Direct Project Implementations Take Flight

By Rich Elmore and Paul Tuten

The Direct Project has taken off, with the first-in-the-nation production use of the Direct
Project for secure direct clinical messaging.

Arien Malec, ONC’s Direct Project Coordinator, announced today that pilots in
Minnesota and Rhode Island are now live with the Direct Project:

 VisionShare has enabled Hennepin County Medical Center to send immunization

information to the Minnesota Department of Health. Testing of immunization (or
syndromic surveillance) communication to a public health agency is a
requirement for Meaningful Use incentives.
 Rhode Island Quality Institute has implemented provider-to-provider health
information exchange supporting Meaningful Use objectives with Dr. Al
Puerini and members of the Rhode Island Primary Care Physicians
Corporation.

And innovative and high-value pilot projects in New York, Tennessee and
California are scheduled to go live later this month.

Also announced:

 29 Health IT Vendors now plan to connect using the Direct Project.

 A consensus-approved Direct Project Security Overview and Direct Project
Overview Presentation have been published.
 A new look and logo for the Direct Project website
 A Direct Project briefing by Dr. David Blumenthal (National Coordinator for Health
IT), Aneesh Chopra (U.S. Chief Technology Officer), and a team of federal and
industry stakeholders will take place at 12 noon ET Wednesday February 2. Live
twitter feed of the event will be posted at #DirectProject.
 Hennepin County Medical Center (HCMC), Minnesota’s
premier Level 1 Adult and Pediatric Trauma Center, has been successfully sending
immunization records to the Minnesota Department of Health (MDH). "This first-in-the-
nation Direct Project for clinical exchange is an important milestone for Minnesota and a
key step toward the seamless electronic movement of information to improve care and
public health," said James Golden PhD, Minnesota’s State Government HIT
Coordinator. Recognizing Minnesota's leadership in delivering high-quality, cost-
effective healthcare, U.S. Senator Amy Klobuchar said that “this is the type of
innovation that can help strengthen our health care system by reducing waste and
improving quality. We need to continue to improve our health care system by continuing
to integrate information technology to better serve patients and providers.” VisionShare,
a company headquartered in Minneapolis, serves as the health information services
provider (HISP) connecting HCMC to the Minnesota Department of Health. In its role as
a HISP, VisionShare will expand this pilot project to additional providers and other
states, including the Oklahoma State Department of Health, which has already
committed to participation in the program.

The Rhode Island Quality

Institute (RIQI), the only organization in the nation to be awarded the Health Information
Exchange, Regional Extension Center, and Beacon Community grants has delivered a
Direct Project pilot project with two primary goals:

1. To demonstrate simple, direct provider-to-provider data exchange between PCPs

and specialists as a key component of Stage 1 Meaningful Use.
2. To leverage Direct Project messaging as a means to seamlessly feed clinical
information from practice-based EHRs to the state-wide HIE, currentcare,
integrating patient data across provider settings and during transitions of care

“This recognition shows that Rhode Island continues to be a nationwide leader in

improving health care with better information technology," said Senator Sheldon
Whitehouse. "Health care providers communicating with each other in a secure and
cost-efficient way helps patients get better sooner with less hassle and confusion.”

“The Direct Project is a giant step forward in improving communication between primary care
providers, specialists, hospitals, laboratories and health information exchanges”, according to
Dr. Albert Puerini Jr., President and CEO at Polaris Medical Management and Rhode Island
Primary Care Physicians. “The Direct Project’s ability to seamlessly transmit relevant
healthcare information greatly enhances the quality of care that is delivered, while also creating
much needed efficiencies within our healthcare system.”

Discussing RIQI’s collaborative approach to health IT, Laura Adams, President and
CEO of RIQI said “Direct allows the Quality Institute to be on the cutting edge –
providing health information exchange via currentcare, delivering the efficient rollout of
technology through the Regional Extension Center, and enabling and measuring real
patient outcome improvements in our Beacon Community.” Throughout the Pilot, RIQI
has worked with a number of key partners, including Arcadia Solutions (program
manager and systems integrator), Inpriva’s Health Information Service Provider
solution that supports the security, trust, and Rhode Island-specific consent laws,
InterSystems, and Polaris Medical Management’s EpiChart.

Federal Government Perspective

Aneesh Chopra at the Roundtable on Federal Government Engagement in Standards
on January 25, 2011 said "I am pleased to report today... the very first Direct
specification email message occurred between a county public hospital in Minnesota
called Hennepin County and the state Health Department on the issue of a patients
immunization record, which is a requirement as part of our meaningful use framework,
supported by a commercial vendor called VisionShare". Speaking of the collaborative
nature of the unique public/private collaboration of the Direct Project, he said "This
voluntary process has turned this around and in fourteen months [from the time a
physician first raised the need to the HIT Standards Committee] the idea is real. And
dozens and dozens of vendors will have this service widely deployed across 2011."
On the Runway
Several other Direct Project implementations are scheduled for take-off later this month.
New York, Tennessee and California are among the states where Direct Project will be
enabling directed health information exchange among a wide variety of participants.
And later this year, look for Connecticut and Texas to join their ranks.

New York

MedAllies, a Health Information Service Provider (HISP), will launch a Direct Project
pilot to demonstrate the delivery of critical clinical information across transition of care
settings in a “push” fashion that supports existing clinical workflows in the Hudson
Valley of New York. MedAllies will implement the full Direct Project infrastructure,
including both the required SMTP backbone, as well as support for the XDR elective
protocol. MedAllies is working with many stakeholders, including EHR vendors
Allscripts, eClinicalWorks, Epic, Greenway, NextGen and Siemens, and clinicians in
both ambulatory and hospital settings.

The three initial use cases include:

· Primary care provider refers patient to specialist including summary care record
· Specialist sends summary care information back to referring provider
· Hospital sends discharge information to primary care provider
Technical integration with leading EHR and Hospital Information System vendors is
underway with pilot exchange alpha sites beginning to go live in Q1 2011.

Tennessee

In this project, CareSpark, a non-profit regional health information exchange supported

by the Tennessee State HIE, and the U.S. Department of Veterans Affairs (VA) seek to
demonstrate Direct Project-based health information exchange between a federal
agency and providers in a private-sector HIE. The main focus will be on facilitating an
improved process for exchanging referrals and consultation reports between VA
providers and private-sector providers in east Tennessee and southwest Virginia. It will
demonstrate two Direct Project user stories: Primary care referral to specialist and
Specialist sends summary care information back to referring provider. Text-based
mammography interpretation reports will be exchanged utilizing source code made
available from the Direct Project workgroups. The project scope will also demonstrate
the routing of mammography referrals from the VA to the private sector provider. It is
also the intent of the participants that this project once fully vetted could be expanded to
additional VA sites. The pilot will exchange information between two different Health
Information Service Providers (HISPs) - the VA and CareSpark, respectively.

California

Redwood MedNet provides health information exchange services in rural

Northern California. The Redwood MedNet Direct Project pilot has one goal: to
deploy directed secure messaging for production data delivery in support of
meaningful use measures. Three meaningful use messaging patterns are in
development.

1. Receipt of Structured Lab Results

2. Immunization Reporting
3. Sharing Patient Care Summaries Across Unaffiliated Organizations
(including both referral to a specialist and discharge summary to a patient
centered medical home)

The project will establish a standards-based way for participants to send

authenticated, encrypted health information directly to known, trusted recipients.
As an HIE in a rural area, participants in the Redwood MedNet directed
messaging project will include small practices, community clinics and small
hospitals, as well as the State immunization registry. The discharge summary
may also incorporate use of a patient controlled health record (PCHR).

Connecticut
Medical Professional Services (MPS) is a clinically-integrated, multi-specialty IPA
in Connecticut with approximately 400 physician members. Along with several
partners, MPS is working to demonstrate successful exchange of laboratory
results back to the ordering provider and exchange of referral information and
summary care information between providers, a local hospital (Middlesex) and a
multi-site FQHC (Community Health Center, Inc.). Electronic exchange of data is
a challenge in this setting because of the diversity of MPS physician practices,
EHRs and HIT tools in place.

The goal set for this pilot is to enable MPS physicians to receive lab results back
from Middlesex Hospital and Quest Diagnostics, to exchange referrals with
Middlesex Hospital, and to exchange referrals and summary care information
among MPS primary care and specialty physicians. Results and referral
information will be exposed through MedPlus, eClinicalWorks, Covisint, or
through a secured e-mail client. In addition, physicians will have the ability to
securely send lab results and care summaries to their patients via Microsoft’s
portal.

Texas

A broad set of stakeholders in South Texas are planning to use Direct to improve
the health status of persons in South Texas with diabetes, including gestational
diabetes. Participants come from the medical community (CHRISTUS Health, the
Health Information Network of South Texas, the Driscoll Children’s Health Plan,
Corpus Christi Medical Center, Public Health Department, Nueces County
Medical Society), community-based social service organizations, colleges, and
employers (the Coastal Bend Diabetes Community Collaborative, The Salvation
Army, the United Way, and others). The main goal for this project is to connect
the OB-GYNs, pediatricians, hospitals, and the State of Texas’ Newborn registry
so they can share information (referrals, lab results, discharge summaries) in real
time with their care teams to improve patient outcomes. Additionally, the project
participants hope to provide patients with better information so that they may
better manage their chronic diseases. This will be accomplished using Direct by
enabling the following use cases:

1. Physician to physician referral

2. Physician to hospital referral
3. Hospital to physician lab results reporting
4. Hospital or physician to state newborn registry

What is the Direct Project?

Today, direct communication of health information from a care provider to another
healthcare stakeholder is most often achieved by sending paper through the mail or via
fax. ONC’s Direct Project (formerly NHIN Direct) benefits providers and patients by
improving the direct transport of structured and unstructured health information, making
it secure, fast, inexpensive and, for some applications, interoperable. Using Direct
Project addresses, a care provider can send and receive important clinical information,
connecting to other healthcare stakeholders across the country.

For more information, see the Direct Project website and keep up with the latest on
Twitter at #DirectProject.

Also, at noon (EST) on February 2, hear about the Direct Project from Dr. David
Blumenthal, National Coordinator for Health IT, Aneesh Chopra – U.S. Chief
Technology Officer, Mark Briggs – CEO VisionShare, Glen Tullman – CEO Allscripts,
Sean Nolan – Distinguished Engineer and Chief Architect Microsoft Health Solutions
Group, Dr. Al Puerini Jr. – President and CEO Polaris Medical Management and Rhode
Island Primary Care Physicians, Doug Fridsma - ONC Director, Office of Interoperability
and Standards and Arien Malec - ONC Direct Project Coordinator.

The Authors
Rich Elmore serves as the Direct Project Communication Workgroup leader and Vice President,
Strategic Initiatives at Allscripts. Paul Tuten participates as the Direct Project Implementation
Geographies Workgroup Leader and is Vice President, Product Strategy & Management at
VisionShare.