Much work remains to be done by states in using Direct technology for interstate health information exchange, but a pilot between California and Oregon healthcare providers shows that it can be done.
That's part of the takeaway in a report from the Western States Consortium (WSC) project, 13 states that collaborated on ways to break down technical and policy barriers to interstate exchange.
California and Oregon are exchanging data following the pilot, which focused on two scenarios, according to a Health IT Buzz post:
- When Direct addresses of participants are known to each other; and
- When Direct addresses of participants are not known to each other
Among the lessons learned, according to the final report:
Process: It's important to define and stay within the scope of the project. That's harder than it sounds.
Providers see the value of information exchange only after a mature legal and regulatory framework has been created that allows it to take place seamlessly in their workflows. Much work remains in this area, the authors say.
- Technology: States may have operating Health Information Service Providers (HISPs) that may not satisfy the WSC applicability statement. Some technical work needs to be completed, according to the authors, as these systems largely are not built to be "plug and play." As the number of HISPs across the nation increases and users expect rapid connections, it will be nearly impossible to know and trust every HISP vendor that wants to connect to an HIE. To that end, it is essential for the HIE to vet HISPs and develop strategies for on-boarding them.
- Policy: Never underestimate the amount of time required to work together on legal agreements/documentation to accomplish an acceptable level of standardization, the authors say.
- Governance: State representatives are very concerned about their role in providing entrepreneurial services without more policy guidance from ONC and their state legislatures.
Going forward, it will be essential to develop a repeatable pattern of state-level governance that can be executed in a flexible way, according to the authors.
The ONC is leaning toward simplified and generalized patient record queries for Stage 3 of Meaningful Use. Non-targeted queries have been a special area of concern for the the HIT Policy Committee, which sent the Privacy & Security Tiger Team back for more discussion on its recommendations in that area.