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Direct Project Overview
February 23, 2012

HIMSS eCollaboration Forum
Direct Project
What is Direct?

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
Direct Project: Why is there a need for Direct?




    Communication of health information among providers and patients still mainly relies on
      mail or fax
      • Slow, inconvenient, expensive
      • Health information and history is lost or hard to find in paper charts

    Current forms of electronic communication may not be secure
      • Encryption features of off-the-shelf e-mail clients not often used in healthcare communications
        today

    Physicians need to transport and share clinical content electronically in order to satisfy
    Stage 1 Meaningful Use requirements.
      • Need to meet physicians where they are now
      • Direct will be one of the communication methods in the Nationwide Health Information Network

Sources: http://www.flickr.com/photos/dougww/922328173/ http://www.flickr.com/photos/greenlagirl/154148230/sizes/o/ http://www.flickr.com/photos/kenjonbro/3418425029/sizes/m/
Direct Project
and other Information Exchange


The Direct Project doesn’t replace other
   ways information is exchanged
   electronically today, but it might          Nationwide Health
   augment them.                              Information Network
                                                   Exchange
The Direct Project supports simple use                                             Direct Project
   cases in order to speed adoption, but
   other methods of exchange might be
   suited for other scenarios.

The Direct Project was designed to
   coexist gracefully with existing
   protocols for data exchange.
                                               Nearby                             EMR to
                                                HIE                              EMR (HIE)
The Direct Project seeks to replace slow,
   inconvenient, and expensive methods
   of exchange (like paper, fax, or carrier             Health information exchange:
   pigeon) and provide a future path to                  a puzzle with many pieces
   advanced interoperability.
Direct Project
 Secure Internet-based Direct Communications



                             Direct Project specifies a simple, secure,
                                scalable, standards-based way for
                              participants to send encrypted health
                              information directly to known, trusted
                                    recipients over the Internet.


b.wells@direct.aclinic.org                                                h.elthie@direct.ahospital.org


                   » 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.
Direct Project
  Facilitates Meaningful Use

   Direct Project facilitates the communication of many different kinds of
   content necessary to fulfill meaningful use requirements.

                                                 Examples of Meaningful Use Content
                                                 »   Patients:
                                                      • Health information
                                                      • Discharge instructions
                                                      • Clinical summaries
                                                      • Reminders
                                        DIRECT
                                                 »   Public Health:
                                                      • Immunization registries
    b.wells@direct.aclinic.org                        • Syndromic surveillance
1) Get a Direct Address (e-mail-like)
                                                      • Laboratory Reporting
    and a security certificate
2) Send mail securely using most e-              »   Other Providers/Authorized Entities:
    mail clients OR contract with a                   • Clinical information
    HIO or HISP that performs
    authentication, encryption and                    • Labs – test results
    trust verification on your behalf                 • Referrals – summary of care record
Direct Project
Organization (as of November 2010)

  The Direct Project represents over 50 organizations and over 200
  participants.
   • Members participate in the Implementation Group and one or more
     of 6 workgroups.



                                 Implementation Group
                         (50+ organizations, 200+ participants)




  Security     Best      Implementation                      Documentation     Reference
                                          Communications
 and Trust   Practices    Geographies                         and Testing    Implementation
Direct Project
Close to 200 Participants in over 50 Organizations
 »   Allscripts                              »   Massachusetts eHealth Collaborative
 »   American Academy of Family Physicians   »   MedAllies
 »   Atlas Development                       »   MIE/NoMoreClipboard.com
 »   Axolotl                                 »   Medical University of SC
 »   CareSpark/MobileMD/Serendipity Health   »   Medicity
 »   Cautious Patient                        »   MedNet
 »   Cerner                                  »   MedPATH Networks
 »   Clinical Groupware Collaborative        »   MedPlus/Quest Diagnostics
 »   Covisint                                »   Microsoft
 »   CSC                                     »   Mirth Corporation
 »   eClinicalWorks                          »   MOSS
 »   Emdeon                                  »   NextGen
 »   Epic                                    »   NIH NCI
 »   FEI                                     »   NIST
 »   Garden State Health Systems             »   NYC Dept. of Health and Mental Hygiene
 »   GE                                      »   Oregon HIE Planning Team
 »   Google                                  »   Redwood MedNet
 »   Greenway Medical Technologies           »   RelayHealth
 »   Harris Corporation                      »   Rhode Island Quality Institute
 »   High Pine Associates                    »   Secure Exchange Solutions
 »   HLN Consulting, LLC                     »   Siemens
 »   IBM                                     »   South Carolina SDE
 »   Indiana State Department of Health      »   Surescripts
 »   Inpriva                                 »   Techsant Technologies
 »   Intel                                   »   TN State HIE
 »   Kryptiq                                 »   VA
 »   LabCorp                                 »   VisionShare
Direct Project
The Process
  Direct standards and specifications are developed by a group of public-
  private stakeholders. Weekly teleconferences and periodic face-to-face
  meetings facilitate active collaboration.
                                   Direct Project Output:
                          •   Standards and Service Definitions
                          •   Implementation Guides                          Vendors
                          •   Reference Implementation                     incorporate
                          •   Pilot project testing and real-world          reference
                              implementation                             implementation
                                                                        into HIT products


                     Wide-scale adoption of Direct
                         standards by late 2012                                 First phase
                                                                                grounded in
                                                                                 real-world
                                                                               pilot projects
                                                         Incorporation of      implemented
                                                         HITPC, HITSC,            by early
                                                         and ONC policy             2011
                                                            guidance
Direct Project
Open and Transparent Collaboration
Direct Project
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 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)
Direct Project: Real-world Implementation

 Direct Project is being demonstrated in real-world pilots across the country
 and is in production use by HIEs, EHRs, and PCHRs


     Gorge Health Connect, Inc. (OR)                                                   Rhode Island
                                             VisionShare (MN)                          Quality Institute
                                                                        MedAllies (NY) (RI)


  Redwood MedNet (CA)                                                                  Medical Professional
                                                                                       Services (CT)



                                       VisionShare (OK)
                                                                CareSpark (TN)

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
Direct Project
Four Steps to Direct

Successful implementation and adoption of Direct relies on four key steps.

                         1                               2                     3                     4




                                  Pilot Demonstrations




                                                             Vendor Adoption




                                                                                   Policy Guidance
  Reference Implementation: Solid, simple set of code and strong documentation.
  Pilot Demonstrations: Successful incorporation of reference implementation in select
   regions to learn from pilot experience for broader standards adoption.
 • Vendor Adoption: Base interfaces available for purchase and code and software
   installed in all HIT exchange products.
 • Scale Through Policy & Governance: Uniform trust framework for broad inter-network
   exchange.

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Ahier himss 2012 - direct project overview presentation

  • 1. Direct Project Overview February 23, 2012 HIMSS eCollaboration Forum
  • 2. Direct Project What is Direct? 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
  • 3. Direct Project: Why is there a need for Direct? Communication of health information among providers and patients still mainly relies on mail or fax • Slow, inconvenient, expensive • Health information and history is lost or hard to find in paper charts Current forms of electronic communication may not be secure • Encryption features of off-the-shelf e-mail clients not often used in healthcare communications today Physicians need to transport and share clinical content electronically in order to satisfy Stage 1 Meaningful Use requirements. • Need to meet physicians where they are now • Direct will be one of the communication methods in the Nationwide Health Information Network Sources: http://www.flickr.com/photos/dougww/922328173/ http://www.flickr.com/photos/greenlagirl/154148230/sizes/o/ http://www.flickr.com/photos/kenjonbro/3418425029/sizes/m/
  • 4. Direct Project and other Information Exchange The Direct Project doesn’t replace other ways information is exchanged electronically today, but it might Nationwide Health augment them. Information Network Exchange The Direct Project supports simple use Direct Project cases in order to speed adoption, but other methods of exchange might be suited for other scenarios. The Direct Project was designed to coexist gracefully with existing protocols for data exchange. Nearby EMR to HIE EMR (HIE) The Direct Project seeks to replace slow, inconvenient, and expensive methods of exchange (like paper, fax, or carrier Health information exchange: pigeon) and provide a future path to a puzzle with many pieces advanced interoperability.
  • 5. Direct Project Secure Internet-based Direct Communications Direct Project specifies a simple, secure, scalable, standards-based way for participants to send encrypted health information directly to known, trusted recipients over the Internet. b.wells@direct.aclinic.org h.elthie@direct.ahospital.org » 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.
  • 6. Direct Project Facilitates Meaningful Use Direct Project facilitates the communication of many different kinds of content necessary to fulfill meaningful use requirements. Examples of Meaningful Use Content » Patients: • Health information • Discharge instructions • Clinical summaries • Reminders DIRECT » Public Health: • Immunization registries b.wells@direct.aclinic.org • Syndromic surveillance 1) Get a Direct Address (e-mail-like) • Laboratory Reporting and a security certificate 2) Send mail securely using most e- » Other Providers/Authorized Entities: mail clients OR contract with a • Clinical information HIO or HISP that performs authentication, encryption and • Labs – test results trust verification on your behalf • Referrals – summary of care record
  • 7. Direct Project Organization (as of November 2010) The Direct Project represents over 50 organizations and over 200 participants. • Members participate in the Implementation Group and one or more of 6 workgroups. Implementation Group (50+ organizations, 200+ participants) Security Best Implementation Documentation Reference Communications and Trust Practices Geographies and Testing Implementation
  • 8. Direct Project Close to 200 Participants in over 50 Organizations » Allscripts » Massachusetts eHealth Collaborative » American Academy of Family Physicians » MedAllies » Atlas Development » MIE/NoMoreClipboard.com » Axolotl » Medical University of SC » CareSpark/MobileMD/Serendipity Health » Medicity » Cautious Patient » MedNet » Cerner » MedPATH Networks » Clinical Groupware Collaborative » MedPlus/Quest Diagnostics » Covisint » Microsoft » CSC » Mirth Corporation » eClinicalWorks » MOSS » Emdeon » NextGen » Epic » NIH NCI » FEI » NIST » Garden State Health Systems » NYC Dept. of Health and Mental Hygiene » GE » Oregon HIE Planning Team » Google » Redwood MedNet » Greenway Medical Technologies » RelayHealth » Harris Corporation » Rhode Island Quality Institute » High Pine Associates » Secure Exchange Solutions » HLN Consulting, LLC » Siemens » IBM » South Carolina SDE » Indiana State Department of Health » Surescripts » Inpriva » Techsant Technologies » Intel » TN State HIE » Kryptiq » VA » LabCorp » VisionShare
  • 9. Direct Project The Process Direct standards and specifications are developed by a group of public- private stakeholders. Weekly teleconferences and periodic face-to-face meetings facilitate active collaboration. Direct Project Output: • Standards and Service Definitions • Implementation Guides Vendors • Reference Implementation incorporate • Pilot project testing and real-world reference implementation implementation into HIT products Wide-scale adoption of Direct standards by late 2012 First phase grounded in real-world pilot projects Incorporation of implemented HITPC, HITSC, by early and ONC policy 2011 guidance
  • 10. Direct Project Open and Transparent Collaboration
  • 11. Direct Project 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 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)
  • 12. Direct Project: Real-world Implementation Direct Project is being demonstrated in real-world pilots across the country and is in production use by HIEs, EHRs, and PCHRs Gorge Health Connect, Inc. (OR) Rhode Island VisionShare (MN) Quality Institute MedAllies (NY) (RI) Redwood MedNet (CA) Medical Professional Services (CT) VisionShare (OK) CareSpark (TN) 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
  • 13. Direct Project Four Steps to Direct Successful implementation and adoption of Direct relies on four key steps. 1 2 3 4 Pilot Demonstrations Vendor Adoption Policy Guidance  Reference Implementation: Solid, simple set of code and strong documentation.  Pilot Demonstrations: Successful incorporation of reference implementation in select regions to learn from pilot experience for broader standards adoption. • Vendor Adoption: Base interfaces available for purchase and code and software installed in all HIT exchange products. • Scale Through Policy & Governance: Uniform trust framework for broad inter-network exchange.