HIEs discover new ways to use 'Direct Project' messaging protocol

Health information exchanges are finding their own ways to use the Direct Project standards to achieve their quality and coordination objectives, panelists revealed in a discussion of the public/private secure messaging protocol at the Health Information and Management Systems Society conference in Las Vegas this week.

The Direct Project is a standardized messaging protocol that allows the secure exchange of key clinical data among healthcare providers and between providers and patients. The protocol enables physicians, hospitals, labs, other providers, HIEs and state health departments to send care summaries, referrals and other data online without dedicated interfaces.

Holly Miller, M.D., CIO of MedAllies, an HIE in the Hudson Valley area of New York, discussed a pilot designed to improve transitions of care after discharge and patient referrals to specialists. In the closed-loop referral process, a primary care doctor sends an "order" for a consult to a specialist and receives a "result" back from the specialist after the patient is seen--all via Direct messages. Similarly, a hospital can push a Direct e-mail to a primary-care physician about a patient's discharge, she said.

Because two-thirds of the physicians who belong to MedAllies have electronic health record systems, the HIE has adopted an EHR-based workflow for Direct messaging. For instance, Continuity of Care Documents (CCDs) can be sent from the Siemens EHR at Albany Medical Center to a practice that uses Allscripts. Besides those two vendors, eClinicalWorks, Epic, Greenway and NextGen are involved in the pilot.

Eventually, Miller noted, Direct could also be used to push summaries of data from all of a patient's providers through the HIE to a patient's personal health record.

Chris Philips, technical manager on the Florida health Information exchange program, explained how the project has integrated Direct messaging and a patient lookup feature to speed up transfer of information between providers. Among the initial users of the healthcare ISP set up to facilitate Direct, she said, are individual clinicians, practices, labs, community health centers, skilled nursing facilities and surgery centers. The HIE is using open-source applications to keep costs low, and has developed a thorough vetting system to ensure all providers who use the system are actually who they say they are.

Mark Bamberg, chief science officer at MEDFx Corp., explained how MedVirginia, an HIE in Virginia, has combined its access to the Nationwide Health Information Exchange (NwHIN) with the Direct Project to supply both "push" and "pull" functions to provider members. MedVirginia can search both its own database and that of the Veterans Health Administration (VHA), for example. Then it can push the data it gleans, such as the medications on a particular patient, to the requesting physician via Direct, he said.

Tim Cromwell, director of standards and interoperability for VHA, is running a nationwide healthcare exchange between the VHA and its private providers, using the NwHIN to trade CCDs. He said the VHA is adding Direct to its toolkit so that it can order tests and consults outside of the firewall of its EHR. VHA is currently piloting the system with mammography orders and results in eastern Tennessee. He said he thinks the same system can be applied to other tests across the country.

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