Acronyms of Change, Part 4B (DIRECT)

In our last blog, Part A of the same topic, Alistair provided a good basic understanding of DIRECT, a term you may not have been familiar with but one that, if you aren’t familiar and aren’t making the right choices now, may cost you dearly in the future.  As the core communication standard chosen by the Office of the National Coordinator of Health Information Technology, DIRECT must now be used by every state Health Information Exchange (HIE) in view of creating an eventual national HIE. DIRECT is worthy of our close attention. 

Why could HIEs cost you a lot of money in the future? First, because there is no long-term money anywhere in health care funding for the ongoing maintenance of the information exchanges. In the national system proposed by the government, DIRECT would be the national standard and would make it possible for all health care facilities and providers to exchange health information using exactly the same recognized and established communications protocols as established early on by the state HIEs.  If this becomes the national functional standard, then it is thought that the cost of using the exchange will be in the range of hundreds of dollars per provider per year. No provider wants to pay this fee, but the alternative is much more costly. Under the government's proposed plan, the financial benefit to be incurred would far exceed the cost paid for using the exchange. Independent or small group providers would realize a net financial gain by using exchanges standardized around DIRECT.

There is competition however, competition that you may easily feel you should support if you aren’t well informed. You may already have been approached by a large health system in your area telling you that patient health information is available through a free web portal, one that lets you simply log in to see all your patient information. Some ODs are already doing this. At first glance, it appears to be a great benefit, very convenient. Unfortunately however, it is the first step in the large health systems trying to take control of the state HIE. The model is to create an information exchange that requires independent providers to access the state and national exchanges through the local health system's communication network. 

There is growing evidence that these networks can indeed support the cost of you accessing patients from within the health system, as it is essentially marketing for the health system and a business plan that can increase referrals into the system. There is also however strong evidence that these same health systems are establishing exchange capabilities that create a profit center for the future. It is likely that, if large health systems successfully control the state exchanges, we will see fees in the thousands of dollars per provider per year to use the exchanges for access to the national system when it involves patients from outside the local health system. 

When your local health system makes a very generous offer to give you a free portal to view patient information, recognize that by doing so you are casting your vote for the future choice that will probably be the most expensive for you. Begin with the end in mind; we recommend DIRECT  Accept a modest fee early on in order to circumvent exorbitant fees later on.


Jim Grue, O.D.