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Channel Surfing

July 20, 2011
by Mark Hagland
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The Federal Direct Project Offers One More Option, Though a Supplementary One, to HIE-Based Clinical Communications

EXECUTIVE SUMMARY

The federal Direct Project may be a viable interim solution that can enhance clinician-to-clinician communications as HIEs continue to be developed.

Phoning and faxing healthcare data and information, especially patient records, are so last-century, but the healthcare industry still hasn't yet fully turbocharged the information superhighway towards health information exchanges (HIEs) and the Nationwide Health Information Network. The question is, what are the possible interim solutions to speeding clinician-to-clinician communications? The energy behind that question seems to be fueling progress on a federal initiative called the Direct Project (www.directproject.org), which is evolving forward among healthcare IT leaders on the provider and vendor sides, and fueling some technical and process collaboration could enhance such communications even as more complex HIE infrastructures continue to be developed.

As the project's website explains it, “The Direct Project specifies a simple, secure, scalable, standards-based way for participants to send authenticated, encrypted health information directly to known, trusted recipients over the Internet.” That mission statement encapsulates both the potentialities and limitations of Direct. Industry experts, and those involved in the demonstration project's development work, agree on one thing: while Direct could provide a very positive communications channel for clinicians around patient information, it will not-nor is it intended to-replace HIEs, or any other large communications superstructures. Instead, for a variety of relatively simple purposes-referring physicians sending their patient visit notes to specialists; clinical laboratories sending lab results to ordering providers; hospitals sending patient record information to their patients; primary care physicians sending patient immunization data to public health authorities, and so on-Direct will be helping to facilitate electronic communication that now in most cases still relies on faxing and other old-fashioned methods of transport, without the need for complex new data infrastructures.

Direct may also knock down barriers of skepticism and avoidance on the part of physicians in private practice, when it comes to participating in communication arrangements with other providers; just ask James Pollowitz, M.D., and Simeon Schwartz, M.D.

CLEARLY, BEING ABLE TO GET INFORMATION, INCLUDING HOSPITAL RECORDS, ONLINE IN REAL-TIME, IS INCREDIBLY IMPORTANT, AND WE'VE HAD THAT ABILITY FOR ABOUT TWO YEARS. -JAMES POLLOWITZ, M.D.

James Pollowitz, M.D.
James Pollowitz, M.D.

Earlier this spring, Pollowitz, an allergist and a member of the three-allergist Allergy and Asthma Associates of Westchester, in Scarsdale, a suburb of New York City, participated in the pilot phase of the Direct Project through his EHR vendor, the Carrollton, Ga.-based Greenway Medical. Meanwhile, Schwartz, who is president of the Westmed Medical group, a 200-plus multispecialty group practice in Purchase, N.Y., also a Westchester County community, worked, alongside other physicians in his group, with their vendor, the Chalfont St. Giles, U.K.-based GE Healthcare, and the Beaverton, Ore.-based Kryptiq, to create the foundation for a messaging capability that will encompass e-prescribing activity.

WE DON'T LIKE REGIONAL HEALTH INFORMATION EXCHANGES, AND OUR PATIENTS IN GENERAL HAVE INDICATED TO US THAT THEY ARE NOT COMFORTABLE HAVING THEIR DATA STORED IN THE ETHER, OUT OF OUR CONTROL. -SIMEON SCHWARTZ, M.D.

Mark Segal, Ph.D.
Mark Segal, Ph.D.

In the case of Allergy and Asthma Associates of Westchester, Pollowitz explains that “They basically created a module in the 2011 version of Greenway that allows you to export certain documents from within the EHR. There is an import feature, too, that I didn't have access to” as part of the initial pilot, he adds. The export capability, which was scheduled to go live about at the time of publication of this article, is something that Pollowitz says he is very much looking forward to taking advantage of. “Clearly, being able to get information, including hospital records, online in real-time, is incredibly important, and we've had that ability for about two years,” he says. “Added to that, being able to copy and paste within the EHR and to export information appropriately, will be a big advance,” he adds.

In the case of the Westmed Medical Group, Schwartz says that, “From my understanding, virtually everything is in place already” in order to go live very soon with Direct-channeled communications.” The first phase, which people are talking about now, is a push methodology, which allows me to do a consult, and send a consult-to-consult letter, and if the recipient is on the system, the document is immediately available to them. In the future,” he says, “I hope I can ultimately pull down the documents I need, from others.”

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