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DirectTrust, CHIME Deal Not All It’s Cracked Up To Be

Posted on September 7, 2017 I Written By

Anne Zieger 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.

Recently, CHIME and DirectTrust announced a deal that sounded pretty huge on the surface. In a joint press release announcing the agreement, the two organizations said they had agreed to work together “to promote the universal deployment of the Direct Trust framework and health information exchange network as the common electronic interface for health information exchange across the U.S.”

Their plans include making the Direct exchange network available anywhere they can, including hospitals, medical practices, pharmacies, labs, long-term care facilities, payers, insurers and health departments, and to top it off, on applications. If things go the way they planned, you’ll hardly be able to kick a health IT rock without finding Direct under it.

As I noted earlier this year, DirectTrust is on something of a roll. In May, it noted that the number of health information service providers who engaged in Direct exchanges grew to almost 95,000 during the first quarter of this year. That’s a 63% increase versus the same period in 2016. The group also reported that the number of trusted Direct addresses which could share PHI grew 21%, to 1.4 million, and that there were 35.6 million Direct exchange transactions during the quarter, up 76% over the same period last year.

Sounds good. But let’s not judge this in a vacuum. For example, on the same day DirectTrust released its first quarter results, the Sequoia Project kicked out a press release touting its performance. In the release, Sequoia noted that its Carequality initiative was under full steam, with more than 19,000 clinics, 800 hospitals and 250,000 providers using the Carequality Interoperability Framework to share health data.

In considering the impact of Carequality, let’s not forget that late last year it connected with rival interoperability group CommonWell Health Alliance. I don’t know if you can say that interoperability effort can corner a market– the organizations using the rival health data sharing networks probably overlap substantially—but it’s certainly an interesting development. While the two organizations were both allied with a leading EMR vendor (CommonWell with Cerner and Carequality with Epic), the agreement has effectively brought the muscle of the two EMR giants together.

I guess it’s fair to say that the Carequality alliance and DirectTrust may own interoperabililty for now, rivaled only by the stronger regional HIEs.  That’s pretty impressive, I admit. Also, it’s interesting to see an accepted health IT organization like CHIME throw its weight behind Direct. I wouldn’t have expected CHIME to dive in here.

That being said, when you get down to it, none of the groups’ capacity for sharing health data is as great as it sounds. For example, if Epic’s Care Everywhere exchange only transmits C-CDA records, you have to ask yourself if Carequality is working at a higher level. If not, we’re in “meh” territory.

Bottom line, it seems clear that these organizations are winning the battle for interoperability mindshare. Both seem to have made a fair amount of progress. But between you and me in the lamppost, let’s not get excited just yet.

Direct, Sequoia Interoperability Projects Continue To Grow

Posted on May 15, 2017 I Written By

Anne Zieger 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.

While its fate may still be uncertain – as with any interoperability approach in this day and age – the Direct exchange network seems to be growing at least. At the same time, it looks like the Sequoia Project’s interoperability efforts, including the Carequality Interoperability Framework and its eHealthExchange Network, are also expanding rapidly.

According to a new announcement from DirectTrust, the number of health information service providers who engaged in Direct exchanges increased 63 percent during the first quarter of 2017, to almost 95,000, over the same period in 2016.  And, to put this growth in perspective, there were just 5,627 providers involved in Q1 of 2014.

Meanwhile, the number of trusted Direct addresses which could share PHI grew 21 percent, to 1.4 million, as compared with the same quarter of 2016. Again, for perspective, consider that there were only 182,279 such addresses available three years ago.

In addition, the Trust noted, there were 35.6 million Direct exchange transactions during the quarter, up 76 percent over the same period last year. It expects to see transaction levels hit 140 million by the end of this year.

Also, six organizations joined DirectTrust during the first quarter of 2017, including Sutter Health, the Health Record Banking Alliance, Timmaron Group, Moxe Health, Uticorp and Anne Arundel Medical Center. This brings the total number of members to 124.

Of course, DirectTrust isn’t the only interoperability group throwing numbers around. In fact, Seqouia recently issued a statement touting its growth numbers as well (on the same day as the Direct announcement, natch).

On that day, the Project announced that the Carequality Interoperability Framework had been implemented by more than 19,000 clinics, 800 hospitals and 250,000 providers.

It also noted that its eHealth Exchange Network, a healthcare data sharing network, had grown 35 percent over the past year, connecting participants in 65 percent of all US hospitals, 46 regional and state HIEs, 50,000 medical groups, more than 3,400 dialysis centers and 8,300 pharmacies. This links together more than 109, million patients, Sequoia reported.

So what does all of this mean? At the moment, it’s still hard to tell:

  • While Direct and Sequoia are expanding pretty quickly, there’s few phenomena to which we can compare their growth.
  • Carequality and CommonWell agreed late last year to share data across each others’ networks, so comparing their transaction levels to other entities would probably be deceiving.
  • Though the groups’ lists of participating providers may be accurate, many of those providers could be participating in other efforts and therefore be counted multiple times.
  • We still aren’t sure what metrics really matter when it comes to measuring interoperability success. Is it the number of transactions initiated by a provider? The number of data flows received? The number of docs and facilities who do both and/or incorporate the data into their EMR?

As I see it, the real work going forward will be for industry leaders to decide what kind of performance stats actually equate to interoperability success. Otherwise, we may not just be missing health sharing bullseyes, we may be firing at different targets.