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Most Promising Health Data Exchange Project: Direct Project

Posted on August 7, 2012 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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 and 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.

Good Luck With That HIE Tech Purchase

Posted on June 21, 2012 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.

Want to buy HIE technology?  It’ll cost you. But more importantly, you’ll still be dealing with a bewildering array of choices, if a new report from KLAS has it right.

According to KLAS, which asked 95 providers about their HIE buying plans, there were a few clear leaders in the field.  Providers surveyed by KLAS reviewed 38 HIE vendor offerings.  Of those, five HIE vendors were considered in more than 10 percent of the providers’ buying plans, researchers found.

If there was a clear leader, it was Medicity, which was considered in 23 percent of HIE buying decisions, according to a report from Healthcare IT News.  Next was Axolotl, with 22 percent; RelayHealth, with 16  percent; ICA, with 11 percent, and Epic, also with 11 percent. (Note: Epic was only being considered seriously when providers want to tie together multiple Epic installations.)

Looked at another way — by vendors mentioned most frequently by providers — the leaders were Axolotl, Cerner, dbMotion (part owned by the University of Pittburgh Medical Center), Epic, GE, ICA, InterSystems, Medicity, Orion and RelayHealth.

If you want to really fit the HIE to your situation, consider the following criteria, the HIN story suggests:

  • Public HIEs – A public exchange may belong to official state agencies or may be semi-independent with direct and typically temporary government backing. Public HIEs demand solutions with strong potential scalability and need standards-based technology.
  • Cooperative HIEs – In this model, otherwise-competitive hospitals work together to form independent HIE organizations, generally with an open invitation to other hospitals, clinics and physician practices. These HIEs often struggle to establish long-term funding and look for vendor solutions that offer flexible and affordable cost alternatives while best adapting diverse EMR technologies.
  • Private HIEs – In some respects, private HIEs are designed to enhance relationships as well as exchange data. Often, a single hospital or IDN creates an HIE hoping to draw in community physicians while protecting or increasing revenues. Funding is less complicated and these HIEs are more likely to be satisfied with solutions that best work with their existing technology.

The truth is, though, that whatever model best fits your HIE purchase, narrowing things down to your short-list isn’t as easy as just picking from KLAS’s top contenders.  Even these leaders have a moderate to tenuous grip on the market, and may or may not have the solution that fits your model. (Note: I’m familiar with Axolotl and Orion, both of which have what may be some of the longest-deployed tech out there, but I can’t vouch that they’re exactly better than anyone else.)

If it were me, I’d look at lesser-known, strongly-backed folks focused directly on the problem. Then, I’d do a co-development program with them so both win.  Got other ideas to share readers?