More ONC guidance sought on scaling out Direct Project

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Meaningful Use Stage 2 adds to the impetus to figure out how to scale the exchange of trust anchors for users of the Direct Project in information exchange.

A recent forum for stakeholders called on the Office of the National Coordinator for Health IT to provide more guidance on creating standard policies and accreditation for health information service providers (HISPs) These networks, or HISPs, are responsible for the routing and security of the messages between providers.

The protocol requires that trust be established between parties exchanging health information, including the acceptance of these trust anchors by both sides, though managing this on a one-to-one basis is too burdensome to be workable.

While HISPs bundle these trust anchors, ONC considers that unworkable, as well, since policies vary, resulting in larger "islands of automation" rather than a unified, interoperable network.

Participants in the forum acknowledged that the difficulties of exchange between HISPs are more often legal or policy-related than technical, according to a report from ONC.

They called for a common set of business practices and requirements to avoid HISP-to-HISP agreements, and asked ONC for a "Ready to Go" set of policies, pilots, and education for vendors and providers by this month. They also set the following targets: Accreditation bodies formed, operating, and ready for business by April, and half of HISPs participating in accreditation by September.

Participants in the forum also were concerned about what to do in the meantime, and planned a workgroup focused on taking intermediate steps, including educating providers while formal accreditation programs or trust communities develop.

MedAllies, a  health information exchange in the Hudson Valley area of New York, uses a closed-loop referral process to improve transitions of care after discharge and patient referrals to specialists. Its pilot uses an EHR-based workflow for Direct messaging that allows a Siemens EHR at Albany Medical Center to be sent to a practice that uses Allscripts. Systems from Epic, Greenway and NextGen are involved, as well.

To learn more:
- read the report

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