Understanding the Direct Project

Looking through some of the recent announcements on the Direct Project, it is not completely clear what NHIN is trying to represent if you are an EMR, Health Care Professional or Health Information Service Professional (HISP).

NHIN’s Direct Project is providing a specification and guidance on how interfaces can be built to exchange information in a secure, encrypted way using “email like” addresses on a network.

This is great! This is not an implementation though.

Health care professionals or ISVs who are looking at the Direct Project to solve their connectivity problems will need to understand that an interface will still need to be built, and encryption and key management will still need to be licensed in order to ensure all data is securely sent and in compliance.

This is a great step forward, and standards help drive adoption and innovation, so we will be excited to see how the trials turn out.

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NHIN (The Direct Project): Ready for Prime Time?

NHIN and NHIN Direct (now called “The Direct Project:) are frameworks for creating a standard system through which health care applications can communicate, share information, and connect with one another. And, according to Shahid Shah, in his article titled An Overview of NHIN and NHIN Direct for Software Developers*, “NHIN is far from settled and is not a forgone conclusion for data exchange, so you shouldn’t rest your complete integration strategy on it. In fact, make sure you have other options available to you.”

I don’t want to be too negative on NHIN or those who are striving to make it a production reality, but if you are considering connecting systems leveraging NHIN, you should understand where NHIN stands as a health information exchange solution.

With the HITECH Act, meaningful use (MU), and incentive payments on the line, a lot of organizations are trying to find their health information integrations solutions now, not in the future. As such, below are some weaknesses of NHIN that might be an issue when trying to implement a health care application integration solution:

  1. Still in early stages of testing with users
  2. Many security policies still need to be defined and implemented by the user
  3. Limited documentation for implementation
  4. May require application development for exchange integration, making it a resource intense solution to roll out

Given that there are a lot of new compliance regulations to meet in order to receive incentives, IT resources will be stretched, and anywhere you can implement a solution that does not require a large amount of overhead and technical expertise is going to be attractive. Even if NHIN and The Direct Project were ready for prime time, integrating your systems (which could be dozens per location), will require a lot of resources, time, and money.

In short, NHIN is not the silver bullet for health information exchange, nor is it the solution that companies, health care professionals, and application integrators can count on now.