Acronyms of Change, Part 4A (DIRECT)

DIRECT was created by the Office of the National Coordinator to specify "a simple, secure, scalable, standards-based way for participants to send authenticated, encrypted health information directly to known, trusted recipients over the Internet." In simple terms, this is the how of Portability. And for those already familiar with certified EHRs, it is via DIRECT that the Continuity of Care Document (CCD) and Record (CCR) will be exchanged.


As we move from EHRs into HIEs, DIRECT represents the standard by which protected patient health information will be shared. A primary care physician who is referring a patient to a specialist (e.g. an MD to an OD) will use the DIRECT standard to provide a clinical summary of that patient to the specialist and to receive a summary of the consultation. DIRECT is not about the actual content exchanged, only the means by which it is exchanged. The standard will meet Meaningful Use requirements. While the standard appears in Stage 1 it will be enforced moreso in Stage 2 and beyond. The formats for information exchange will include CCDs, CCRs, HL7 lab results, PDFs, TIFs, text and more. 


One very interesting and instructive element within the Direct Project is the workgroup on Best Practices for Content and Workflow.

"The goal of the Direct Project is to enable a wide network for directed health information exchange, with a backbone of universal addressing and universal transport, to improve health and health care. This goal requires a balancing act between two subordinate goals that often conflict: 

1. Opening exchange to a wide variety of exchange participants, including physicians who may not (yet) have complete electronic health records 
2. Enabling rich clinical workflows based on semantic interoperability with structured healthcare contents

The first goal argues for placing minimal barriers on content, to allow upgrade from fax and paper to electronic transactions. The second goal argues for restrictions on content to defined healthcare standards to enable rich clinical experience, cognitive support, and improved outcomes."

These two subordinate goals must, of course, be reconciled. In the meantime, they serve as a reminder that we are moving toward defined clinical standards undergirded by Clinical Decision Support and which end with pay-for-performance outcomes, also known as outcomes-based reimbursement.



Today's post has been largely informational. Be sure to check in for part B on this topic, a relevant heads-up perspective from Dr. Grue about why you need to get interested in ONC Direct.

For more information about the Direct Project, please see the Direct Project Boot Camp slide presentation or visit the Project Wiki and the project website."

Alistair Jackson, M.Ed.