ONC is giving $285,000 to DirectTrust, a trade association that is creating a security and trust framework for directed exchanges of information. The office also provided $205,000 to the EHR/HIE Interoperability Work Group (IWG), led by the New York eHealth Collaborative (NYec), which is developing plug-and-play interoperability for both directed exchange and query-based exchange. A directed exchange setup enables secure point-to-point electronic exchanges of clinical data between care providers. Query-based exchange capability lets providers find or request data from other providers.
DirectTrust's participation in the ONC cooperative will focus on the continued development of a national accreditation program for health information service providers (HISPs), certificate authorities, and registration authorities that act as trusted agents for users of directed exchange. DirectTrust has created such a program in conjunction with the Electronic Health Network Accreditation Commission (EHNAC). Since it debuted in February, a dozen HISPs and certificate authorities have applied for recognition, said David Kibbe, MD, president and CEO of DirectTrust, at a press conference held to announce the ONC awards.
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ONC's agreement with IWG calls for this group -- which includes 19 states, 20 EHR vendors and 22 health information exchange (HIE) vendors -- to continue its efforts to build interoperability while also addressing issues such as patient matching and querying provider directories.
IWG already is working with an ONC spinoff, the eHealth Exchange (formerly the Nationwide Health Information Network Exchange), through a partnership with Healtheway, which manages that national exchange. The partners have selected the Certification Commission on Health IT (CCHIT) to test and certify EHR and HIE software and eHealth Exchange participants for the ability to interoperate without customized interfaces.
Although the amounts that ONC awarded to the two organizations are not large, their official recognition shows the government's support for them. It also gives ONC sway in directing the activities of the organizations and aligning them with ONC's goals in the area of HIE governance.
Last year, ONC issued a request for information that included suggestions on a governance structure for the NwHIN Exchange. After being rebuffed by industry stakeholders, ONC backed off and decided that rather than creating a new governance structure, it would allow the industry to continue working out its own approaches to HIE governance.
At the press conference, Claudia Williams, director of HIE initiatives for ONC, said that, under the Exemplar HIE Governance Program, ONC would let the grant recipients implement the work themselves. But the organizations will collaborate with ONC on determining the scope and direction of the work, and the agency will also connect their efforts with other ongoing initiatives at ONC, she added.
Williams noted that the Meaningful Use stage 2 rules require providers to exchange patient information across organizational and vendor boundaries. To do this, they are expected to use the Direct secure messaging protocol, which must be imbedded in EHRs for them to be certified for Meaningful Use, starting next year.
The HISPs provide the technical means to transmit these messages, as well as the security and trust framework for ensuring that messages are correctly routed and that senders and receivers can identify each other. But up to now, HISPs have found it difficult to communicate with each other, because they lack agreements that embody this security and trust framework.
Kibbe said that the point of accreditation by EHNAC was to eliminate the need for every HISP to contract with other HISPs to create conditions of trust and guarantee certain standards of performance. "Accreditation enables parties to take a test and receive recognition and a seal of approval," he said, thereby making it more efficient and less costly for HISPs to do business with each other.
Asked how IWG would tackle the problem of provider directories, David Whitlinger, executive director of NYeC, replied that the collaborative would have to sort through various strategies for collecting and distributing Direct addresses. Among the possible approaches: a federated model that would allow participants to view addresses in local directories, or a mastery directory approach in which they'd be collected in one place and distributed locally.
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