Use Cases Driving Uptick in Health Data Exchange with Direct

October 26, 2016
Health IT Interoperability

By Kyle Murphy, PhD 

The use of the Direct standard to enable health information exchange continues to rise.

In a recent update, DirectTrust announced significant increases in the use of Direct exchange and the number of authenticated addresses for sending and receiving protected health information using the health IT standard.

By the close of the 2016 third quarter, healthcare organizations connected to DirectTrust health information service providers (HISPs) and using Direct exchange was up 62 percent over the previous year, an increase of 69,000 organizations.

Increases likewise extended to the number of trusted Direct addresses necessary sharing sensitive health data and Direct exchange transactions. Year over year, the number of these addresses rose by 37 percent, eclipsing the 1.3-million mark, whereas the number of transactions grew by 64-percent to approximately 22 million.

DirectTrust President & CEO David Kibbe, MD, MBA, attributed the growth to use cases beyond the EHR Incentive Programs and meaningful use, whose requirements for health data exchange promote the Direct standard.

“We’ve entered a new phase of growth for Direct exchange; one in which Meaningful Use (MU) is no longer the single major driver of adoption," he said. "New and often innovative use-cases are springing up in which Direct replaces fax, phone, and/or mail in the workflows of healthcare-related organizations whose professionals don’t necessarily use EHRs and don’t directly benefit from the MU incentive bonuses."

In a recent interview with, Reliant Medical Group's Larry Garber, MD, explained how the organization's use of Direct is benefitting both providers and patients of the physician group headquartered in central Massachusetts.

The use case most responsible for driving Direct exchange among Reliant clinicians comes by way of a connection to the state's health information exchange, the Mass HIway, to receive Direct messages from nearby emergency departments.

"It's one thing to let us know where the patient is. It's another thing to actually make sure that the patient gets better care at that point," said the internist and clinical informaticist.

"Instead of getting notified that our patient is in the emergency room and then having to manually call the emergency room and fax something there," Garber continued, "we realized that we could get our electronic health record to automatically send the patient summary right to the emergency room using Direct messaging and have it load directly into their electronic health record, right into their EHR system, and make it available instantly for the emergency room physician to help improve the care that our patients get."

Reliant worked with emergency departments at nearby hospitals to determine the right kind and amount of information the latter need to treat patients effectively.

"We're sending a consolidated CDA/CCD besides including the standard elements of meds, allergies, problems, and immunizations also includes the narrative that goes along with the problem," Garber explained. "In our electronic health record, we have summaries that describe the history of each problem. It's more than just a list of diagnoses. We also send the most recent test results from the last three months."

Expanding the use of Direct exchange is underway at Reliant in two ways. The first is in the form of building new relationships with other hospitals in the region.

"Right now we are working with UMass Memorial, MetroWest Medical Center, as well as AdCare Hospital and making one-off relationships with them to make sure that they're sending us information, we understand what they're sending us, and we know how to process it. We're in the middle of projects with each one of them individually," Garber added.

Another is working with the C-CDA documents more substantially to either enhance the clinical record or automate important patient interactions. In terms of building out a patient's electronic record, Reliant staff are working to parse C-CDAs received from hospital visits to identify new immunizations and update the record accordingly.

As for improving recovery post-discharge, the organization is working with Worcester's St. Vincent Hospital to ensure that discharged patients receiving appropriate guidance about their medications. " "Through Direct, they are sending us a CDA document at hospital discharge. We look at the coded medication list that gets sent to us and if patients were discharged on any high-risk medications automatically notify a pharmacist to contact those patients to make sure that they get closer follow-up," said Garber.

At the same time, Reliant's connection to Mass HIway means its providers are still receiving alerts when their patients present hospitals throughout the state, such as those to the east in Boston.

For organizations such as Reliant, the keys to advancing health data exchange via Direct are clearly integration and automation.

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