Direct Messaging Energizes Wisconsin's Health Information Exchange

The Direct Project, the national protocol for secure clinical
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The Wisconsin Statewide Health Information Network (WISHIN) will use the Direct Project, a secure clinical messaging protocol, to jumpstart health information exchange (HIE) throughout Wisconsin, as the state's designated, not-for-profit entity starts to develop a robust, bidirectional HIE.

WISHIN has contracted with the ABILITY Network, based in Minneapolis, to provide the technological capabilities required for Direct messaging, including identity verification, certificate management, and the exchange itself. Earlier this year, ABILITY conducted the first test of the Direct Project by linking the Hennepin County Medical Center in Minneapolis to the Minnesota Department of Health.

Created by a public-private consortium that includes the Office of the National Coordinator of Health IT (ONC), the Direct Project is a push technology that allows physicians, hospitals, labs, pharmacies, and other entities to exchange results, reports, and other clinical data over a secure network. Providers can view Direct messages on a website or use their electronic health records (EHRs) to send and receive messages if those EHRs have Direct capability.

WISHIN Direct will soon be available on the organization's website. Wisconsin hospitals will be able to start using it in September to comply with the Meaningful Use requirements before the end of the federal government's fiscal year.

Meaningful Use is only one reason for WISHIN to adopt Direct, WISHIN CEO Joe Kachelski told InformationWeek Healthcare. WISHIN also views Direct as a way "to get information moving" right away, he said. It will take some time for WISHIN and Wisconsin healthcare organizations to implement a full, statewide HIE that will allow clinicians to share portions of their EHRs and do queries for patient information. Meanwhile, providers can use Direct to communicate with one another, regardless of whether or not they have an EHR.

Direct messaging can help providers improve the continuity of care when patients move among healthcare settings, Kachelski said. In addition, it can reduce or eliminate the use of faxes, which are an administrative burden on providers.

Some of Wisconsin's largest groups are users of the Epic EHR, so it would be fairly simple to connect them with Direct messaging. But in Kachelski's view, the real value of Direct is its ability to link providers with disparate EHRs, as well as those that are still using paper records. For example, he noted that few nursing homes have EHRs, but hospitals could use Direct to send inpatient data on patients they refer to long-term care facilities.

WISHIN will charge users $25 per month per Direct address, with volume discounts available to organizations with multiple addresses, Kachelski said.

Meanwhile, there are indications that Direct is beginning to take hold nationally. The ABILITY Network, for example, has become a state-approved "health data intermediary" in Minnesota, which allows it to build a statewide HIE, according to ABILITY president John Feikema. ABILITY has also begun signing up individual physicians for Direct messaging. For the first year, the service will be free; after that, ABILITY will probably charge about $15 per month per Direct address.

While the company functions as a health ISP (HISP), in Minnesota, it also serves as the technology partner for other states and regional HIEs. For instance, Feikema says, it is providing the expertise for the Direct initiative at the Michiana HIE in South Bend, Ind., and a statewide HISP in Rhode Island.

Shortly after the Direct Project was announced last winter, its sponsors said that more than 20 states, along with 60 healthcare providers, EHR vendors, and other entities, were supporting the protocol. Recently, according to Feikema, ONC claimed that vendors representing about 80% of the market had made their products Direct-capable or were in the processing of adding that capability.

Feikema and Kachelski agree that Direct will be a long-term component of HIE, even after bidirectional HIEs become widespread. "It's a very efficient tool for people to exchange information," Feikema said, noting that Direct covers a high percentage of the use cases for data interchange.

Kachelski said, "Direct is a small but important step. You may not be able to draw a straight line from the Direct kind of exchange to a robust bidirectional exchange, but in terms of workflow and starting to think differently about how information might be shared and used to advance clinical decision making, Direct does open the door to the possibilities that are out there."

Find out how health IT leaders are dealing with the industry's pain points, from allowing unfettered patient data access to sharing electronic records. Also in the new, all-digital issue of InformationWeek Healthcare: There needs to be better e-communication between technologists and clinicians. Download the issue now. (Free registration required.)

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