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Direct Project Pilots Announced

Today David Blumenthal, Aneesh Chopra and other government and private sector worthies somehow held a press conference in DC despite the big freeze. It was to announce the first successful use of The Direct Project. Formerly called NHIN Direct, the idea behind The Direct Project is that providers–especially those outside of the large systems that are plugged into the perpetually emerging HIEs, can send secure messages containing patient information to each other and to patients. Imagine you're moving from New York to San Diego–this way your records could be sent securely and electronically essentially as an email attachment from one doc to another. If this works it is, in the Vice-President's words, a Big F–ing Deal; it will mean that doctors and patients can routinely exchange information that today is communicated in one tech CEO's words only by paper aeroplane. So today on THCB we're printing a very detailed article by two of the vendor representatives who've been working behind the scenes to make this happen.

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  1. Regarding the comments above – human bodies also respond to the laws of physics and other natural sciences, and the information age has allowed an explosion of evidence-based guidelines and principles that have become impossible to manage without HIT (in the 60s and 70s, one could actually read a couple of journals and the most current copy of Harrison’s and be up to date) – even evidence about different people’s phenotype of certain liver enzymes resulting in different metabolism of medications; it’s not magic, it’s science. The magic that is currently romanticized comes from the need to manage too much data, and resorting to ‘the sixth sense’ and hunches in diagnostics and therapeutics, merely because there is no reproducible, standardized way to get to the data (symptoms, signs, studies, lab / Xray data). True, it is still impossible to deliver an adequate standard of care given the currently-uncoordinated, non-interoperable HIT framework we have now; we are in transition, admittedly. But once we have all the docs on such a healthcare internet, we will see increasingly sophisticated means of delivering care. HIEs will allow population and cohort studies that will make Framingham look like elementary…there will be associations we won’t expect, such as people who live in certain areas having higher rates of certain diseases or symptoms, and then we can work to find answers. As for the evidence that standardization works, please read Atul Gawande’s book, Checklist Manifesto, quoting his own WHO-sponsored studies.

  2. “it is impossible to deliver the standard of care equitably and consistently in a paper-based system”
    And it is equally impossible to do so in an EMR based system. The problem, as we know, is time. Also, standards that have been created by those with a financial interest in thier widespread use even with no evidence of improved health.
    “the airline industry and other examples prove that safety and reliability records approaching perfection are achievable in complex systems; that means if I really care about patients, which I do, then I will invest much energy in promoting a revamping of the healthcare delivery system towards HIT and standardization.”
    Complete non-sequitor. An analogy (and, in this case, a very poor analogy, as Cory indicates) is not proof.

  3. JS Walker:
    Interesting you should choose the airline industry. Everyone in health care does these days.
    The fact the airline industry is safer is a result of computerization, true. But it is also dealing with a limited number of variables in a system of physics, that is well understood. The science is fairly well worked out.
    that is nothing like medicine where the biologic and physiologic variables are nearly infinite- two people with the same disease may not respond the same way to the same medication – that’s why the airline analogy doesn’t work for medical care.
    BUT -interestingly enough the EMR is one aspect of medicine we can compare to the airline industry. In terms of the mundane tasks of scheduling and showing up at the airport, all those computers have occasionally made it more convenient and just as often made it more painful .Recall your last pleasant experience at the airport.

  4. The comments above noted, I am a rural family physician in full-time clinical practice, and have devoted countless hours to healthcare reform promotion and HIT / HIE promulgation – for these simple reasons:
    1. it is impossible to deliver the standard of care equitably and consistently in a paper-based system;
    2. implementing EMR by itself – without proper integration and interoperability with non-same clinical entities – is potentially a complication more than a help to clinical practice;
    3. the airline industry and other examples prove that safety and reliability records approaching perfection are achievable in complex systems; that means if I really care about patients, which I do, then I will invest much energy in promoting a revamping of the healthcare delivery system towards HIT and standardization.
    And this dream is already coming true. Please give it a chance.

  5. In my pediatric practice I have to wait to get records primarily because the sender has not gotten around to sending them, or the patient didn’t ask (authorize) them to be sent, or our telephone request gets put into the usual queue; all human processes. So, the electronic records may only be as efficent and as speedy as their human handlers.

  6. Peter:
    What does efficient mean in this context.
    If I am in my office and I need a three page summary of a patient’s history and lab, how is a fax that inefficient?
    Exactly what does all this EMR do on a practical level that is that much better?
    What do you lose in information gathering and documenting that you gain in speed?
    So you get vaccination records faster? So you find allergies out immediately?
    From a practical care standpoint where are all these efficiencies?
    I’m asking becauseI don’t understand -and I do work in a doctor’s office.

  7. It’s easy to underestimate the potential positive impact of this system if you’ve never worked in a doctor office.
    Most information exchange b/w independent providers and/or patients is phone/fax/mail.. Not too efficient.

  8. You guys are nuts…the medical care would be much better if the money wasted on this crap: “New York to San Diego–this way your records could be sent securely and electronically essentially as an email attachment from one doc to another. If this works it is, in the Vice-President’s words, a Big F–ing Deal; it will mean that doctors and patients can routinely exchange information that today is communicated in one tech CEO’s words only by paper aeroplane.”;
    wasspent on nurses and training other human resources to take care of patients instead of the “big f’n computer”.
    Get real and stop smokin weed.

  9. Or my records could be mailed in, oh, say a week.
    Less time than it would take to get my new doctor’s appointment.
    And more readable and far less likely to get hacked into.

  10. ” imagine you’re moving from New York to San Diego–this way your records could be sent securely and electronically essentially as an email attachment from one doc to another”
    And that makes you healthier because. . . .?

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