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Direct Project Addresses Transitions of Care

March 7, 2011
by David Raths
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MedAllies CEO A. John Blair III, M.D., describes Hudson Valley Initiative’s pilot to ease message transport

The Direct Project, a connectivity effort led by the Office of the National Coordinator (ONC), is finding a receptive audience among some physician groups seeking to exchange basic clinical information.

Last year ONC brought together 200 volunteers who worked to assemble consensus standards for some basic types of exchange of authenticated and encrypted health data that could take place without requiring a fully functioning health information exchange. This year, seven pilot projects using Direct Project specifications are under way.

“ONC really got it right this time,” says A. John Blair III, M.D., CEO of Fishkill, N.Y.-based MedAllies, a health information services provider working on one of the Direct pilot projects.

Along with Taconic IPA and Taconic Health Information Network and Community (THINC), MedAllies is part of the Hudson Valley Initiative (HVI), an effort to spur a high level of electronic health record usage in physician offices and to boost interoperability. Following the direction of integrated systems such as Pennsylvania’s Geisinger Health System, Hudson Valley physician groups are seeking to create embedded care manager positions to focus on high-risk patients, Blair adds. The connectivity efforts have to put an emphasis on care coordination and transition.

The project is focusing on common care transition episodes such as a patient discharge from a hospital back to their primary care physician. Other use cases include a consultation request from a primary care provider to a specialist, then the clinical consultation from the specialist back to primary care.

The Direct Project infrastructure includes a Simple Mail Transfer Protocol (SMTP) backbone and support for the XDR (Cross-Enterprise Document Reliable Interchange) protocol, which permits direct document interchange between EHRs in the absence of a document-sharing infrastructure.

The clinical sites involved are Albany Medical Center, Asthma and Allergy Associates of Westchester, Community Care Physicians, Health Quest System (Vassar Brothers Medical Center, Putnam Hospital Center and Northern Dutchess Hospital), Institute for Family Health, Scarsdale Medical Group LLP. Their EHR vendor partners are Allscripts, eClinicalWorks, Epic, Greenway, NextGen and Siemens.

So how does this Direct Project approach relate to the ongoing process of building out HIEs?

“We see this as existing outside an HIE,” Blair says. HIEs offer access to more of a complete patient record, he adds.

One potential benefit of Direct is that rather than receiving a large bucket of data, the clinician can get a much more targeted message such as a discharge summary. Examples of Direct Project exchanges include the results of e-referrals and e-consultations. When a patient is discharged from the hospital, that information can be routed to a primary care practice’s care coordinator, a scheduler, the physician, or all three. “That way it can’t fall through the cracks,” he says.

The Hudson Valley pilot sites are already exchanging data, and Blair says the EHR vendors are working to build the XDR protocol into their next versions. Then MedAllies could potentially roll out a national network by the end of the year, he says.

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