Maybe This is the Solution to the Electronic Medical Records Logjam
After seven years of work under two Presidents, we've failed to break down most of the barriers that prevent doctors and hospitals with different information systems from exchanging data with one another and with patients. But that might be changing with the advent of the Direct Project, which was announced Wednesday by National Health IT Coordinator David Blumenthal, Chief U.S. Technology Officer Aneesh Chopra, and several other government officials and health IT vendors involved in the initiative.
The Direct Project is a standardized messaging protocol that allows doctors, hospitals and other providers to send care summary documents, lab results, referrals and other data directly to one another without special interfaces. It also enables them to upload clinical data to patients' personal health records. Although the Direct Project is compatible with the National Health Information Network, a public/private collaborative designed it under the leadership of the Office of the National Health IT Coordinator.
HITECH to the rescue
Part of the impetus for the Direct Project came from the HITECH Act, the section of the 2009 economic stimulus package that offers incentives to providers who can show "meaningful use" of their electronic health records (EHRs). Meaningful use requires physicians to test the "interoperability" of their EHR with other providers' EHRs, and they also have to make care summaries available to patients upon request. The Direct Project would enable them to do that by sending attachments over a secure messaging system that's functionally similar to e-mail.
But an equally important goal of the Direct Project is to enable providers -- especially independent physicians and community hospitals -- to exchange clinical information online at a time when organized health information exchanges are still few and far between. Of course, much more needs to be done to make EHRs and other IT systems truly capable of understanding one another. But the Direct Project is a big step forward in connectivity. As Blumenthal put it at the press conference, "It's one of the elementary methods of creating interoperability...It's a critical tool for that movement of information."
Patients should also benefit from this advance in connectivity. Microsoft (MSFT) executive Sean Nolan said that any consumer who has a personal health record (PHR) on Microsoft HealthVault will be able to upload medical records via the Direct Project. Google Health and other PHR vendors can be expected to follow suit.
But there are some laggards
The drawback is that only some EHR companies have incorporated the Direct Project protocol so that their customers can exchange information with patients or each other. Among the leading vendors that have done so are Allscripts (MDRX), Cerner (CERN), Epic, GE (GE), Greenway, and Siemens (SI).
The first two applications of the Direct Project have already occurred in Minnesota and Rhode Island. In Minneapolis, the Hennepin County Medical Center successfully sent immunization records to the Minnesota Department of Health. The Rhode Island Quality Institute, which is building a statewide health information exchange (HIE), has used Direct to transmit patient data from physician practices to that HIE, and doctors who belong to Rhode Island Primary Care Physicians, a doctor network, have used it to send online referrals to specialists.
Other Direct Project initiatives will be launched in New York, California and Tennessee this month, and in Connecticut and Texas later on.
"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," commented Dr. Albert Puerini Jr., president and CEO of Rhode Island Primary Care Physicians.
To which I'd add one other point: If small-practice doctors believe that they can use EHRs to coordinate care and increase access to data without spending oodles of money on interfaces, they'll start to see how information technology can really improve their lives, as well as the quality of care. Then the investment in EHRs might seem worthwhile to them.
Image supplied courtesy of Wikimedia Commons.
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