Provoking providers to Direct exchange new prerogative in select states


Physicians and hospitals can disclose health information electronically and securely with recipients they know now that 27 states and Guam have gone live with simple directed exchange.

More than 5,000 providers have signed up for Direct services in those states, which include Ohio, West Virginia, North Dakota, Rhode Island and Mississippi.

A dozen more states will begin in July to offer Direct Project services as part of the State Health Information Exchange Program, according to a report announced June 18 by the Office of the National Coordinator for Health IT, which funds the state HIE program.

The Direct Project protocol for secure messaging saves time for doctors and patients, replaces the fax machine, avoids the need for expensive duplicate tests and supports better care. Direct is a streamlined version of the standards, services and policies for the Nationwide Health Information Network (NwHIN).

As more providers use Direct, more vendors will include it in their electronic health records (EHRs) and personal health records (PHRs). State HIEs are coming up with new use cases, including sharing information with patients, sending lab results and alerts, and populating repositories to support query-based exchange, according to Brett Andriesen, a project officer at the Office of the National Coordinator for Health IT in a June 18 blog post.

“As we have seen over and over in technology development, having a standardized way to solve a basic problem — in this case, getting information from here to there securely and electronically — enables all kinds of interesting and unexpected innovation,” he said.

States are using these tried-and-true approaches to drive use of Direct:

1. Focus on provider needs through high values uses. In Florida, hospitals are using Direct to transmit to the state-required newborn hearing screening data, which will also make reviews and reports by audiologists more efficient, in addition to reducing hospital paper and ink costs. In Ohio, the Greater Cincinnati Beacon Community and the HealthBridge regional health information organization are collaborating on a Direct transition-of-care demonstration. Two participating area hospitals are testing the use of Direct to send providers discharge summaries when patients leave the hospital, and the capability will be deployed to several other hospitals this year.

2. Start with who you know and market to existing providers. The Delaware Health Information Network (DHIN) utilized its existing user base of 80 percent of the state’s providers and communications channels, such as their website and email listserv, to promote a limited-time offer for Direct services. DHIN has the highest rate of signups to date. Wisconsin Statewide Health Information Network also has run an offer to discount Direct services for any signer in 2012.

3. Harness the power of network effects. The Arkansas Office of Health IT identified organizational and geographic care communities or networks, which already communicated regularly, through which they can extend outreach about Direct. The state’s Federally Qualified Health Centers is a critical node that needed an inexpensive way to communicate within their network to better coordinate care, and 500 providers signed up for Direct.

4. Make use of existing successful partnership and let them experience the innovation. Outreach about health information exchange, like Direct, is most effective when it is through trusted sources, such as the states’ regional health IT extension centers. Alaska is partnering with provider champions to identify physician needs and high-impact networks that could use Direct. The Nebraska Health Information Initiative partnered with the state’s regional health IT extension center, Wide River Technology Extension Center, to build awareness about Direct benefits, including developing a webinar, especially for providers in rural areas. 

5. Communicate about Direct services. Rhode Island conducts one-on-one practice visits that are coordinated through their extension center and Beacon programs. It also has a website space dedicated to the Direct Project and has held a series of webinars. Wisconsin has created a newsletter for providers in the state and sent letters to labs to introduce their lab survey and recruit participants for their direct lab pilot.

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