Post on 25-Dec-2015
THE DIRECT PROJECTUPDATE FOR THE FEDERAL HIT WORKGROUPArien MalecCoordinator, NHIN Direct Project
04/19/23
The NHIN Direct Project
A project to create the set of
standards and services that
with a policy framework enable
simple, directed, routed, scalable
transport over the Internet to be
used for secure and meaningful
exchange between known
participants in support of
meaningful use
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The Direct Project Secure Internet-based Point-to-Point Messaging
» Simple. Connects healthcare stakeholders through universal addressing using simple push of information.
» Secure. Users can easily verify messages are complete and not tampered with in travel.
» Scalable. Enables Internet scale with no need for central network authority.
» Standards-based. Built on common Internet standards for secure e-mail communication.
b.wells@direct.aclinic.org h.elthie@direct.ahospital.org
The Direct Project Facilitates Meaningful Use
» Patients:
• Health information
• Discharge instructions
• Clinical Summaries
• Reminders
» Public Health:
• Immunization registries
• Syndromic surveillance
» Other Providers/Authorized Entities:
• Clinical information
• Labs – test results
• Referrals – summary of care record
04/19/23
b.wells@direct.aclinic.org
The Direct Project facilitates the communication of many different kinds of content necessary to fulfill meaningful use requirements.
Examples of Meaningful Use ContentExamples of Meaningful Use Content
1) Get a Health Internet (email-like) address and a security certificate
2) Send mail securely using most e-mail clients OR contract with a HIO or HISP that performs authentication, encryption and trust verification on your behalf
The Direct Project Facilitates Meaningful Use
» Other Providers/Authorized Entities:• Clinical information • Labs – test results• Referrals – summary of care record
» Patients:• Health information • Discharge instructions• Clinical Summaries• Reminders
» Public Health:• Immunization registries• Syndromic surveillance
04/19/23
b.wells@direct.mclinic.org
The Direct Project facilitates the communication of many different kinds of content necessary to fulfill meaningful use requirements.
Examples of Meaningful Use ContentExamples of Meaningful Use Content
D I R E C T
Open Government and Focused Collaboration
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CORE PRINCIPLES
Prioritization
Transparency
Engagement
Rapid Results
FocusedCollaboration
A Thousand Flowers Bloom
Commandand Control
Low High
Participation
Classic
Trade-Off
Lo
wH
igh
Focus
The Importance of High Quality Open Source Libraries
» The history of the Internet shows the power of permissively licensed open source in driving standardization:
• TCP/IP: Berkeley TCP/IP stack• DNS: BIND• HTTP: Apache
» Successful open standards have easily accessible high-quality libraries trivially available to developers, including high quality documentation
» A key deliverable of the Direct Project is a BSD-licensed software stack enabling:
• Client-side connectivity, for EHRs, EHR Modules, PHRs, etc. and• Server-side connectivity for “out of the box” HIOs and Health
Information Service Providers (HISPs)
04/19/23
Close to 200 Implementation Group Participants
» Alere» Allscripts» American Academy of Family Physicians» Argonne National Laboratory» Atlas Development» Axolotl» CareSpark/MobileMD/Serendipity Health» Cautious Patient» Cerner» Clinical Groupware Collaborative» CSC » eClinicalWorks» EHR Doctors» Emdeon» FEI» GE» Google» Greenway Medical Technologies» Harris Corporation,» High Pine Associates» HLN Consulting, LLC» IBM» ICA» Inpriva» Intel» Kryptiq
» LabCorp» Massachusetts eHealth Collaborative» MedAllies» Medical University of SC, » Medicity» MedNet» MedPlus/Quest Diagnostics » Microsoft» Mirth Corporation» MOSS» Nationwide Health Information Technology» NIH NCI» NIST» NYC Dept. of Health and Mental Hygiene’s PCIP» Oregon HIE Planning Team» Redwood MedNet» RelayHealth» Rhode Island Quality Institute» Secure Exchange Solutions» Siemens» South Carolina SDE» SureScripts» Techsant Technologies» TN State HIE» VA» VisionShare
Most of the top EHR and HIE technology vendors, national service and IT providers (Surescripts, Quest, LabCorp, Microsoft, Google etc., good participation with states), VA strongly involved as a federal partner
Development Progress
» All volunteer team» Rapid and consistent growth on the C# side
• C# team had to write much more code (DNS, MIME) than Java team due to better libraries on the Java side
• API documentation in good shape, unit testing lagging behind» Java team has excellent progress on engineering quality (unit tests,
documentation)» 3-5 active developers/day
NHIN Direct High-Level Project Plan
ImmediateNext 90 Days
Short Term3 to 9 months
Long Term9 to 36 monthsActivity
Standards and Specification Development Activity
Real-world Implementation Activity
Regulatory Activity
Policy Activity
Immediate Initiatives
Short Term Initiatives
Long Term Initiatives
Initial Pilot Implementation
Expansion of Pilots
Draft Specification Complete
Transition to an SDO Ongoing Maintenance
Evaluation for inclusion by NHIN and ONC Endorsement
HITPC Tiger Team Framework and Policy Review
Feedback to NHIN Governance
Feedback on initial lessons learned
Ongoing Review and Feedback
Wide-Scale Deployment
Evaluation by HITSC
CareSpark (TN)
Direct Project Real-World Implementation
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Redwood MedNet (CA)
Carolina eHealth Alliance (SC)
MedAllies (NY) Rhode Island Quality Institute (RI)
Medical Professional Services (CT)
The Direct Project is architected for rapid adoption by:
• Thousands of hospitals• Hundreds of thousands of physicians• Millions of providers• Tens (or hundreds?) of millions of patients• Many other stakeholders in healthcare
The Direct Project will be demonstrated in real-world pilots across the country