Healthcare Business News
Dawn FitzGerald

Tenn. pilot project takes 'Direct' route

By Joseph Conn
Posted: April 2, 2013 - 2:15 pm ET

Five Tennessee healthcare organizations have joined a pilot project to exchange information using the federally developed Direct secure-messaging protocol.

Four of the organizations participating in the pilot, called the Health eShare Direct Project, are based in Chattanooga—HealthSouth Chattanooga Rehabilitation Hospital, Erlanger Health System, Southeast Tennessee Area Agency on Aging and Disability and Home Health Care of East Tennessee and Hospice.

The fifth provider is Memphis-based managed-care organization Health Choice, a joint venture between MetroCare Physicians and Methodist LeBonheur Healthcare. Health Choice has developed a patient-centered medical home, Memphis Accountable Care Home.

Direct is a collection of standards and specifications developed under the auspices of the Office of the National Coordinator for Health Information Technology at HHS for sending encrypted, peer-to-peer messages. It has recently been coupled with the broader Connect protocol, also developed with ONC assistance, for more-advanced health information exchange.

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Direct is likely to become the lingua franca for basic health information interoperability, such as the transmission of patient-care summaries, under the Stage 2 meaningful-use requirements of the federally funded EHR incentive payment program.

The Direct pilot project “is a great opportunity for healthcare providers to effortlessly comply with federal requirements governing health information exchange,” said George Beckett, health IT coordinator for the Tennessee Office of eHealth Initiatives, in a news release. “Once these providers in Chattanooga and Memphis begin using Direct services to communicate and share information, we hope they will be excited about how easy it is to use and will quickly see the time-saving and cost-saving benefits.”

The project is sponsored by the Nashville-based Tennessee Regional Extension Center, one of a network of health IT extension centers nationwide established with ONC grants under the American Recovery and Reinvestment Act of 2009. The Tennessee center is an arm of Qsource, a not-for-profit quality improvement and health IT organization. Tennessee received nearly $11.7 million from the ONC to set up the extension center and contracted with Qsource to run the IT extension program statewide. Qsource also oversees the state's health information exchange efforts under a separate ONC grant.

“The Direct project is not going to replace the totality of the state's plans for health information exchange,” said Dawn FitzGerald, CEO of Qsource, in an interview. “But the pace of that program isn't rapid enough for the providers to be eligible for Stage 2 of meaningful use.”

Direct, meanwhile, as a Web-based technology “is simple, affordable and available to almost any provider with little or no investment almost immediately,” she said.

That said, according to FitzGerald, “You do have to modify your workflow in order to appropriately implement it and get the most value” out of it, hence the participation of the extension service, and not the state HIE program, in helping educate providers, as well as registering them on behalf of Direct service providers.

“We think there will be six vendors,” providing Direct services in the state this year, she said.

The Chattanooga-based providers have picked care transitions and the exchange of care summaries as their pilot project use case, FitzGerald said. The Health Choice medical home pilot will use Direct messaging for both transitions of care and for referrals to specialists, she said.

“It's not the dream and the totality of HIE,” FitzGerald said, but Direct “is an excellent starting place.”

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