Collaboration and Federation: IHE Creating Direct Project Provider Directory

The Direct Project’s use is increasing at a rapid pace. The Meaningful Use-required transport standard is easy to use and is finally starting to change the discussion those in the health IT industry are having around health information exchange.

The Direct Project’s use is increasing at a rapid pace. The Meaningful Use-required transport standard is easy to use and is finally starting to change the discussion those in the health IT industry are having around health information exchange.

We’re seeing a move from talking about the sustainability and interfacing challenges of HIE organizations to a new discussion focused on a one-to-one exchange of patient data between referring caregivers.

While that actually may seem like a step back to the point-to-point model, the real difference with Direct is that the one-to-one exchange will also involve the patient, who now can directly receive and send his or her summary of care information (C-CDA), avoiding the hassles involved with requesting record transfer from a previous physician. Add in Blue Button functionality and all the needed tools are beginning to fall into place.

This new, one-to-one dynamic is made possible due to the ease of use of the Direct standard (SMTP-based “secure email”) and also because all 2014-certified EHRs are required to support the Direct protocol, which is increasing distribution and the use of the push-based method, even though it is just one of many communication standards typically employed by interface engines in a health system’s architecture.

One key element missing from the Direct Project story is a directory of providers’ Direct email addresses. How can a Direct message be sent if neither the sender nor the receiver knows the Direct email address? There is not a common Direct email phone book, per se, of providers’ addresses freely available on the Internet.

IHE USA has been hard at work on this project via the HPD Provider Directory Task Group, a collaboration with the ONC, Interoperability Working Group, and eHealth Exchange. Their end goal is to create an IHE HPD (health provider directory) profile that can be used across the health IT industry to query databases that match the search parameters.

Currently, provider email addresses are scattered in as many places as you can imagine, therefore creating and maintaining a single database directory would be impossible and also quickly out of date as new addresses are added on a daily basis. This diffusion of locations has required IHE to employ a federated approach to searching for and successfully matching a provider.

I was able to see a demo of the Federated HPD in action at the HIMSS14 Interoperability Showcase, a collaboration between CareEvolution, Inpriva, NextGate, SureScripts, and Verizon. The results were impressive and produced Direct email addresses after applying the ID algorithm and querying various unaffiliated sources to find the correct provider.

The group is very close to releasing the finished profile, but there are two areas that are still a work in progress:

• Federation Facilitation. Absence of a centralized authoritative directory requires federation capability (within and across organizations) to use existing directories so that electronic addresses of providers and their systems can be discovered during workflows.
• Error Handling. Provide ability for a client to implement local policies and workflows based on complete/incomplete responses received.

During a webinar April 1, the group reached out to vendors and asked them to participate in a virtual connectathon to test the IHE HDP profile and work through these challenges. According to their timeline, the IHE HPD profiles are available this month for trail implementation and the group hopes products will begin to hit the market this summer.

The IHE work group’s stated goals:

• Keep IHE HPD profile in sync as much as possible, and remain vendor and technology neutral
• Ensure the technology is ready for implementation prior to it being a candidate for broad industry adoption
• Meet the requirements for the Direct Project, for the eHealth Exchange, and for state directories/International working group (IWG), etc.

The ONC, not surprisingly, has high interest in seeing the healthcare provider directory progress to help advance the use of Direct.

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