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March 21, 2011

Direct Project reaches critical mass: Interoperability on the horizon

The ONC announced today that the Direct Project now has commitments from about sixty health care and health IT organizations to support its vision of secure direct messaging of health information.  Given the level of support across twenty states, a number of integrated delivery systems and many EHR vendors, the Direct Project will allow for secure health information messaging for up to 160 million Americans.  Specifications for the Direct Project are now final, and draft documentaiton is available, too.  (For more information, see the anouncement about the widespread adoption of the Direct Project, complete with links to more detail on its website.  For further background, see the Direct Project's earlier announcement of its first live secure transmission of medical records.  For a good explanation of what it all means, togehter with a graphical representation of the change in information flow enabled by Direct, see Fred Trotter's blog.)

Given the tangled web of connections that must be maintained in order to effectively coordinate care of many patients -- each PCP, on average, coordinates care with 229 doctors across 117 different practices, according to a study of patients covered by fee-for-service Medicare -- any tool that alleviates the strain of maintaining these connections should be welcome.

The Direct Project has essentially short-circuited the laborious development process envisioned for health data interchange, and in less than a year has imagined -- and now come close to executing -- a mechanism for sharing of health information from a patient's physician with, say, a tertiary hospital in another state, without the need for laborious transmissions up the food chain to a statewide and nationwide exchange and then back down the food chain to the referral center.  There may be applications for a different, more robust, infrastructure; however, as a non-technical person, I very much like the idea of direct communication of information from one provider to another -- this seems to be the true essence of interoperability.  By contrast, other approaches seem mired in detail and delay, and running on a timetable completely unrelated to the meaningful use implementation schedule.  For more on this point, see the comments of the Society for Participatory Medicine on the PCAST Report; as public policy committee chair of the Society, I participated in the development of these comments.  (For the insomniacs out there, here is the full health information technology report of the President's Council of Advisors on Science and Technology.) 

David Harlow
The Harlow Group LLC
Health Care Law and Consulting



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