As the trades rush be “firstest” with interesting or alarming info on the meaningful use Stage 2 NPRMs, we are seeing the observation that the health information exchange envisioned in Stage 2 is primarily point-to-point using secure e-mail technology, as most state HIEs and many regional ones aren’t operational or ready for more advanced types of exchange.
There are two important points to keep in mind.
- The secure email technology in Direct can be used for much more than email. The technology supports sending data directly into EHRs or out of EHRs and it supports sending structured data. In fact the NPRMs contemplate using Direct to send various consolidated CDA documents for transitions of care and patient engagement.
- The glass is half full, not half empty.
Having Direct has enabled CMS and ONC to create higher thresholds for conformance with sending structured data. Otherwise they would have had to give performance waivers to EPs and hospitals that did not work in an area supported by a robust HIE or where the HIE couldn’t on-board all available users in the time frames required for Stage 2.
Would we all like for all EPs to have richer functionality through a query mechanism? Resoundingly yes.
If we had a query mechanism would that eliminate the need for push? No.
Direct gets something going with an absolute minimum of the need for intermediate organizations to guarantee the trustworthiness of one participant to the other.
Should we mourn the reality that the more complex issues around query aren’t going to be solved evenly throughout the country, or should we celebrate the larger number of EPs and hospitals that will be interoperating sooner?
I choose the latter.
The direct glass may only be half full, but you can die of thirst waiting waiting for a half-empty glass to be filled.