Direct Project gives doctors secure access to data exchange

Many physicians, even those with electronic medical records, wonder what the advantage is to having their offices "connected" when their systems don't talk to their hospital's systems or the system of the specialist to whom they have referred patients.

When completed, the Nationwide Health Information Network will bring the connectivity physicians and patients are looking for by linking multiple health information exchanges from across the country in a way that will allow them to talk to one another.

But health information exchanges -- the presumed backbone of the network -- have been slow to grow into viable operations. Without them, doctors hoping to qualify for meaningful use incentives need some way to exchange information securely.

Physicians practicing in areas without a structured exchange might not have the ability to "talk" or interoperate with other practices or hospital systems. But there is a way for physicians to exchange information with other physicians and even patients in a secure environment compliant with the Health Insurance Portability and Accountability Act.

The Direct Project, a component of the NHIN, is a project that the Health and Human Services Office of the National Coordinator for Health Information Technology has been working on for more than a year.

Direct Project is a public-private collaboration, which includes several competing technology companies, that came together to form uniform standards for secure information exchange. Unlike the NHIN in full, a place where physicians can query for certain information loaded onto the network, the Direct Project merely allows secure exchange of data between two points -- for example, physician to hospital, or physician to physician.

Who's participating

More than 80 EMR vendors, personal health record vendors and information exchanges have signed on to the Direct Project, so users of any of those systems will have the technology available to them. A list of vendors is on the project's website. If a practice's vendor is a participant, then it probably has the ability to send messages using the system, or it can get an upgrade to its system that will give the practice that ability.

Users of Direct Project-enabled technology, such as EMRs, personal health records and other health IT systems with messaging components, can send and receive secure information if both parties have systems that support the Direct Project.

Though it does not replace fully functional HIEs, it can satisfy some of the meaningful use requirements for data exchange.

Arien Malec, coordinator of the Direct Project, said the venture allows physicians who use it to send summaries of patient records. Doctors also can provide patients with information such as lab and test results or continuity-of-care reports electronically in a secure message.

Jennifer Covich Bordenick, CEO of the eHealth Initiative, said the Direct Project "is not a silver bullet," however. "It doesn't allow [EMRs] to engage with other [EMRs]. It's just a safe way to send stuff securely."

Aneesh Chopra, the federal government's chief technology officer, said in February that Direct Project's standardized platform "dramatically lowers costs and barriers to secure health information exchange."

Many barriers have prevented the growth of health information exchanges nationwide, leaving many doctors -- even those with EMRs -- unable to exchange data electronically. A July report by the eHealth Initiative looked at some of those barriers and how they affect the growth of organized information exchanges. The report found a net growth of 9% in the number of exchange initiatives in 2011, for a total of 255, even as at least 10 exchanges have closed or consolidated since the last survey was taken a year ago.

However, only 24 health information exchanges were considered financially viable in that they no longer required government or private grants to survive. Although that number is up from 18 in 2010, it shows the struggle exchanges have in getting physicians and hospitals to invest in them, as well as provide information for them.

A separate study by the market research group KLAS found that the number of private exchanges has more than doubled in the past year, to 171. In a statement, researchers speculated that public exchanges may be declining because of government oversight and fear over long-term funding.

The private exchanges KLAS spotlighted are run by vendors, hospitals and others, and often are tapped only by those affiliated with the owner.

Bordenick said exchanges that have expanded their offerings are in a much stronger position than their counterparts. The eHealth report found that 85 of the advanced exchanges are offering at least one service that supports meaningful use requirements; 113 plan to incorporate the Direct Project into their service offerings.

Testing of the Direct Project began this year among private health care organizations and public health agencies in Minnesota and Rhode Island. It is now accessible to anyone using a system that supports the Direct Project. The Direct Project also makes it possible for patients with health information stored on Google Health to keep that data when the personal health record platform shuts down next year. Microsoft HealthVault announced that Google Health users could transfer their information to a HealthVault account using the Direct Project protocols.

Malec said the use of the Direct Project between Google Health and HealthVault is "a really important validation of the value of data portability and liberation for patients."

Bordenick said it is notable that two large technology companies are using the Direct Project protocols. "Perhaps it will make other physicians and providers think this is a credible way to do this."