Direct, how do I get it?

If we've done a half decent job of convincing you that you need to get your hands on Direct, you may still be wondering how you get access to these secure communications capabilities.

The first thing to note is that you must work with a Health Information Service Provider (HISP). In some cases, the HISP may be identified and accessed through your state office. For the state Health Information Exchange, there are usually several state-approved HISPs. More importantly, the state office may still have a grant program for which you can qualify. We know of some states that offered a mini-grant for a first year free license. However, as time passes, the incentive programs will expire and more and more we'll see HISPs that simply operate in all states.

Once you've identified a HISP (your software vendor may also be working with a preferred HISP, as we are) you'll find that Direct is available in two ways: one, as an integrated solution within your EHRs and, two, as a non-integrated solution. The latter is an online solution that you'll access through either a web portal or some sort of email client. Note that if you're getting Direct free through your state HIE, you're probably being offered a standalone solution as regards your own EHR. It may connect to the state HIE but it's only your software vendor that can embed the functionality into your eye care EHR. So, the integrated solution is only available if your software vendor has done the integration work.

So what are the advantages of an integrated solution versus a non-integrated or standalone one? An integrated solution through your vendor will offer significant workflow efficiencies, such as having the communications at your fingertips within the exam record.  A non-integrated portal will not give you such an embedded solution in your clinician workflow. Software vendors won’t likely interface directly with every state-based HIE or HISP so when states do provide a free portal, it is a non-integrated web-based portal.

Perhaps the best example I can give of free versus integrated would be e-prescribing. In the early days of the NEPSI program, we saw a free online solution. That was a 5-year pilot program that eventually became a paid service. More important, it was never an integrated solution and did not qualify most users for Meaningful Use. Certified Complete EHRs require a fully integrated eRX solution. Though Direct is not (yet) part of MU Attestation, the question of efficiency remains important for doctors, and embedded solutions mean greater efficiency.

To be continued ...

Alistair Jackson, M.Ed.