HIMSS: Direct/CONNECT Update
ORLANDO, Fla. -- In the last year, the Office of the National Coordinator for Health IT (ONC) has gone from 38 employees to 138 due to the HITECH Act, said Doug Fridsma, MD, PhD, director at the Office of Interoperability & Standards at the ONC before speaking to an audience on the agency’s update to CONNECT and the Direct Project during the 2011 Healthcare Information Management and Systems Society (HIMSS) conference.

“Technology is not the primary goal,” said Fridsma. “It’s about adoption” and in the end, ONC wants that adoption of technology to help find avenues to meaningful use. To work toward meaningful use, ONC needs to establish trust and part of establishing larger conditions of trust is to establish trust locally, Fridsma stated.

The national health IT agenda, including the American Recovery and Reinvestment Act (ARRA) and the President’s reform agenda, focuses on building an open and transparent government.

Fridsma noted that the steps in promoting the national health IT agenda include establishing standards, technology services and trust to support interoperability; stimulate adoption of interoperable EHRs; and promote the meaningful use of EHRs to improve quality and efficiency.

To help establish accomplish these goals, the Nationwide Health Information Network (NHIN) was established as a set of policies, standards and services to enable the internet to be used for secure and meaningful exchange of health information to improve health and healthcare.

Fridsma noted that three components form the NHIN “ecosystem,” including:
  • NHIN Exchange - A collection of thought leaders, vendors and healthcare organizations that facilitate information exchange.
  • CONNECT software – A federally funded, open source software product that allows the exchange of health information via a platform for participation and innovation.
  • The Direct Project – A project to create the set of standards and services that, with a policy framework, enable simple, directed and routed transport over the internet to be used for exchange between known participants in support of meaningful use.

For CONNECT, Fridsma stated that, so far, organizations including the Department of Defense, Social Security Administration and the Centers for Disease Control and Prevention have demonstrated exchange with federal and non-federal organizations. Additionally, Fridsma mentioned that over 20 private sector organizations will have completed building products that communicate with CONNECT by the end of 2011 and that state and private sector organizations have also opted to adopt and use CONNECT in their products for interoperability.

“The Direct Project is a great example to convene the community” as ONC works towards creating a bi-directionality to help facilitate meaningful dialogues between users, Fridsma stated.

Over 60 organizations and 200 participants have committed to rolling out Direct-enabled tools, Arien Malec, coordinator for the Direct Project reported. According to Malec, Direct provides secure internet-based communication via a scalable, standards-based architecture.

One deliverable of the Direct Project is a BSD-licensed software stack to enable client-side connectivity for EHRs, EHR modules and personal health records and server-side connectivity for health information organizations and health information service providers. "We recognize information exchange is not a one-size-fits-all model,” Malec said. Noting that information exchange will require a whole suite of tools, he touted that “behind every well-adopted internet standard lies an open source library.”

The Direct Project began about a year ago and within 10 months, the first directed communication occurred via the transfer of immunization data during the transition of care in Minnesota.

There are four steps to the successful implementation and adoption of Direct, Malec noted. These include:
  • Reference Implementation: Simple set of code and strong documentation.
  • Pilot Demonstrations: Incorporation of reference implementations in select regions to learn for broader standards adoption.
  • Vendor Adoption: Case interfaces available for purchase and code and software installed in all health IT exchange products.
  • Policy Guidance.

Malec stated that the agency has already completed the first two stages and is well on the way to completing the third and fourth. Malec encouraged the audience to provide their voice on the subject in the future moving towards achieving organizational goals.