10 HIEs to tap Direct protocol during disasters

Health information exchange organizations in 10 states in the South, East and Midwest have entered into an agreement to use the federally developed Direct clinical messaging protocol to help their members transmit and receive patient medical records in the event of a disaster.

The ability to electronically exchange the medical records of disaster victims has long been a goal of healthcare information technology boosters, dating at least as far back as 2005 and Hurricane Katrina. The survivability and interoperability of records through the use of health IT systems and regional health information exchanges proved crucial to continuity of care during the tornado strikes this spring in Oklahoma.

The latest states to jump on the Direct interoperability bandwagon include Alabama, Georgia, Louisiana, Florida, South Carolina, North Carolina, Virginia, Michigan, Wisconsin and West Virginia. All of their state-wide health information exchange organizations have established the capability to exchange messages with at least one other state, and will continue to work with one another to enable the exchange of records between them in the event of their residents being displaced from their homes, according to an announcement today by the Office of the National Coordinator for Health Information Technology.

“Through disasters … we have learned the importance of protecting patients' health records through electronic tools like health information exchanges,” said ONC chief Dr. Farzad Mostashari. “Patients are better off when states and health information exchange organizations work together to ensure that health information can follow patients when they need it the most.”

Work on the Direct Project began in 2010. The information exchange protocol specifies how the senders and receivers of a clinical message—such as a patient care summary—can authenticate who they are, encrypt the message, transmit it and verify its receipt.

Direct was designed for use by providers who knew one another and already had a clinical or business communication relationship. Typical examples included a hospital and an affiliated, office-based primary-care physician or a specialist and a primary-care physician.

The idea was seen as an alternative to the more elaborate and still largely unavailable “query and response” model of interoperability, where providers deposit records in a common database and then search for specific patients' information. The Nationwide Health Information Network required for common interoperability is still under development.

As a result, Direct is being widely adopted by health information exchange organizations as a key interoperability tool. They see it as the best path to meeting Stage 2 rules to justify electronic health-record incentive payments under the Patient Protection and Affordable Care Act. The Stage 2 rules go into effect for eligible hospitals Oct. 1 and for physicians and other eligible professionals Jan. 1.

Development of Direct messaging capabilities between these compact states remains a work in progress, according to ONC officials.

Follow Joseph Conn on Twitter: @MHJConn