One Nation, One EHR –The Direct Project

The essence of Health Information Exchange (HIE) lies in easily accessible health information to improve the quality of care delivered by the healthcare community. Complicated formats intrinsic to many EHR systems are generally counterproductive to this basic nature of HIEs and can prove to be a hindrance against delivering quality care. So the natural question arises, what can be done to remove such blockades in the inherent design of these EHRs to facilitate their intended requisites? A popular solution proposed to answer this query is to develop a holistic system of sharing health information between healthcare providers and other concerned entities on a national level within the healthcare continuum.

With the expected level of complications in developing such a system, a lot of critics would say that the notion of a national EHR system is far-fetched and would dismiss the idea altogether. Their objection would be justified if we considered the amount of time invested into the development and implementation of health information interoperability throughout the nation and still not attaining the desired results. Not even a single developed country so far has managed to go a hundred percent electronic with their clinical documentation. That being said, we have examples of numerous countries that have successfully devised and kicked off a national EHR system including France, Singapore, Sweden and Germany. These systems have been successfully deployed for quite some time now and are functioning with improved efficiency while acquiring a larger database of patients by the day.

 

When one ponders over the matter, the ideal solution would be to implement such a system in the United States as well. It wouldn’t matter which hospital you visited or if you switched providers, your private health record would be accessible in a secure format no matter where the point of care is located. Reflect on the example where your physician refers you to another specialist. Imagine if the specialist already had your health information upon your arrival instead of you having to remember your previous tests, medications and diagnoses. Wouldn’t that be much more convenient and helpful as compared to the alternative?

The fact of the matter is that the government is not oblivious to the huge potential which lies in developing such an interface on a national scale. Significant efforts have been made towards achieving such a system. The government’s endeavors came to fruition in March of 2010 when the Direct Project was launched and furthered the struggle to form a robust nationwide health information network. The Direct Project was developed in order to create a secure, simple and scale able platform which is standardized to send/receive authenticated health information to trusted entities over the internet. More than fifty different organizations and 200 participants are currently employing the Direct Project to their benefit. These participants consist of PHR and EHR vendors, system integrators, medical organizations, federal organizations, health IT consultants and many more. We will try to illustrate some implemented instances pertaining to the Direct Project with some examples in this extract.

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Florida

The Newborn Hearing Screening Program (NBS) in Florida mandates the state’s hospitals to monitor all newborn babies to check for any potential hearing impairment which the infants might be experiencing. This process is carried out in order to make instant interventions in case a problem is detected so that any undesirable effects of hearing loss may be countered. Conventionally, the NBS processing was largely accomplished through fax. This meant that hospitals were required to present screening results to the state and NBS had to provide a compilation of results which were accumulated back to the hospitals through fax. One can imagine the inefficiencies as a consequence of using such an outdated medium. Right now, Florida is employing the Direct Project to make electronic transmissions for NBS and the results have spoken in volumes. The cost incurred for paper during processing has virtually been eliminated along with the hassle of using paper which accompanies it. Furthermore, it has created a sizeable increase in the efficiency of workflows for audiologists and various other professionals conducting the screenings.

California

The St. Joseph Health System and Redwood MedNet in California are collaborating to implement the Direct Project to enhance care delivery for newborns. Maternity wards inside different facilities will make use of the Direct Project to deliver newborns’ health information to their concerned pediatricians. Moreover, this health information will be transmitted to the patients’ HealthVault accounts as well which will enable parents to view their babies’ health data even prior to their discharge from the hospital. Redwood MedNet takes this even a step further; using the leverage of the Direct Project Redwood MedNet is providing hospitals the capacity to share clinical summaries once patients are discharged from the hospital. This gives hospitals the capability to demonstrate proposed Meaningful Use requirements which direct providers to electronically share care summaries during a patient’s transition from one clinical setting to another.

Guam

Guam HIE is tackling several distinct aspects in their implementation of the Direct Project for the Department of Defense (DoD) and the Department of Veterans Affairs (VA). VA and Guam HIE are at present referring VA patients in Guam for mammography by means of the Direct Project. They are looking towards using the resourcefulness of the Direct Project in making all future referrals for VA patients, providing a simple mechanism to expedite test results and imaging results alike. Guam HIE is also planning to employ the Direct Project to exchange military patient information with the Department of Defense as well.

Approximately 30 states across the country have gone live with the Direct Project with numerous others to follow. Providers may now share confidential patient health information electronically to ensure informed referrals and safer care transitions to other care delivery organizations via the Direct Project services presented by the ONC. Unnecessarily spending money on duplicated results is abolished once this innovation is adopted. The Direct Project will undoubtedly prove to be an innovative tool to enhance patient care and become a time saver for both doctors and patients.

 

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