Up at 5AM: The 5AM Solutions Blog

Here's one way to securely exchange health information

Posted on Thu, Feb 03, 2011 @ 01:18 PM

Yesterday, one of our clients, the Office of the National Coordinator for Health IT (ONC), announced the pilot launch of its newest project, the Direct Project (http://wiki.directproject.org/). The project represents an innovative, simple approach to enabling the exchange of health information.

"This is an important milestone in our journey to achieve secure health information exchange, and it means that health care providers large and small will have an early option for electronic exchange of information supporting their most basic and frequently-needed uses," said Dr. David Blumenthal, the National Coordinator for Health Information Technology. 

The Direct Project brought together public and private organizations to collaborate on defining some specifications to enable health information exchange. ONC’s open-armed approach allowed state and federal agencies, and companies and healthcare providers large and small, to actually work together for, well, the greater good.  Each participant had a stake in the game, and was motivated to see it realized. All of us in health IT know the pain of being able to exchange information on a one-to-one rather than one-to-many basis. We regularly suffer the pain of mapping data from one system to another. As more groups engage in HIE, the multiple-mapping problem is only going to get worse, so we’re all motivated to come to a “good enough” common agreement about how it should be done.

"This is a new approach to public sector leadership, and it works," said Aneesh Chopra, the United States Chief Technology Officer.  "Instead of depending on a traditional top-down approach, stakeholders worked together to develop an open, standardized platform that dramatically lowers costs and barriers to secure health information exchange. The Direct Project is a great example of how government can work as a convener to catalyze new ideas and business models through collaboration."

The two initial pilot programs really will test out whether the Direct specifications will work for information exchange...
  • Minnesota’s Hennepin County Medical Center (HCMC) is using Direct to send immunization records to the Minnesota Department of Health (MDH).
  • The Rhode Island Quality Institute (RIQI) will use Direct in two ways. First, it will use Direct to send patient information from provider to provider. Second, it will use Direct to securely feed clinical information, with patient consent from practice-based EHRs to the state-wide HIE, currentcare. (I have to admit I particularly like this one, as provides a way to connect Direct information with the Nationwide Health Information Network, which 5AM supports.)
And there are several other pilot projects in the works, in Tennessee, New York, Connecticut, Oklahoma, California, and South Texas. Cool stuff.

What is the Direct Project, though? The program’s own language is visionary:

The Direct Project was launched in March 2010 as a part of the Nationwide Health Information Network, to specify a simple, secure, scalable, standards-based way for participants to send authenticated, encrypted health information directly to known, trusted recipients over the Internet in support of Stage 1 Meaningful Use requirements.  Participants include EHR and PHR vendors, medical organizations, systems integrators, integrated delivery networks, federal organizations, state and regional health information organizations, organizations that provide health information exchange capabilities, and health information technology consultants.

Information transfers supported by Direct Project specifications address core needs, including standardized exchange of laboratory results; physician-to-physician transfers of summary patient records; transmission of data from physicians to hospitals for patient admission; transmission of hospital discharge data back to physicians; and transmission of information to public health agencies.  In addition to representing most-needed information transfers for clinicians and hospitals, these information exchange capabilities will also support providers in meeting "meaningful use" objectives established last year by HHS, and will thus support providers in qualifying for Medicare and Medicaid incentive payments in their use of electronic health records.

Lofty goals. But the mechanism to enable this health information exchange really couldn’t be simpler: SMTP, S/MIME, and X.509. The way I like to explain it (and I’m happy to be refuted by those more closely involved with the Direct Project) is that it’s a secure electronic fax (yes, that is an oxymoron). You have an address of the person or entity who should receive info, and you send it to them. I know there are proponents of more sophisticated, presumably more “secure” ways to send info from one person to another, but this group of distinguished and invested collaborators were able to devise a solution by invoking “keep it simple, stupid” methodology. I can’t fault them for that. Their resulting specification/tech stack is simple, secure, scalable, and standards-based - just what they set out for it to be.

Will the Direct Project change the world, by opening up a way to securely exchange health information as easily as sending a fax or an email? Let’s let the pilot projects prove that out. I’m amazed that the “get them all in a room and see what happens” collaboration model actually yielded a simplest workable solution. We can only fret about how hard these issues are for so long. It’s time to do something already – I’m glad to see that happening.

More info on ONC can be found here: http://www.healthit.gov/. Info on the Direct Project can be found here: http://wiki.directproject.org/. And info on ONC’s latest collaboration project, which seeks "volunteers to collaborate on interoperability challenges critical to meeting Meaningful Use objectives for 2011" by TOMORROW, is here. (I’ll write more on that one later).


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