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EMR Vendors Struggle With Meaningful Use Stage 2

Posted on October 29, 2013 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.

CCHIT head Alisa Ray, clearly, is trying to put it delicately. EMR vendors are “struggling a little bit” when it comes to meeting 2014 criteria. “It  has been a slow start,” Ray told Healthcare IT News.

Usually, hearing this would lead to an inside baseball discussion of vendor operations, which wouldn’t be very exciting. But the thing is, meeting 2014 certification criteria is necessary to allow providers to meet Meaningful Use Stage 2. So vendor struggles in complying with CCHIT’s criteria should concern providers a great deal.

There are three areas of Stage 2 that are proving to be an issue for vendors: clinical quality measures, interoperability and automated measure calculation for reporting metrics, Ray said.

This has led to a real lag in certifications. About 40 companies had listed products with the CCHIT in 2011, but a scant 21 percent of those have stepped up and gotten certified in the 2014 criteria.

According to Ray’s chat with Healthcare IT News, “almost everyone has struggled and been surprised by the complexities” of meeting 2014 standards.  Despite having gone through the process yearly since 2006 with CCHIT, several have had to go through repeated certification trials to meet criteria.

ICSA Labs’ Amit Trivedi, meanwhile, noted that while there were close to 3,000 listings, with many having multiple listings — Cerner alone had 800 — so far there less than 300 on ONC’s Certified Health IT Products list.

There are signs that EMR vendors will catch up, the HIT story suggests. For example, vendors have been working particularly hard to offer Continuity of Care Documents or Direct messaging, a capability providers must demonstrate for Meaningful  Use Stage 2, said Matt Kohler, vice president of Network Infrastructure Services at Surescripts.

But vendors clearly have some serious development challenges ahead if they want to keep up with the pace set by Meaningful Use Stage 2.  If I were a provider reading this, I’d call my vendor right away and see where they were at in the certification process.

Eyes Wide Shut – Managing Multi-EMR Meaningful Use Stage 2 Is Hard

Posted on October 2, 2013 I Written By

Mandi Bishop is a healthcare IT consultant and a hardcore data geek with a Master's in English and a passion for big data analytics, who fell in love with her PCjr at 9 when she learned to program in BASIC. Individual accountability zealot, patient engagement advocate, innovation lover and ceaseless dreamer. Relentless in pursuit of answers to the question: "How do we GET there from here?" More byte-sized commentary on Twitter: @MandiBPro.

Most discussions on Meaningful Use (MU) seem to focus on a single healthcare provider organization (acute or ambulatory), with a single EMR, and a single Medical Record Number (MRN) pool generating unique patient identifiers. Even in that context, the complaints of the difficulties of successfully implementing the technology and obtaining the objectives are deafening. How daunting might those challenges seem, multiplied across a large integrated delivery network (IDN), attempting to make enterprise-wide technology and operational process decisions, in alignment with MU incentive objectives?

Imagine you are an IDN with 9 hospital facilities, sharing a single EMR. You also have 67 ambulatory practices, with 7 additional EMRs. You’ve made the progressive choice to implement a private health information exchange (HIE) to make clinical summary data available throughout the IDN, creating a patient-centric environment conducive to improved care coordination. To properly engage patients across the IDN and give them the best user experience possible, you’ve purchased an enterprise portal product that is not tethered to an EMR, and instead sources from the HIE. And because you’ve factored the MU incentive dollars into the budget which enabled these purchasing decisions, there is no choice but to achieve the core and select menu measures for 2014.

It is now October 2013. The first quarter you’ve chosen to gather Stage 2 attestation data starts on April 1, 2014. All your technology and process changes must be ready by the data capture start date, in order to have the best opportunity to achieve the objectives. Once data capture begins, you have 90 days to “check the box” for each MU measure.

Tech check: are all the EMRs in your IDN considered Certified Electronic Health Records Technology (CEHRT) for the 2014 measures?

Your acute EMR is currently 2 versions behind the newly-released MU 2014-certified version; it is scheduled to complete the upgrade in November 2013. Your highest-volume ambulatory EMR is also 2 versions behind the 2014-certified version, and it cannot be upgraded until March 2014 due to vendor resource constraints. Your cardiology EMR cannot be upgraded until June due to significant workflow differences between versions, impacting those providers still completing Stage 1 attestation. One of your EMRs cannot give you a certification date for its 2014 edition, and cannot provide an implementation date for the certified version. The enterprise portal product has been 2014-certified as a modular EMR, but the upgrade to the certified version is not available until February 2014.

Clearly, your timeline to successfully test and implement the multitude of EMR upgrades required prior to your attestation date is at risk.

Each EMR might be certified, but will it be able to meet the measures out of the box?

Once upgraded to the 2014 version, your acute EMR must generate Summary of Care C-CDA documents and transmit them to an external provider, via the Direct transfer protocol. Your ambulatory EMRs must generate Transition of Care C-CDA documents and use the same Direct protocol to transmit. But did you purchase the Direct module when you signed your EMR contract, or maintenance agreement?

Did you check to see whether the Direct module that has been certified with the EMR is also an accredited member of DirectTrust?

Did you know that some EMRs have Direct modules that can ONLY transmit data to DirectTrust-accredited modules?

You determine your acute EMR will only send to EMRs with DirectTrust-accredited modules, and that you only have a single ambulatory EMR meeting this criteria. That ambulatory EMR is not the primary target for post-acute care referral.

You have no control over the EMRs of providers outside the IDN, who represent more than 20% of your specialist referrals.

Your 10% electronic submission of Summary of Care C-CDA documents via Direct protocol measure is at risk.

Is your organization prepared to manage the changes required to support the 2014 measures?

This is a triple-legged stool consideration: people, process, and technology must all align for change to be effective. To identify the process changes required, and the people needed to support those processes, you must understand the technology that will be driving this change. Of all the EMRs in your organization, only 2 have provided product specifications, release notes, and user guides for their 2014-certified editions.

Requests for documentation about UI, data, or workflow changes in the 2014 versions are met with vague responses, “We will ask product management and get back to you on that.” Without information on the workflow changes, you cannot identify process changes. Without process change recognition, you cannot properly identify people required to execute the processes. You are left completely in the dark until such time as the vendors see fit to release not only the product, but the documentation supporting the product.

Clearly, your enterprise program for Meaningful Use Stage 2 health IT implementation and adoption is at risk.

What is the likelihood that your Meaningful Use Stage 2 attestation will be a successful endeavor for the enterprise?

As a program manager, I would put this effort in flaming red status, due to the multitude of risks and external dependencies over which the IDN organization has zero control. I’d apply that same stoplight scorecard rating to the MU Stage 2 initiative. There is simply too much risk and too many variables outside the provider’s control to execute this plan effectively, without incurring negative impacts to patient care.

The ONC never said Meaningful Use would be easy, but does it have to be this hard?

Eyes Wide Shut – Is This Meaningful Use?

Posted on September 25, 2013 I Written By

Mandi Bishop is a healthcare IT consultant and a hardcore data geek with a Master's in English and a passion for big data analytics, who fell in love with her PCjr at 9 when she learned to program in BASIC. Individual accountability zealot, patient engagement advocate, innovation lover and ceaseless dreamer. Relentless in pursuit of answers to the question: "How do we GET there from here?" More byte-sized commentary on Twitter: @MandiBPro.

Again and again, I find myself expounding upon the need to differentiate between the “letter of the law” and the “spirit of the law” of Meaningful Use Stage 2. I believe whole-heartedly in the transformative power of health IT, and support the future vision of the Meaningful Use objectives of patient empowerment and nationwide standards for records transmission and interoperability. The spirit of the “law” is a revolutionary movement towards a technology-enabled, patient-centric healthcare system, where clinical data can be shared and consumed instantly, whenever patient desires or requires it.

The letter of the “law” is daunting, and its implementation could be seen as not only counter-revolutionary, but detrimental to the very patient population it is designed to engage and empower.

Consider this acute care scenario:

You’re a hospital healthcare provider, discharging a patient, in compliance with the patient-specific education and Summary of Care measures. You log in to your EMR, complete the discharge instructions in the correlated workflow, print the discharge summary and any condition-specific educational information for the patient, revisit their room to insure that they can review the instructions and ask any questions, and you’re on to assessing the condition of the next patient in need of care. Right?

How many times did you have to close the “patient-specific education” suggestion windows that popped up, alerting you to available materials for download, keyed off diagnosis codes or lab results?

How many minutes did you spend looking for the HISP address of the patient’s cardiologist, so you could transmit the Summary of Care document to them via the Direct module of your EMR? How many clicks did you have to use to FIND the Direct module in your EMR? And how many minutes did you spend cursing the ONC for requiring Direct for Summary of Care transmission for 10% of your discharged patient population when the cardiologist’s address was rejected by the Direct module, giving you a message that the receiver is not DirectTrust-accredited?

How much time did the discharge process take you before your facility decided to attest to Meaningful Use Stage 2? How much time does it take you now?
Consider this ambulatory care scenario:

You’re support staff for a general practitioner, who is deploying a patient portal in support of patient engagement measures. At check-in (or check-out), you provide the patients with the URL for enrollment and access, give them information on the benefits of having their medical records available electronically, encourage them to communicate electronically with their provider with questions or concerns, and you send them on their empowered and engaged way.

How many minutes did you spend validating each portal account owner’s identity once their enrollment request came? How many minutes did you spend validating the relationship of the portal account owner to each of the patients he/she requests to associate with the account? How did you document the due diligence done to insure no medical records are improperly released per HIPAA and other federal guidelines, as in the case of custodial disputes, behavioral health patients, or emancipated minors?

How many minutes did you spend walking patients through the enrollment, login, medical records view, and secure message functions? How much time did you spend answering questions from patients about the portal, rather than the health concerns that prompted the visit?

How much time did the check-out process take before your GP decided to attest to Meaningful Use Stage 2? How much time does it take you now?

In both of these scenarios, did you or the patient see any measurable difference in care as a result of the EMR’s new functionality?

Now, consider the aggregate of these scenarios over an entire day – dozens of encounters, dozens of clicks, dozens of minutes spent engaging the EMR to record requisite “clicks” for attestation numerator reporting, rather than engaging the patient.

Is this meaningful use of a healthcare provider’s time and energy? Is this meaningful use of health IT, meeting very specific targets to obtain finite objectives rather than enabling innovation and deriving best practice long-term solutions?

Is this what the ONC intended?

Health IT Tweet Roundup – Neil Versel Edition

Posted on July 21, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

As you know, each weekend I like to do a roundup of interesting tweets and add a bit of commentary. This time I thought it would be fun to grab some tweets from just one person, Neil Versel. Neil has been doing a number of really great posts on his blog Meaningful Health IT News lately (Full Disclosure: Neil’s blog is part of the Healthcare Scene blog network). The following tweets highlight some of Neil’s recent blog posts.


I agree that Blue Button Plus is a great step forward for Blue Button. This post is particularly interesting because Neil didn’t see the promise of Blue Button before the changes were made and it was called plus.


This is a great discussion on the meaningful use requirements and Blue Button’s role in them. Join in if you have some knowledge on the area about what your EHR is doing.


Neil’s right about people who don’t cover healthcare regularly not understanding many of the true dynamics at play. I do find it interesting that Neil is such a fan of clinical decision support. I still think it’s in such an infant state. I can’t wait for much more advanced clinical decision support.

Cerner Supports Blue Button +

Posted on July 5, 2013 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.

Cerner has announced plans to support and participate in the Blue Button + initiative, marking a small step towards freer sharing of patient health information by its clients.

Blue Button +, launched as the Automate Blue Button Plus Initiative, is the next generation version of the Blue Button technology for consumer download of health information. This next gen Blue Button is intended to provide a blueprint for better-structured and secure transmission of personal health data.

What this announcement means in practical terms, according to an entry in Cerner’s blog, is that the EMR giant will make it possible for its Cerner Direct clients to securely zap information to any personal health record participating in Blue Button +.  Cerner Direct users will also be able to send automated reminders to people managing specific health conditions or who need age/gender-specific check-ups, plus send out summaries of care and instructions following a health visit.

Cerner Direct, as readers probably guessed, uses standards drawn from the Direct Project, a set of standards and documentation allowing providers to push data from one point to another. Cerner has obtained accreditation from the Direct Trusted Agent Accreditation Program offered by DirectTrust and the Electronic Healthcare Network Accreditation Commission.

And why is Cerner taking this step? “The primary goal we have for our clients is to help create a trusted, reliable group of participants with which to securely exchange health care information using Direct protocols over the open internet, helping them reduce their liabilities by creating an efficient, secure method of communication based on best practices,” writes Andy Heeren of Cerner.

This sounds like a reasonable move toward greater data interoperability, if not an earthshaking one. It will be interesting to see where Cerner takes this.

The Path to Healthcare Interoperability Standards

Posted on June 24, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve been thinking a lot about the issues associated with healthcare interoperability. One of the biggest excuses/problems out there is the idea of interoperability standards. Healthcare certainly has plenty of interoperability standards, but adoption and implementation of the actual standards has been the major issue.

I do think that meaningful use and EHR certification is making some difference in regards to standards. I think that Direct Project is likely going to become a pretty solid standard for exchanging some healthcare documents. However, it’s limited in it’s scope.

Instead, I think we’re going to see a different path to healthcare interoperability. It’s going to be led by a few prominent organizations that start sharing info. Once those organizations start sharing data, whatever standard they use will start to spread and will become the standard for interoperability in healthcare.

Which organization or group of organizations will be the ones that break out and establish the standard? I still think the jury is out on that one, but a couple prime candidates are: CommonWell and Healtheway.

I’d love to hear if you see another path to healthcare interoperability or other initiatives that could break through and be successful.

What Would ONC’s Dr. Doug Fridsma Do? (THIS Geek Girl’s Guide to HIMSS)

Posted on March 2, 2013 I Written By

Mandi Bishop is a healthcare IT consultant and a hardcore data geek with a Master's in English and a passion for big data analytics, who fell in love with her PCjr at 9 when she learned to program in BASIC. Individual accountability zealot, patient engagement advocate, innovation lover and ceaseless dreamer. Relentless in pursuit of answers to the question: "How do we GET there from here?" More byte-sized commentary on Twitter: @MandiBPro.

I know you’ve all been wondering how I’m planning to spend my mad crazy week at HIMSS in New Orleans. Well, maybe not ALL of you, but perhaps at least one – who is most likely my blog boss, the master John Lynn. Given the array of exciting developments in healthcare IT across the spectrum, from mobile and telehealth to wearable vital sign monitoring devices, EMR consolidation to cloud-based analytics platforms, it’s been extraordinarily difficult to keep myself from acting like Dori in “Finding Nemo”: “Oooooh! Shiny!” I’ve had to remind myself daily that I will have an opportunity to play with everything that catches my eye, but that I am only qualified to write and speak intelligently on my particular areas of expertise. And so, I’m proud to say I’ve finally solidified my agenda for the entire week, and I cannot WAIT to go ubergeek fan girl on so many industry luminaries and fascinating up-and-comers making great strides towards interoperability, deriving the “meaning” in “Meaningful Use” from clinical data, and leveraging the power of big data analytics to improve quality of patient experience and outcomes.

On Sunday, I’m setting the stage for the rest of the week with a sit-down with ONC’s Director of Standards and Interoperability and Acting Chief Scientist, Dr. Doug Fridsma. His groundbreaking work in interoperability spans multiple initiatives, including: the Nationwide Health Information Network (NwHIN) and the CONNECT project, as well as the Federal Health Architecture. For insight into his passion for transforming the healthcare system through health IT, check out his blog: From The Desk of the Chief Science Officer.

Through the rest of the week, I aspire to see the world through Dr. Fridsma’s eyes, focusing on how each of the organizations and individuals contribute to the standards-based processes and policies that form the foundation for actionable analytics – and improved health. I’ve selected interviews with key visionaries from companies large and small, who I feel are representative of positive forward movement:

Health Care DataWorks piques my interest as an up-and-comer to watch, empowering healthcare systems to improve outcomes and reduce medical costs by providing accelerated EDW design and implementation, whether on-premise or via SaaS solution. Embedded industry analytics models supporting alternative network models, population-based payment models, and value-based purchasing allow for rapid realization of positive ROI.

Emdeon, is the single largest clinical, financial, and administrative network, connecting over 400,000 providers and executing more than seven billion health exchanges annually. And if that’s not enough to attract keen attention, they recently announced a partnership with Atigeo to provide intelligent analytics solutions with Emdeon’s PETABYTES of data.

Serving an area near and dear to my heart, Clinovations provides healthcare management consulting services to stakeholders at each link in the chain, from providers to payers and supporting trading partners – in areas from EMR implementation (and requisite clinical data standards) to market and vendor assessments, and data management activities throughout. With the dearth in qualified SME resources in the clinical data field, I look forward to learning about how Clinovations plans to manage their growth and retain key talent.

Who doesn’t love a great legacy decommissioning story? Mediquant proports adopting their DataArk product can result in an 80% reduction in legacy system costs through increased interoperability across disparate source systems and consolidated access. The “active archiving” solution allows for a centralized repository and consolidated accounting functions out of legacy data without continuing to operate (and support) the legacy system. Longitudinal clinical records? Yes, please!

Those are just a few on my must-see list, and I think Dr. Doug Fridsma would be proud of their vision, and find alignment to his ONC program goals. But will he be proud of their execution?

Can’t wait to find out, on the exhibit hall floor – and in the hallway conversations, and the client case study sessions, and the general scuttlebutt – at HIMSS!

Most Promising Health Data Exchange Project: Direct Project

Posted on August 7, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The most promising healthcare data exchange I see coming is the Direct Project. Sure, it’s not the nirvana of health information exchange, but it’s a really reasonable step in the right direction. Plus, it’s something that’s feasible and achievable.

Aaron Stranahan wrote a great post on the ICA HITme blog which talks about a key characteristic of the Direct Project.

Earlier I mentioned that whitelists were only half the story. Rather than create a whitelist as a list of addresses, Direct focuses on which third parties (or CA’s) an organization trusts to vouch for addresses. In this way, a “circle of trust” can be created without the administrative overhead of listing out every address unless an organization really wants to. Instead, each organization exchanging Direct messages can decide for itself with which entities, and by extension the processes they represent, they’ll interact.

As you may have guessed, building a whitelist of CA’s involves key exchange. In this case, your Direct service provider, aka “HISP,” will collect the public key, for whichever third parties you trust, to sign off on messages you will receive. In the world of Direct, these public keys are called “Trust Anchors” as a nod to the idea of the circle of trust these third parties represent.

So, that’s it- Direct is about whitelists, but with a twist that simultaneously reduces administrative burden and ensures that messages are encrypted following best practices. It’s a whitelist on steroids! Next time someone asks why they can’t send a Direct “email” message to their gmail account you’ll know it’s because gmail isn’t in your organization’s circle of trust.

One of the biggest challenges to any HIE program is knowing who everyone is and in whom you trust. I love the way Direct Project is approaching this “Trust Circle.” It’s reasonable and is a major reason why I believe that Direct Project will be a major success. I’ll be glad once every EHR vendor supports the Direct Project.

ONC is More Focused on HIE than EMR

Posted on July 3, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I can’t remember where I heard or read this, but I remember that when I did it stuck with me and I knew I had to write about it. Here’s the comment someone made (sorry I can’t attribute it properly):

Frankly, ONC is more focused on info exchange than EMR in the long run.

That’s a pretty strong statement, and one I really can’t argue against. In fact, if ONC didn’t have $36 billion out there hanging on the terms meaningful use of a certified EHR, they’d probably be doing even more with HIE and less with EHR.

I think ONC should actually be applauded for many of the health information exchange initiatives that it’s been pushing forward. I think that the Direct Project (which I broadly include in health information exchange) is one of the most exciting things in healthcare exchange right now and ONC should take a lot of credit for making it happen. I’m still waiting for my friends who happen to be physicians to talk to me about using direct project. Then, I’ll know it’s really gone mainstream, but I think it shows such promise that one day they will be telling me about it.

Yes, as most of you know, I still somewhat begrudgingly wish that the EHR incentive money would have gone towards exchange of healthcare information instead of EHR. It would have incentivized something that doesn’t have natural physician incentives to adopt. Plus, an EHR would have been essential to really exchanging information if the “healthcare data exchange stimulus” money was executed properly. Then, market dynamics would determine EHR adoption to a much larger extent. Water under a bridge it seems, but maybe someone at ONC could scrape some money together to prove me wrong.

With all of that said, I think ONC wants the healthcare information flowing. They see EHR as a step towards that end, but that’s the end goal. We’ll just see if they have the tools and resources needed to see it through a midst all the other healthcare IT distractions.

Meaningful Use Stage 2 and HIE Transport – Meaningful Use Monday

Posted on March 19, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ll admit that I’m far from an expert on all the various HIE transport standards and movement happening in making health information exchange a reality in healthcare. However, meaningful use stage 2 is a big step towards getting doctors to exchange information. So, I’ll leverage some experts comments on HIE in meaningful use stage 2 to hopefully get the conversation started. Then, I’m sure some other HIE standards geeks will join in the comments to help us all further understand what’s happening.

John Moehrke has some of the best information I’ve seen for those interested in HIE and meaningful use stage 2. In one post he described his initial “fantastic” impressions of meaningful use stage 2 in regards to security privacy and HIE transport. Here’s the section on HIE transport:

HIE Transport:They have given us one or two Push style transports, and recognized that they interoperate by way of a proxy service that can convert forward and backward. There is no real surprises here as ONC has spent much time developing the Direct Project. Healthcare Providers and EHR developers should really be focusing beyond Direct, but supporting minimal Direct is a good thing to do. It allows us as an industry to move away from the FAX, and start universally communicating and manipulating Documents. I will note that these more Exchange like HIE models would still be considered compliant under the optional third transport.

I think he’s dead on that the majority of providers are going to get to know Direct really well in order to meet the meaningful use stage 2 requirements. In another more detailed post on the various HIE transport options including 3 options within the Direct Project: Full Service HISP, email integration, and integrated into the EHR.

John Moehrke has 3 great images I’ve embedded below which illustrate the above 3 models:

In the Full Service HISP, the user uploads the health information to a web portal or possibly emails the information to the HISP. This model reminds me of the various physician portals I’ve seen out there. They’ve worked really well for doctors who do a lot of referrals and need to exchange data. Although, logging into a portal isn’t the most seamless way of sharing data.

The email integration option requires you to have some good IT experience to be able to configure your email properly to support the identity and security configuration that will be required on your email system. Considering the number of doctors I know that still use aol.com, yahoo.com and gmail.com accounts, this won’t be a good solution for them. I bet even Google Apps accounts won’t support this, but it would be really cool if they did. Would be a really smart move by Google to have gmail support it if they could. The nice part is that once it’s configured you can sign and encrypt the email in a pretty seamless fashion.

Integrating the direct project specification directly into the EHR is the best option since it provides the user a seamless experience. The challenge will be on the EHR vendors to be able to integrate it into their EHR software, but I expect many will see this as the best way to service their customers. It will be harder on the EHR vendor, but the EHR vendors that do this extra effort will have much happier users.

Hopefully this gives a decent overview of the Direct Project options. John Moehrke has a lot more technical details on the subject if you want to read more about those. I know he’s pretty active on Twitter, so I’ll ping him now to have him take a look at this post so I can add any clarifications if needed as well.

I’m excited to see the Direct Project in widespread use. I think the Direct Project vision has best been described as replacing the fax machine. The move to exchanging documents using direct will be a good step forward. Sure, it’s just the first step, but it’s an important and useful one.