Direct Project — Hooray!?

Fortunately NHIN will not even tell you that the Direct Project is the end-all solution to making the ubiquitous exchange of health information a reality.

That being said, many interpret it as a simple evolutionary step to secure health information exchange and compliance. Let’s take a look at what the Direct Project is and specifies:

  1. The Direct Project is a specification or recommendation about how secure health information exchange can be achieved via the SMTP protocol,
  2. In order to interface to the Direct Project network, you will still need to rely on a health information service provider,
  3. Each participant in the Direct Project will have a published Health Domain Name or HDN which is used for authentication; this will look like an email address or domain to users and is how other participants will identify each other

There are many other requirements that outline what is needed to adhere to the Direct Project specification, but above are the high-level concepts. In itself, it is a great and elegant approach to solving the problem of interoperability and health data exchange, but there are some items of concern that need to be addressed when determining how to gain widespread adoption:

  1. While some vendors are supporting the Direct Project in software patches and new releases of software, what does this mean for healthcare professionals that do not have applications that will comply? How will they interface to the Direct Project?
  2. What about large hospitals or groups that have many systems from multiple vendors? Will their router be able to interface to the Direct Project network without increasing the work load of already over-stretched IT staff?
  3. While some vendors have updates and patches for adhering to the Direct Project specification, are there other requirements needed in order to comply, e.g. changes to a hospital’s SMTP server?

At Cloak Labs we are very excited about the Direct Project and believe it does provide a solid foundation for improving health information exchange. Our concern, however, is that it will require that healthcare providers to allocate over-stretched resources to meet the requirements of Direct and get their health IT systems to integrate with the network even if their EMR/EHR supports Direct.

We believe that as an added goal of the Direct Project, implementation and integration should not be difficult and that health IT folks need a solution that will minimize the impact to their workflows and current workload.

Cloak Labs is defining a better way for health IT professionals to take advantage of everything the Direct Project has to offer while minimizing the impact to their IT infrastructure and workflows.



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