Direct Project | EMR and HIPAA

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

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

Written by: John Lynn

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

Written by: John Lynn

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

Written by: John Lynn

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.

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Most Promising Health Data Exchange Project: Direct Project

ONC is More Focused on HIE than EMR

Meaningful Use Stage 2 and HIE Transport – Meaningful Use Monday

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