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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.

Two Primary Obstacles to PHR Adoption per Epic

Posted on May 11, 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.

I recently happened upon the interoperability page on Epic’s website. Yes, I realize the irony of Epic and interoperability in the same sentence. In fact, that’s why I was so intrigued by what Epic had on their website about interoperability.

I’ll leave what they called the “physician-guided” interoperability using their Care Everywhere product for another post. In this post I just want to highlight their “freestanding Personal Health Record (PHR)” section. I was most intrigued by what Epic lists on that page as the “two primary obstacles to patient PHR adoption”:

Lucy [Epic’s PHR] is free of the two primary obstacles to patient PHR adoption:
1. There are no advertisements on Lucy.
2. Epic will not sell patient data for secondary uses.

I find this really intriguing. Let’s look at each one individually.

First, I can’t say I’ve ever heard someone say that the reason they aren’t using an EHR is because of the advertisements. I’m sure there are a few out there that wouldn’t enjoy the ads and might not use a PHR because of them, but I believe they are few and far between. Plus, PHR use has been so low that most haven’t used a PHR enough to have seen ads. So, that’s not an obstacle. Not to mention, what PHR software has ads there now? As best to my knowledge Microsoft HealthVault, NoMoreClipboard and even the now defunct Google Health have never shown ads before.

Now to the second point about selling patient data for secondary uses. This could potentially be a bigger issue. There’s little doubt that there’s value in aggregate health data. A PHR is a legitimate way to collect that aggregate health data. Some certainly have some fear of their individualized health data being learned and so they don’t want to input their health data into a PHR. However, I believe there’s a larger majority that don’t care about this all that much. Sure, they want to make sure that the PHR uses proper security in their system. They also don’t want their individual data sold, but I expect a large user base doesn’t really care if aggregate healthcare data is sold in order for them to get a product that provides value to them.

In fact, this highlights the real problem with PHR software generally. To date, the PHR has offered little value to the patient. This is the primary obstacle to patient PHR adoption. I’ve hypothesized previously a couple things that could change that patient value equation: physician interaction in the PHR and paper work completion.

The real problem with PHR software is providing the patient value, not ads or sold patient data.