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“Direct” is Much More than Email

by Wes Rishel  |  March 6, 2012  |  1 Comment

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.

  1. 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.
  2. 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.

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Category: interoperability  vertical-industries  

Tags: arra  ehr  healthcare-interoperability  meaningful-use  simple-interop  

Wes Rishel
VP Distinguished Analyst
12 years at Gartner
45 years IT industry

Wes Rishel is a vice president and distinguished analyst in Gartner's healthcare provider research practice. He covers electronic medical records, interoperability, health information exchanges and the underlying technologies of healthcare IT, including application integration and standards. Read Full Bio

Thoughts on “Direct” is Much More than Email

  1. Jitin Asnaani says:

    Wes, I love your posts: you have a unique talent for stretching an analogy as much as possible but no farther.

    Alas, as a former Coordinator of the Direct Project, I certainly had to take to the heart the old phrase “perception is reality”, especially when trying to articulate the value of Direct to those who were not tech-savvy, or even worse, those who knew just enough to be dangerous. We have no lack of either in the HIE community, in both the pubic and private sectors. And so “Direct == secure email” became the go-to analogy to help people to understand what Direct was, though it was semantically flawed (as you’ve very correctly articulated); it was still better than meaningless constructs such as “directed exchange” or raw details like SMTP+S/MIME. Heck, even “push-based exchange” left people scratching their heads.

    And hence the value of posts such as yours, part of a continuous effort to get people to realize that Direct is what physicians, nurses, patients and others have been asking for – have been good money for, actually – for ages: a simple way to be able to securely send health information to another participant. It won’t replace query/response any more than GMail will replace YouTube, but there’s no denying the value and power of of each.

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