Direct Messaging Called Major Advance in State’s HIE Effort

It looked a little like a beehive. Health information exchange conference attendees clustered around a series of kiosks, crowding in to see a hands-on demonstration of direct messaging — a relatively new electronic interface promoted by the national Direct Project that allows secure transmission of a wide variety of files, from MRIs to lab results, even between health care providers with different electronic health record systems.

“The big deal is [the entire California HIE community is] focused on direct,” said Pamela Lane, deputy secretary of the state’s Health Information Exchange, part of the Health and Human Services Agency.

“Direct is a way of tackling the interoperability problem,” Lane said. “It’s a quick, easy way to implement a universal, or at least broadly applicable, solution.”

The interoperability exhibit — put together by Cal eConnect — was clearly a big hit at the conference. “It gives people an opportunity to see it in action,” Lane said. “A lot of folks in HIE have read about it or heard about it, but they see the demonstration and they go, ‘Oh, now I get it.'”

Focus on Innovations, Next Steps

The annual Redwood MedNet conference, “Connecting California to Improve Patient Care in 2012: Practical Solutions for Health Information Exchange and Quality Analytics,” gathered most of the stakeholders and experts in California’s HIE world for two days of meetings last week in Rohnert Park.

Discussions focused on innovations in technology, as well as on the next steps that need to be taken in HIE policy and production — but the conversation kept coming back around to a common theme.  

“We’re not here for health IT,” said Claudia Williams, the director of the state HIE program at the Office of the National Coordinator for Health IT in Washington, D.C. “We’re here for health improvement for individual patients, we’re here for improvement of population health and for lowering costs of medical care.”

Almost every aspect of national health care reform depends on improvement of the health information technology system, Williams said, to ensure smoother, more efficient and more complete integrated care for patients.

According to Williams, 45% of providers now are electronically prescribing and 57% of office-based physicians are using EHR systems — which is a huge leap forward, she said.

“We have a long ways to go, but we’re on that path,” Williams said. “We’re seeing this burgeoning of the [health information] exchange. … Adoptions [of HIT] are going up, the federal dollars are going out the door to support it, and now we’re seeing the tipping point. I would like to say that this is the year we turn the corner.”

One of the ways to speed up while taking that turn lies in the use of direct messaging — also known as direct exchange — between providers, Lane said. The inability to quickly convey information is one of the bigger issues facing providers who use EHR systems, she said.

The way to do that now is through use of direct messaging software, Lane said.

“What they’re showing [at the interoperability exhibit] is different components of data that can be moved over that technology, whether that’s parts of EHRs or continuity of care documents, so you can see a transaction and the form in which it’s received. [They are] real data, and you see [them] immediately.”

It’s similar to email, with a few major differences. The size of files can be immense. Enhanced, digitized, high-resolution MRIs, for instance, take a lot of data space to transmit and the number of file formats is practically endless, Lane said. The biggest difference between this kind of transfer of data and email is security, Lane said.

“This is secure,” she said. “Direct is a secure method, and email is not.”

Keeping patient information secure is crucial. “The security imperative of it meant that it had to be encrypted. It had to be transformed. And then at the endpoint, it had to be untransformed. And that was a huge problem. Fixing that,” she said. “That’s a huge accomplishment and a huge leap. It’s a breakthrough. That’s what it’s all about.”

Right now, Lane said, federal officials are promoting direct messaging for treatment and care purposes only, not for payment use or research purposes. “It’s just for clinical data elements,” Lane said. “Research and data analytics, those are all valid reasons to use it, but they’re not promoted at this point.”

The ability for providers to use different EHR systems and still be able to communicate effortlessly is a dramatic advance, Lane said. “From the provider perspective, it’s very expensive, to solve an interface problem with every other provider. In the past, every one of those [connections] needed an interface,” she said. “Here, you get past the need for multiple interfaces.”

To Lane, this innovation is emblematic of the kind of change that needs to happen for health care reform to succeed.

“The key is getting HIE to work. Making the patient experience better requires data to move,” Lane said. “That’s the tool part that gets us to the patient care we need.”

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