THE DIRECT PROJECTUPDATE FOR THE FEDERAL HIT WORKGROUPArien MalecCoordinator, NHIN Direct Project

04/21/23

The NHIN Direct Project

A project to create the set of

standards and services that

with a policy framework enable

simple, directed, routed, scalable

transport over the Internet to be

used for secure and meaningful

exchange between known

participants in support of

meaningful use

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The Direct Project Secure Internet-based Point-to-Point Messaging

» Simple. Connects healthcare stakeholders through universal addressing using simple push of information.

» Secure. Users can easily verify messages are complete and not tampered with in travel.

» Scalable. Enables Internet scale with no need for central network authority.

» Standards-based. Built on common Internet standards for secure e-mail communication.

b.wells@direct.aclinic.org h.elthie@direct.ahospital.org

The Direct Project Facilitates Meaningful Use

» Patients:

• Health information

• Discharge instructions

• Clinical Summaries

• Reminders

» Public Health:

• Immunization registries

• Syndromic surveillance

» Other Providers/Authorized Entities:

• Clinical information

• Labs – test results

• Referrals – summary of care record

04/21/23

b.wells@direct.aclinic.org

The Direct Project facilitates the communication of many different kinds of content necessary to fulfill meaningful use requirements.

Examples of Meaningful Use ContentExamples of Meaningful Use Content

1) Get a Health Internet (email-like) address and a security certificate

2) Send mail securely using most e-mail clients OR contract with a HIO or HISP that performs authentication, encryption and trust verification on your behalf

The Direct Project Facilitates Meaningful Use

» Other Providers/Authorized Entities:• Clinical information • Labs – test results• Referrals – summary of care record

» Patients:• Health information • Discharge instructions• Clinical Summaries• Reminders

» Public Health:• Immunization registries• Syndromic surveillance

04/21/23

b.wells@direct.mclinic.org

The Direct Project facilitates the communication of many different kinds of content necessary to fulfill meaningful use requirements.

Examples of Meaningful Use ContentExamples of Meaningful Use Content

D I R E C T

Open Government and Focused Collaboration

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CORE PRINCIPLES

Prioritization

Transparency

Engagement

Rapid Results

FocusedCollaboration

A Thousand Flowers Bloom

Commandand Control

Low High

Participation

Classic

Trade-Off

Lo

wH

igh

Focus

Wikis, blogs, open code repositories, oh my…

04/21/23

The Importance of High Quality Open Source Libraries

» The history of the Internet shows the power of permissively licensed open source in driving standardization:

• TCP/IP: Berkeley TCP/IP stack• DNS: BIND• HTTP: Apache

» Successful open standards have easily accessible high-quality libraries trivially available to developers, including high quality documentation

» A key deliverable of the Direct Project is a BSD-licensed software stack enabling:

• Client-side connectivity, for EHRs, EHR Modules, PHRs, etc. and• Server-side connectivity for “out of the box” HIOs and Health

Information Service Providers (HISPs)

04/21/23

Close to 200 Implementation Group Participants

» Alere» Allscripts» American Academy of Family Physicians» Argonne National Laboratory» Atlas Development» Axolotl» CareSpark/MobileMD/Serendipity Health» Cautious Patient» Cerner» Clinical Groupware Collaborative» CSC » eClinicalWorks» EHR Doctors» Emdeon» FEI» GE» Google» Greenway Medical Technologies» Harris Corporation,» High Pine Associates» HLN Consulting, LLC» IBM» ICA» Inpriva» Intel» Kryptiq

» LabCorp» Massachusetts eHealth Collaborative» MedAllies» Medical University of SC, » Medicity» MedNet» MedPlus/Quest Diagnostics » Microsoft» Mirth Corporation» MOSS» Nationwide Health Information Technology» NIH NCI» NIST» NYC Dept. of Health and Mental Hygiene’s PCIP» Oregon HIE Planning Team» Redwood MedNet» RelayHealth» Rhode Island Quality Institute» Secure Exchange Solutions» Siemens» South Carolina SDE» SureScripts» Techsant Technologies» TN State HIE» VA» VisionShare

Most of the top EHR and HIE technology vendors, national service and IT providers (Surescripts, Quest, LabCorp, Microsoft, Google etc., good participation with states), VA strongly involved as a federal partner

Development Progress

» All volunteer team» Rapid and consistent growth on the C# side

• C# team had to write much more code (DNS, MIME) than Java team due to better libraries on the Java side

• API documentation in good shape, unit testing lagging behind» Java team has excellent progress on engineering quality (unit tests,

documentation)» 3-5 active developers/day

NHIN Direct High-Level Project Plan

ImmediateNext 90 Days

Short Term3 to 9 months

Long Term9 to 36 monthsActivity

Standards and Specification Development Activity

Real-world Implementation Activity

Regulatory Activity

Policy Activity

Immediate Initiatives

Short Term Initiatives

Long Term Initiatives

Initial Pilot Implementation

Expansion of Pilots

Draft Specification Complete

Transition to an SDO Ongoing Maintenance

Evaluation for inclusion by NHIN and ONC Endorsement

HITPC Tiger Team Framework and Policy Review

Feedback to NHIN Governance

Feedback on initial lessons learned

Ongoing Review and Feedback

Wide-Scale Deployment

Evaluation by HITSC

CareSpark (TN)

Direct Project Real-World Implementation

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Redwood MedNet (CA)

Carolina eHealth Alliance (SC)

MedAllies (NY) Rhode Island Quality Institute (RI)

Medical Professional Services (CT)

The Direct Project is architected for rapid adoption by:

• Thousands of hospitals• Hundreds of thousands of physicians• Millions of providers• Tens (or hundreds?) of millions of patients• Many other stakeholders in healthcare

The Direct Project will be demonstrated in real-world pilots across the country

Questions?

04/21/23