Straight Talk About Direct

Those of us who have spent years arguing in favor of standards based health information exchange (HIE) have just had a few good months. The federal government has asked IT vendors and providers what it can do to advance health information sharing across organizations. This has drawn new attention to “interoperable” health IT systems and the quality and economy of care delivered to Medicare and Medicaid beneficiaries.

In late March, the Office of the National Coordinator for Health IT (ONC) awarded cooperative agreement grants to two non-profit trade groups working to certify and credential electronic health records (EHRs) and health exchange service providers whose products are capable of secure data sharing — that is, of “talking to one another.”  (Disclosure: I am the President and CEO of one of these alliances, DirectTrust.)  The tone of the conversation has definitely changed.

My sense, though, is that most people still don’t have a firm grasp on the issues. They remain uncertain or confused about what interoperable health information exchange really means to providers and patients, how it can be achieved, the barriers that remain to be overcome, and who is making the decisions about these matters. So this seems like a good time for both an update and a refresher of sorts on the nature of health information exchange, and to explain why this is not a good time to reduce spending on health IT in America.

Let’s start with what is probably the most important thing to understand: we are very, very close to national deployment of a relatively simple standard, known as Direct, that enables secure Internet transport of health information between people, organizations, and software. Direct exchange permits users of any EHR to send and receive messages and files from any users ofany other EHRs, regardless of operating system or vendor. In fact, Direct facilitates secure messaging, with attachments, to and from anyone with Internet access. It makes EHRs interoperable with one another, but also facilitates secure communication with providers and patients using Internet devices of almost any kind.

It sounds almost too good to be true, especially since EHRs have become scandalously well known for their inability to exchange information. In mid-April, six Republican Senators issued a report complaining about this, saying in part: “We are seriously concerned that, despite the billions of taxpayer dollars spent (on EHRs) and providers who may be penalized, (Medicare) does not yet seem to have an adequate plan to achieve secure, meaningful interoperability.” Is it possible that, after so many years, this is about to change for the better? Do the feds actually have a plan to achieve secure, meaningful interoperability?

The answer is “Yes,” there is a plan, and it’s about to go fully into effect. Every EHR that is certified for the second stage of the federal Meaningful Use incentive program – this program pays doctors and hospitals to purchase these software systems – must be Direct compliant, and so capable of interoperable health information exchange. Stage 2 starts in early 2014.  The EHR vendors are readying their software now to do Direct exchange. Many are testing their applications, and several have already passed the interoperability tests and received Direct compliant certification.

There is more good news. More complicated health information exchange protocols and standards are in the works that will let clinicians find and query records of patients who have been tested or treated at different health care organizations. New initiatives are underway, including an IT vendor alliance, to solve the problems associated with patient matching, consent, and provider location directories. Together with Direct exchange, these query-based systems for record sharing mean that providers will be able to locate their patients’ other providers, communicate with them directly, and access each other’s electronic storage systems, thus reducing the need to repeat expensive or risky tests and procedures. This ability to reduce cost through better data sharing will be particularly valuable in health systems like ours in the US, where the average Medicare patient sees thirteen or more different providers in any given year, and where the data are typically siloed within each institution.

In the near future, I’ll be blogging about Direct exchange, explaining in greater detail how it works, what providers need to do to assure privacy and security are maintained, and how patients can take advantage of this new interoperability to access and share their health data with whomever they choose. But for right now, I wanted to get the word out:  Direct is coming and could change our health care system and our lives for the better.

David C. Kibbe MD, MBA, is a Family Physician and Senior Advisor to the American Academy of Family Physicians who consults on healthcare professional and consumer technologies.

3 replies »

  1. Sounds like a step in the right direction but how does the patient access their own health information using technologies like Direct?

  2. Thanks for the post. I truly hope Direct takes off as planned. The old idea of a myriad HIEs acting as regional data clearinghouses never made sense to me, and neither did the antiquated EDI standards.

    However, I wouldn’t count any chickens before they hatched. The business model of large EHR vendors depends on high switching costs, while easy data exchange lowers such costs. With real interoperability, what’s to stop clients from migrating all their data to a new system?

    When large EHR vendors seem to embrace and expand interoperability standards, they’re more likely trying to slow down, re-fashion and eventually extinguish the effort. Billions of dollars are at stake for them, and you can bet they won’t give up easily.

Leave a Reply

Your email address will not be published. Required fields are marked *