Senator Amy Klobuchar said that “this is the type of innovation that can help strengthen our health care system by reducing waste and improving quality. We need to continue to improve our health care system by continuing to integrate information technology to better serve patients and providers.” VisionShare, a company headquartered in Minneapolis, serves as the health information services provider (HISP) connecting HCMC to the Minnesota Department of Health. In its role as a HISP, VisionShare will expand this pilot project to additional providers and other states, including the Oklahoma State Department of Health, which has already committed to participation in the program.

The Rhode Island Quality Institute (RIQI), the only organization in the nation to be awarded the Health Information Exchange, Regional Extension Center, and Beacon Community grants has delivered a Direct Project pilot project with two primary goals:

  1. To demonstrate simple, direct provider-to-provider data exchange between PCPs and specialists as a key component of Stage 1 Meaningful Use.
  2. To leverage Direct Project messaging as a means to seamlessly feed clinical information from practice-based EHRs to the state-wide HIE, currentcare, integrating patient data across provider settings and during transitions of care

“This recognition shows that Rhode Island continues to be a nationwide leader in improving health care with better information technology," said Senator Sheldon Whitehouse. "Health care providers communicating with each other in a secure and cost-efficient way helps patients get better sooner with less hassle and confusion.”

“The Direct Project is a giant step forward in improving communication between primary care providers, specialists, hospitals, laboratories and health information exchanges”, according to Dr. Albert Puerini Jr., President and CEO at Polaris Medical Management and Rhode Island Primary Care Physicians. “The Direct Project’s ability to seamlessly transmit relevant healthcare information greatly enhances the quality of care that is delivered, while also creating much needed efficiencies within our healthcare system.”

Discussing RIQI’s collaborative approach to health IT, Laura Adams, President and CEO of RIQI said “Direct allows the Quality Institute to be on the cutting edge – providing health information exchange via currentcare, delivering the efficient rollout of technology through the Regional Extension Center, and enabling and measuring real patient outcome improvements in our Beacon Community.” Throughout the Pilot, RIQI has worked with a number of key partners, including Arcadia Solutions (program manager and systems integrator), Inpriva’s Health Information Service Provider solution that supports the security, trust, and Rhode Island-specific consent laws, InterSystems, and Polaris Medical Management’s EpiChart.

Federal Government Perspective

Aneesh Chopra at the Roundtable on Federal Government Engagement in Standards on January 25, 2011 said "I am pleased to report today… the very first Direct specification email message occurred between a county public hospital in Minnesota called Hennepin County and the state Health Department on the issue of a patients immunization record, which is a requirement as part of our meaningful use framework, supported by a commercial vendor called VisionShare". Speaking of the collaborative
nature of the unique public/private collaboration of the Direct Project, he said "This voluntary process has turned this around and in fourteen months [from the time a physician first raised the need to the HIT Standards Committee] the idea is real. And dozens and dozens of vendors will have this service widely deployed across 2011."

On the Runway

Several other Direct Project implementations are scheduled for take-off later this month. New York, Tennessee and California are among the states where Direct Project will be enabling directed health information exchange among a wide variety of participants. And later this year, look for Connecticut and Texas to join their ranks.

New York

MedAllies, a Health Information Service Provider (HISP), will launch a Direct Project pilot to demonstrate the delivery of critical clinical information across transition of care settings in a “push” fashion that supports existing clinical workflows in the Hudson Valley of New York. MedAllies will implement the full Direct Project infrastructure, including both the required SMTP backbone, as well as support for the XDR elective protocol. MedAllies is working with many stakeholders, including EHR vendors Allscripts, eClinicalWorks, Epic, Greenway, NextGen and Siemens, and clinicians in both ambulatory and hospital settings.

The three initial use cases include:

Technical integration with leading EHR and Hospital Information System vendors is underway with pilot exchange alpha sites beginning to go live in Q1 2011.


In this project, CareSpark, a non-profit regional health information exchange supported by the Tennessee State HIE, and the U.S. Department of Veterans Affairs (VA) seek to demonstrate Direct Project-based health information exchange between a federal agency and providers in a private-sector HIE. The main focus will be on facilitating an improved process for exchanging referrals and consultation reports between VA providers and private-sector providers in east Tennessee and southwest Virginia. It will demonstrate two Direct Project user stories: Primary care referral to specialist and Specialist sends summary care information back to referring provider. Text-based mammography interpretation reports will be exchanged utilizing source code made available from the Direct Project workgroups. The project scope will also demonstrate the routing of mammography referrals from the VA to the private sector provider. It is also the intent of the participants that this project once fully vetted could be expanded to additional VA sites. The pilot will exchange information between two different Health Information Service Providers (HISPs) – the VA and CareSpark, respectively.


Redwood MedNet provides health information exchange services in rural Northern California. The Redwood MedNet Direct Project pilot has one goal: to deploy directed secure messaging for production data delivery in support of meaningful use measures. Three meaningful use messaging patterns are in development.

  1. Receipt of Structured Lab Results
  2. Immunization Reporting
  3. Sharing Patient Care Summaries Across Unaffiliated Organizations (including both referral to a specialist and discharge summary to a patient centered medical home)

The project will establish a standards-based way for participants to send authenticated, encrypted health information directly to known, trusted recipients. As an HIE in a rural area, participants in the Redwood MedNet directed messaging project will include small practices, community clinics and small hospitals, as well as the State immunization registry. The discharge summary may also incorporate use of a patient controlled health record (PCHR).


Medical Professional Services (MPS) is a clinically-integrated, multi-specialty IPA in Connecticut with approximately 400 physician members. Along with several partners, MPS is working to demonstrate successful exchange of laboratory results back to the ordering provider and exchange of referral information and summary care information between providers, a local hospital (Middlesex) and a multi-site FQHC (Community Health Center, Inc.). Electronic exchange of data is a challenge in this setting because of the diversity of MPS physician practices, EHRs and HIT tools in place. The goal set for this pilot is to enable MPS physicians to receive lab results back from Middlesex Hospital and Quest Diagnostics, to exchange referrals with Middlesex Hospital, and to exchange referrals and summary care information among MPS primary care and specialty physicians. Results and referral information will be exposed through MedPlus, eClinicalWorks, Covisint, or through a secured e-mail client. In addition, physicians will have the ability to securely send lab results and care summaries to their patients via Microsoft’s HealthVault Messaging Center.


A broad set of stakeholders in South Texas are planning to use Direct to improve the health status of persons in South Texas with diabetes, including gestational diabetes. Participants come from the medical community (CHRISTUS Health, the Health Information Network of South Texas, the Driscoll Children’s Health Plan, Corpus Christi Medical Center, Public Health Department, Nueces County Medical Society), community-based social service organizations, colleges, and employers (the Coastal Bend Diabetes Community Collaborative, The Salvation Army, the United Way, and others). The main goal for this project is to connect the OB-GYNs, pediatricians, hospitals, and the State of Texas’ Newborn registry so they can share information (referrals, lab results, discharge summaries) in real time with their care teams to improve patient outcomes. Additionally, the project participants hope to
provide patients with better information so that they may better manage their chronic diseases. This will be accomplished using Direct by enabling the following use cases:

  1. Physician to physician referral
  2. Physician to hospital referral
  3. Hospital to physician lab results reporting
  4. Hospital or physician to state newborn registry

What is the Direct Project?

Today, direct communication of health information from a care provider to another healthcare stakeholder is most often achieved by sending paper through the mail or via fax. ONC’s Direct Project (formerly NHIN Direct) benefits providers and patients by improving the direct transport of structured and unstructured health information, making it secure, fast, inexpensive and, for some applications, interoperable. Using Direct Project addresses, a care provider can send and receive important clinical information, connecting to other healthcare stakeholders across the country.

Rich Elmore is the Direct Project Communication Workgroup leader and is a  VP at Allscripts. Paul Tuten is the Direct Project Implementation Geographies Workgroup Leader and is  VP at VisionShare

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2 replies »

  1. Extremely exciting and promising work…thank you for sharing and summarizing. A very important, strategic step in the formation of a true health care internet. Thank you to all who have worked so hard to make this dream now real. I look forward to seeing better patient care outcomes from being able to access the patient’s information at the point of care.