DirectTrust released for public comment a white paper containing more than 50 recommendations aimed at the more than 350 electronic health record (EHR) vendors and health IT products' vendors that provide Direct Interoperability, urging them to significantly improve the usability of their products for secure, interoperable clinical messaging.
The paper, "Feature and Function Recommendations to the HIT Industry to Optimize Clinician Usability of Direct Interoperability to Enhance Patient Care," was authored by a DirectTrust workgroup whose members are physicians and nurses with significant experience using Direct messaging to support health record sharing for care coordination and transitions of care. The authors encourage public comment on the paper before March 30.
DirectTrust is a non-profit, vendor neutral, self-regulatory entity initially created by and for participants in the Direct exchange community, including health internet service providers (HISPs), certificate authorities (CAs), registration authorities (RAs), doctors, patients and vendors. DirectTrust supports both provider-to-provider and patient-to-provider Direct exchange.
The paper describes ways for vendors to standardize and enhance their users’ experience in handling both inbound and outbound Direct clinical messages, and for facilitating how the clinical information exchanged during care coordination is managed and used.
The paper categorizes the recommendations into three categories –Required/Urgently Needed; Highly Desired and Advanced/Future Development. Examples of "required" recommendations include: that EHR software send Direct messages in "real time", not in delayed or batch mode; that multiple, common structured and unstructured file formats can be attached to any Direct message; e.g. PDF, Word, CCDA; and that all EHR systems must be able to automate patient matching of incoming Direct messages for patients that already exist in the recipient EHR.
“Sharing patients' clinical information across commonly-encountered boundaries of health IT systems is critically important to clinicians and their teams who are coordinating their patients' care across different providers and organizations,” Steven Lane, M.D., clinical informatics director at Sutter Health and co-chair of the Clinicians Steering Workgroup, said in a prepared statement. “Right now, in the typical medical community there is great diversity in the brands of EHRs and other health IT systems used by clinicians for Direct messaging. We're calling for all these vendors to make available more consistent and standardized software features to manage Direct clinical messages and their attachments. The existing variability in usability among different vendors' products is unacceptably high and poses a barrier to Direct interoperability, and thus to the adoption of secure messaging by clinicians to support common care coordination workflows.”
Highly desired recommendations include ensuring the ability to customize templates for specific clinical circumstances (e.g., discharge, referral, specific diagnosis, encounter types) and implementation of industry-wide standardized discrete data terminology for additional data types including procedures and laboratory results.
“In a community where high risk patients receive care from multiple clinicians associated with diverse organizations using different EHR systems, Direct interoperability can put critical clinical information in front of the physician inside their own EHR,” Holly Miller, M.D., co-chair of the Workgroup and chief medical officer at MedAllies, said in a statement. “This has been found to prevent patient adverse events and to be potentially lifesaving. Direct interoperability has provided basic connectivity. Now the HIT community needs to enhance usability, and address deficiencies and inconsistencies of messaging content and functionality.”
Miller added, “Clinicians recognize the possibilities for clinical efficiencies through enhancements to their systems and are clamoring for these improvements. Our hope is that this white paper will be used to help EHR and other vendors understand what clinicians need to support safe, secure, efficient and cost effective patient care as patients transition across their medical neighborhoods. This is about standardizing software features and functions so clinical personnel can reliably do their jobs and deliver high value patient care.”
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