Tuesday, January 14, 2014

Recap of 2011-2013 and Happy New Year 2014

It has been a very long while since I posted.  I keep being reminded that others want to know what I am up to these days.  I never gave an update for the second half of 2011, 2012 or 2013 for that matter....so fast forwarding through a timeline in bullet points, here goes:
The above bullets highlight why I have been silent for far too long. I have been busy, but in a good way.  As I start 2014, I feel blessed and privileged to be working with stakeholders in East Tennessee to help deploy connected health care across our region.  I continue to work with etHIN staff to on board stakeholders, help with the selection of new technology solutions and provide general subject matter expertise to the staff as we navigate these ever changing requirements for Meaningful Use and Interoperability standards and requirements in general. 

Today/January 14, 2014, I get to conduct the East Tennessee Regional HIMSS Conference in Knoxville, TN at the Crowne Plaza Hotel (401 W Summit Hill Dr, Knoxville, TN 37902). This event brought 180-200 people together in 2013 when we held a connected demonstration showing how data would flow from system to system for a patients journey.  I will be posting some links and updates on the outcome from the 2013 conference separately and at a later date.  More to come on this year's event as well.  Stay tuned...

Later this month/January 27 - 31, 2014, I will be traveling to Chicago, IL to volunteer my time as an IHE USA Connectathon Monitor.  This means I will be validating vendor testing results.  I always look forward to this event.  I get to catch up with many old friends and usually make new friends among the 500+ in attendance.  The attendees are primarily development resources from various health care solution vendors who come together to test their products for conformance to the IHE profiles.  The past few years, the event has grown to include other parallel events.  If you want to learn more about the 2014 Connectathon event go here.

2014 is also my fourth year as IHE QRPH Planning Committee Co-chair for the IHE International domain sponsored by HIMSS and RSNA. The domain has grown to have a separate planning and technical committee and even has four co-chairs now.  With the help of the entire committee, we continue to grow our domain to have a large number of attendees at all our meetings. I am looking forward to my travel to Vienna, Austria to support the Planning and Technical Committee meeting February 10 - 14, 2014. On February 14, 2014, we will hold a joint Planning Committee meeting with representatives from HL7 and ISO to see how we an collaborate more on Public Health standards for Vital Records.  

February 23 - 26, 2014, I will travel to Orlando, FL to attend the Health care Information Management and Systems Society (HIMSS) Annual conference where I get to visit with 40,000+ peers from the health care industry.  I always love to visit with all my friends from years past. 

I promise to do better and post more often in 2014.  I will be reporting back on these future events with pictures and details.  Please let me know if there are specific topics you want me to blog about in 2014. I hope to see many of you at the various events listed above and hope that you are having a fabulous New Year so far.  Take care, Didi Davis (HIT Gypsy)

Tuesday, January 3, 2012

Goodbye to 2011 - A Recap of the Year's Events - Part 1

As 2011 washes into history making way for 2012, I want to send my warmest and most sincere wishes for a Healthy, Happy and Most Blessed New Year in 2012 for all. 

I entered 2011 finishing up my duties as Interim CEO for CareSpark.  I have had the pleasure of working with CareSpark since 2005 first as a volunteer and then starting in 2009, I contracted to provide strategic and technical services in support of their implementation of the Nationwide Health Information Network (NwHIN), the SSA Sponsored Project as well as a limited CMS pilot with three HIE's. 

Unfortunately, CareSpark made the decision to close and announced it in July 2011.  I had really hoped that the community would be able to come together to move the services forward under the CareSpark umbrella.  I am still busy running my business, Serendipity Health, LLC, that has provided full time employment for me this year for which I am grateful.  It has been quite some time since I have posted, so I will start this first post of the year giving you a recap of some of the highlights that I experienced in 2011.  

In January 2011, I had the opportunity to volunteer my time as one of the IHE North American Connectathon monitors helping grade/evaluate vendor tests for various Integrating the Healthcare Enterprise (IHE) profiles. Over 4000 tests were completed by over 450 health IT system engineers.  These engineers represent over 100 HIT organizations who had the goal of testing interoperability and working to fine tune their implementations in over 150 products to meet the requirements of the various IHE International profiles. These same profiles make up components of the many NwHIN and Meaningful Use standards. This group picture is of all the monitors that worked together to pull off the grand task of grading the over 4000 tests over the one week event.

January in Chicago is not my favorite place to be, but I feel honored that I was asked to help and gladly volunteered my time to help the healthcare industry with this worthwhile effort. The event this year will be held January 9-14, 2012.  
In February 2011, I attended the Healthcare Information Management and Systems Society (HIMSS) Annual Conference along with some 30,000+ other attendees. The week started with me being one of the presenters at the Interoperability Workshop held early in the week.  My contribution to the agenda was to wrap up the workshop with the overview of US relevant standards including NwHIN and The Direct Project that are required for providers to implement Meaningful Use. The workshop sold out attendance and was very interactive for all attendees. I shared the presenter duties with Lee Jones, Keith Boone, and Bob Yencha.   

The week was full of activities and networking. Steve Leiber and David Blumenthal presented to a standing room only audience at the HIMSS Interoperability Showcase.  The next several topics were all included in the Showcase which was the largest ever at nearly one acre in size.  It had all the typical areas represented as well as the area hosted by Office of the National Coordinator (ONC) showing approximately 40 demonstrations highlighting how health practitioners are securely exchanging health data between doctor's offices, hospitals, benefit providers, government agencies and with other health organizations, all across America.  I am happy to report that two stations within the ONC area, showcased some of my contracted endeavors from 2010 through 2011.  

The AmeriHealth Mercy and Independence Blue Cross station showcased the initiative created by both organizations that gives health care providers better access to health plan information and improves the quality of member care.  I am proud to have been involved in a small way with this innovative way of leveraging the standards by various stakeholders focusing on two use cases - sharing medication information and hospital admission through secure patient portals, provider portals, and HIEs.
The second station that I was involved with was one of eight pilots demonstrating the use of Direct Project specifications.  I have been involved with the Direct Project since it's launch in March 2010. This demonstration illustrated the feasibility of utilizing the Direct Project constructs to enable secure messaging between a federal agency (Veterans Affairs), and a regional health information exchange network (CareSpark). This demonstration showed the secure, standards-based transmission of a referral for mammography from a VA medical center to a private sector provider clinic, and the reply from the private sector provider clinic with a text based report. 

This CareSpark pilot demonstration  transitioned to the Health Information Partnership for Tennessee (HIP-TN) after the HIMSS conference and resulted in the delivery of live patient information in September 2011.  I feel very lucky to be managing the Direct Project strategy as well as the NwHIN Exchange onboarding and acting as the CTO contracted to HIP-TN both last year and now going into 2012.  I count my blessing each day and give thanks for the priviledge to help my own state and Keith Cox, CEO of HIP-TN with our go forward strategies to improve the healthcare quality while reducing the costs associated.  

Michael J. Fox was one of the keynote speakers and the DeLorean time machine used in the Back to the Future trilogy was on display on the showroom floor.  I had a good friend offer to take the picture of me in front of it. Yes, it is a bit silly, but I just had to when the offer was made.  Thanks Cliff...

One of the days there was a Tweetup of of us "technogeeks" in the HIT industry who showed to support the cause of outreach and education.  I finally got to meet up with some of the wonderful folks I have had the opportunity to work with over my 22 year career in HIT. 

I attended several events over the course of the week in Orlando at HIMSS, including the H.I.T. Men and Women Reception which toasts the art and inspired vision of today's most powerful healthcare IT leaders. I am honored to serve on the TN HIMSS Board with Michael Hollis who is the brainchild for this event. At HIMSS 2011, I was lucky enough to walk the red carpet with Michael and Antoine Aggasi both of which are working to advance interoperable healthcare. I am going to end this post update today since I have written quite a bit for your to digest and tomorrow morning will be here before i know it.  

I will give the update on the remainder of the year tomorrow so stay tuned for another post soon.  I have been asked by so many of my friends lately what I have been up to, so I share this with those who care. If you don't care, then you would not have read this far.  I promise to post more often this coming year and reconnect with many of you who I look forward to seeing and working with again in 2012.  Until next time.....

Tuesday, June 28, 2011

Integrating the Healthcare Enterprise (IHE) Offers Free Educational Webinar Series

ATTENTION all interested IT professionals interested in learning more about IHE and it's domain work within the current 11 domains (Radiology, Cardiology, Laboratory, Anatomic Pathology, Eye Care, Patient Care Devices, IT Infrastructure, Patient Care Coordination, Quality, Research & Pubic Health, Pharmacy, & Radiation Oncology)

Beginning June 28 Integrating the Healthcare Enterprise (IHE) kicks off its annual free webinar series with a wide range of topics to educate organizations about the benefits of IHE’s Technical Frameworks and Profiles. Clinical end users, attend the general sessions to learn how use of IHE-based products help end users solve today’s interoperability challenges. Product vendors, attend sessions to learn how and why implementing IHE into your products is a smart business decision. Plus, learn how to prepare for participation in the IHE North American Connectathon 2012 and HIMSS12 Interoperability Showcase. Please click here for a schedule of webinars. These are also recorded for future playback if you are unable to attend on the day of the event.  Happy Learning!

Friday, June 24, 2011

IHE Quality, Research & Public Health supplements published for Public Comment

Well it has been quite a bit of time since my last blog, so I apologize, but life has been busy at Serendipity Health for me. I am not complaining as business is good and I will blog more about some of the work I have been doing associated to HIT in other posts soon, I promise.   

As co-chair for the Quality, Research and Public Health (QRPH) domain for IHE International, I thought it was most important to bring your attention to some newly published supplements out for public comment.  Amit Popat and I are happy to co-chair the QRPH domain that has many, very talented and forward thinking individuals who are trying to solve some of the interoperability issues that are leading edge and necessary for the future of health care improvement.  

I encourage all who are involved with health information exchange and HIT to please review the supplements listed below and provide public comment to allow us to improve this documentation for future use. Please feel free to contact me to learn more about our domain and the work we are forging forward.  

IHE Community,

Quality, Research and Public Health supplements published for Public Comment

The IHE Quality, Research and Public Health Technical Committee has published the following supplements to the forthcoming IHE Quality, Research and Public Health Technical Framework for public comment in the period from June 17, 2011 to July 17, 2011:

·       Early Hearing Care Plan (EHCP) 
·       Mother and Child Health (MCH) 
·       Physician Reporting to a Public Health Repository-Cancer Registry (PRPH-Ca) 
·       Public Health Reporting (PH-rpt) 
·       Quality Measure Definition - Early Hearing (QMD-EH) 
·       Quality Measure Execution - Early Hearing (QME-EH) 
·       Retrieve Process for Execution (RPE)

The documents are available for download at http://www.ihe.net/Technical_Framework/public_comment.cfm. Comments submitted by July 17, 2011, will be considered by the Quality, Research and Public Health Technical Committee in developing the trial implementation version of the supplements.  Comments should be submitted at http://www.ihe.net/qrph/qrphcomments.cfm.

Wednesday, February 2, 2011

Direct Project Implementations Take Flight

2011 has started off with a frenzy over EHR Adoption and Meaningful Use.  Serendipity Health and I owe my followers an update on many items, but today's topic will highlight a "New Way" being led by the Office of the National Coordinator.  There is a live update is being given by Dr. David Blumenthal as I type this today to leaders in Washington, DC. 
I am proud to have been part of this process with countless industry leaders that has led to these achievements.  Please read more about the success of open and transparent government facilitated standards development that has resulted in the Direct Project.  With permission, I am providing this write up by two of my colleagues who are on the Communications committee with me for this project.  These implementations will be shown in a live interactive demonstration at the HIMSS 2011 Annual Conference as part of the the Interoperability Showcase in Orlando, FL later this month.  I hope to see many of you there.  Stay tuned for more blog posts to come.

Direct Project Implementations Take Flight
By Rich Elmore and Paul Tuten
The Direct Project has taken off, with the first-in-the-nation production use of the Direct Project for secure direct clinical messaging.
Arien Malec, ONC’s Direct Project Coordinator, announced today that pilots in Minnesota and Rhode Island are now live with the Direct Project:
  • VisionShare has enabled Hennepin County Medical Center to send immunization information to the Minnesota Department of Health.  Testing of immunization (or syndromic surveillance) communication to a public health agency is a requirement for Meaningful Use incentives.  
  • Rhode Island Quality Institute has implemented provider-to-provider health information exchange supporting Meaningful Use objectives with Dr. Al Puerini and members of the Rhode Island Primary Care Physicians Corporation.
And innovative and high-value pilot projects in New York, Tennessee and California are scheduled to go live later this month.  
Also announced:

Hennepin County Medical Center (HCMC), Minnesota’s premier Level 1 Adult and Pediatric Trauma Center, has been successfully sending immunization records to the Minnesota Department of Health (MDH). "This first-in-the-nation Direct Project for clinical exchange is an important milestone for Minnesota and a key step toward the seamless electronic movement of information to improve care and public health," said James Golden PhD, Minnesota’s State Government HIT Coordinator. Recognizing Minnesota's leadership in delivering high-quality, cost-effective healthcare, U.S. Senator Amy Klobuchar said that “this is the type of innovation that can help strengthen our health care system by reducing waste and improving quality. We need to continue to improve our health care system by continuing to integrate information technology to better serve patients and providers.”  VisionShare, a company headquartered in Minneapolis, serves as the health information services provider (HISP) connecting HCMC to the Minnesota Department of Health. In its role as a HISP, VisionShare will expand this pilot project to additional providers and other states, including the Oklahoma State Department of Health, which has already committed to participation in the program.
The Rhode Island Quality Institute (RIQI), the only organization in the nation to be awarded the Health Information Exchange, Regional Extension Center, and Beacon Community grants has delivered a Direct Project pilot project with two primary goals:

  1. To demonstrate simple, direct provider-to-provider data exchange between PCPs and specialists as a key component of Stage 1 Meaningful Use.
  2. To leverage Direct Project messaging as a means to seamlessly feed clinical information from practice-based EHRs to the state-wide HIE, currentcare, integrating patient data across provider settings and during transitions of care
“This recognition shows that Rhode Island continues to be a nationwide leader in improving health care with better information technology," said Senator Sheldon Whitehouse. "Health care providers communicating with each other in a secure and cost-efficient way helps patients get better sooner with less hassle and confusion.”

“The Direct Project is a giant step forward in improving communication between primary care providers, specialists, hospitals, laboratories and health information exchanges”, according to Dr. Albert Puerini Jr., President and CEO at Polaris Medical Management and Rhode Island Primary Care Physicians.   “The Direct Project’s ability to seamlessly transmit relevant healthcare information greatly enhances the quality of care that is delivered, while also creating much needed efficiencies within our healthcare system.”
Discussing RIQI’s collaborative approach to health IT, Laura Adams, President and CEO of RIQI said “Direct allows the Quality Institute to be on the cutting edge – providing health information exchange via currentcare, delivering the efficient rollout of technology through the Regional Extension Center, and enabling and measuring real patient outcome improvements in our Beacon Community.” Throughout the Pilot, RIQI has worked with a number of key partners, including Arcadia Solutions (program manager and systems integrator), Inpriva’s Health Information Service Provider  solution that supports the security, trust, and Rhode Island-specific consent laws, InterSystems, and Polaris Medical Management’s EpiChart.
Federal Government Perspective
Aneesh Chopra at the Roundtable on Federal Government Engagement in Standards on January 25, 2011 said "I am pleased to report today... the very first Direct specification email message occurred between a county public hospital in Minnesota called Hennepin County and the state Health Department on the issue of a patients immunization record, which is a requirement as part of our meaningful use framework, supported by a commercial vendor called VisionShare".  Speaking of the collaborative nature of the unique public/private collaboration of the Direct Project, he said "This voluntary process has turned this around and in fourteen months [from the time a physician first raised the need to the HIT Standards Committee] the idea is real. And dozens and dozens of vendors will have this service widely deployed across 2011."
On the Runway
Several other Direct Project implementations are scheduled for take-off later this month.  New York, Tennessee and California are among the states where Direct Project will be enabling directed health information exchange among a wide variety of participants.  And later this year, look for Connecticut and Texas to join their ranks.  
New York
MedAllies, a Health Information Service Provider (HISP), will launch a Direct Project pilot to demonstrate the delivery of critical clinical information across transition of care settings in a “push” fashion that supports existing clinical workflows in the Hudson Valley of New York. MedAllies will implement the full Direct Project infrastructure, including both the required SMTP backbone, as well as support for the XDR elective protocol. MedAllies is working with many stakeholders, including EHR vendors Allscripts, eClinicalWorks, Epic, Greenway, NextGen and Siemens, and clinicians in both ambulatory and hospital settings.
The three initial use cases include:
· Primary care provider refers patient to specialist including summary care record
· Specialist sends summary care information back to referring provider
· Hospital sends discharge information to primary care provider
Technical integration with leading EHR and Hospital Information System vendors is underway with pilot exchange alpha sites beginning to go live in Q1 2011.
In this project, CareSpark, a non-profit regional health information exchange supported by the Tennessee State HIE, and the U.S. Department of Veterans Affairs (VA) seek to demonstrate Direct Project-based health information exchange between a federal agency and providers in a private-sector HIE. The main focus will be on facilitating an improved process for exchanging referrals and consultation reports between VA providers and private-sector providers in east Tennessee and southwest Virginia. It will demonstrate two Direct Project user stories: Primary care referral to specialist and Specialist sends summary care information back to referring provider. Text-based mammography interpretation reports will be exchanged utilizing source code made available from the Direct Project workgroups. The project scope will also demonstrate the routing of mammography referrals from the VA to the private sector provider. It is also the intent of the participants that this project once fully vetted could be expanded to additional VA sites. The pilot will exchange information between two different Health Information Service Providers (HISPs) - the VA and CareSpark, respectively.
Redwood MedNet provides health information exchange services in rural Northern California. The Redwood MedNet Direct Project pilot has one goal: to deploy directed secure messaging for production data delivery in support of meaningful use measures. Three meaningful use messaging patterns are in development.
  1. Receipt of Structured Lab Results
  2. Immunization Reporting
  3. Sharing Patient Care Summaries Across Unaffiliated Organizations (including both referral to a specialist and discharge summary to a patient centered medical home)
The project will establish a standards-based way for participants to send authenticated, encrypted health information directly to known, trusted recipients. As an HIE in a rural area, participants in the Redwood MedNet directed messaging project will include small practices, community clinics and small hospitals, as well as the State immunization registry. The discharge summary may also incorporate use of a patient controlled health record (PCHR).
Medical Professional Services (MPS) is a clinically-integrated, multi-specialty IPA in Connecticut with approximately 400 physician members. Along with several partners, MPS is working to demonstrate successful exchange of laboratory results back to the ordering provider and exchange of referral information and summary care information between providers, a local hospital (Middlesex) and a multi-site FQHC (Community Health Center, Inc.). Electronic exchange of data is a challenge in this setting because of the diversity of MPS physician practices, EHRs and HIT tools in place.
The goal set for this pilot is to enable MPS physicians to receive lab results back from Middlesex Hospital and Quest Diagnostics, to exchange referrals with Middlesex Hospital, and to exchange referrals and summary care information among MPS primary care and specialty physicians. Results and referral information will be exposed through MedPlus, eClinicalWorks, Covisint, or through a secured e-mail client. In addition, physicians will have the ability to securely send lab results and care summaries to their patients via Microsoft’s portal.
A broad set of stakeholders in South Texas are planning to use Direct to improve the health status of persons in South Texas with diabetes, including gestational diabetes. Participants come from the medical community (CHRISTUS Health, the Health Information Network of South Texas, the Driscoll Children’s Health Plan, Corpus Christi Medical Center, Public Health Department, Nueces County Medical Society), community-based social service organizations, colleges, and employers (the Coastal Bend Diabetes Community Collaborative, The Salvation Army, the United Way, and others). The main goal for this project is to connect the OB-GYNs, pediatricians, hospitals, and the State of Texas’ Newborn registry so they can share information (referrals, lab results, discharge summaries) in real time with their care teams to improve patient outcomes. Additionally, the project participants hope to provide patients with better information so that they may better manage their chronic diseases. This will be accomplished using Direct by enabling the following use cases:
  1. Physician to physician referral
  2. Physician to hospital referral
  3. Hospital to physician lab results reporting
  4. Hospital or physician to state newborn registry
What is the Direct Project?
Today, direct communication of health information from a care provider to another healthcare stakeholder is most often achieved by sending paper through the mail or via fax. ONC’s Direct Project (formerly NHIN Direct) benefits providers and patients by improving the direct transport of structured and unstructured health information, making it secure, fast, inexpensive and, for some applications, interoperable.  Using Direct Project addresses, a care provider can send and receive important clinical information, connecting to other healthcare stakeholders across the country.
For more information, see the Direct Project website and keep up with the latest on Twitter at #DirectProject.  
Also, at noon (EST) on February 2, hear about the Direct Project from Dr. David Blumenthal, National Coordinator for Health IT, Aneesh Chopra – U.S. Chief Technology Officer, Mark Briggs – CEO VisionShare, Glen Tullman – CEO Allscripts, Sean Nolan – Distinguished Engineer and Chief Architect Microsoft Health Solutions Group, Dr. Al Puerini Jr. – President and CEO Polaris Medical Management and Rhode Island Primary Care Physicians, Doug Fridsma - ONC Director, Office of Interoperability and Standards and Arien Malec - ONC Direct Project Coordinator.
The Authors
Rich Elmore serves as the Direct Project Communication Workgroup leader and Vice President, Strategic Initiatives at Allscripts.  Paul Tuten participates as the Direct Project Implementation Geographies Workgroup Leader and is Vice President, Product Strategy and Management at VisionShare.

Monday, November 29, 2010

The Direct Project - Where We Are Today

This article originally appeared in The Health Care Blog and O'Reilly Radar. by Brian Ahier, Rich Elmore and David C. Kibbe The Direct Project announced today the completion of its open-source connectivity-enabling software and the start of a series of... read the rest.

I have copied highlights below, but please note that CareSpark will be piloting the standards used by the Direct project to demonstrate our ability to be a Health Information Service Provider (HISP) communicating to the Veterans Administration.  Carespark (Tennesee) will be linking the VA with private clinics providing health services to veterans.  This is of particular interest to me as my father and mother-in-law locally receive health care benefits from the VA. In addition, I have multiple family members across TN and the state of Tennessee has over 500,000 veterans with over 1 million dependents who will eventually benefit when the pilots move into production in the future.  

The Direct Project announced today the completion of its open-source connectivity-enabling software and the start of a series of pilots that will be demonstrating directed secure messaging for healthcare stakeholders over the internet. The Direct Project specifies a simple, secure, scalable, standards-based way for participants to send authenticated, encrypted health information directly to known, trusted recipients over the Internet.

Also announced:
  • A new name - The Direct Project was previously known as NHIN Direct 
  • An NHIN University course(The Direct Project - Where We Are Today), to be presented  by Arien Malec, November 29 at 1PM ET, sponsored by the National eHealth Collaborative
  • An extensive list of HIt vendors (20+) that have announced plans to leverage the Direct Project for message transport in connection with their solutions and services.  
  • Presentations at the HIT Standards Committee on Tuesday, November 30 where three or more vendors will be announcing their support for the Direct Project. 
  • A thorough documentation library including a Direct Project Overview 
  • Best practice guidance for directed messaging based on the policy work of the Privacy and Security Tiger team
  • A new website at DirectProject.org
  • A new hashtag #directproject for following the Direct Project on twitter.
What is The Direct Project?
Today, communication of health information among providers and patients is most often achieved by sending paper through the mail or via fax. The Direct Project seeks to benefit patients and providers by improving the transport of health information, making it faster, more secure, and less expensive. The Direct Project will facilitate “direct” communication patterns with an eye toward approaching more advanced levels of interoperability than simple paper can provide.

The Direct Project provides for universal boundaryless addressing to other Direct Project
participants using a health internet “email-like” address.

The Direct Project focuses on the technical standards and services necessary to securely transport content from point A to point B and does not specify the actual content exchanged.  When The Direct Project is used by providers to transport and share qualifying clinical content, the combination of content and The Direct Project-specified transport standards may satisfy some Stage 1 Meaningful Use requirements. For example, a primary care physician who is referring a patient to a specialist can use The Direct Project to send a clinical summary of that patient to the specialist and to receive a summary of the consultation.

How might the Direct Project be Used?

2009-10 Congress and agencies of the federal government have created regulations that require physicians and hospitals participating in the ARRA/HITECH incentives awarded for meaningful use of EHR technology to:
  • send messages and data to each other for referral and care coordination purposes;
  • send alerts and reminders for preventive care to their patients;
  • send patients clinical summaries of their visit and of their health information
  • receive lab results from labs
  • send immunization and syndromic surveillance data to public health agencies
  • integrate with HIT vendor systems
There are already organizations that have announced the establishment of national clinical exchange networks, including integration with the Direct Project. States and HIO’s will need to decide how best to provide Direct Project services to their constituents, whether by partnering with existing exchange networks or incorporating direct messaging into the services they provide.
The Direct Project Implementation
The Direct Project is organizing real-world pilots to demonstrate health information exchange using The Direct Project standards and services. Six pilots are ramping up including:

Rhode Island Quality Institute, Redwood MedNet and MedAllies will be sending Continuity of Care
Documents to other providers for referrals and transitions of care. Visionshare will be linking to
immunization registries. Carespark (Tennesee) will be linking the VA with private clinics providing health services to veterans. And Connecticut’s Medical Professional Services, an IPA, will be
linking Middlesex Hospital with primary care providers.


Connectivity among providers is facilitated by Health Information Service Providers (HISP). HISP describes both a function (the management of security and transport for directed exchange) and an organizational model (an organization that performs HISP functions on behalf of the sending or receiving organization or individual).
Best Practices
The Direct Project is bound by a set of policies that have been recommended to the HIT Policy Committee (HITPC) or are being examined by the HITPC’s Privacy and Security Tiger Team for directed messaging. Within this context, the Direct Project has developed best practice guidance for secure communication of health data among health care participants who already know and trust each other. The Direct Project assumes that the Sender is responsible for several minimum requirements before sending data, including the collection of patient consent. These requirements may or may not be handled in an electronic health record, but they are handled nonetheless, even when sharing information today via paper or fax. For example, a sender may call to ask whether a fax was sent to the correct fax number and was received by the intended provider. The following best practices provide context for the Direct Project standards and services:
  • The Sender has obtained the patient’s consent to send the information to the Receiver.
  • The Sender and Receiver ensure that the patient’s privacy preferences are being honored.
  • The Sender of a Direct Project transmission has determined that it is clinically and legally appropriate to send the information to the Receiver.
  • The Sender has determined that the Receiver’s address is correct.
  • The Sender has communicated to the receiver, perhaps out-of-band, the purpose for  exchanging the information.
  • The Sender and Receiver do not require common or pre-negotiated patient identifiers. Similar to the exchange of fax or paper documents, there is no expectation that a received message will be automatically matched to a patient or automatically filed in an EHR.
  • The communication will be performed in a secure, encrypted, and reliable way, as described in the detailed The Direct Project technical specifications.
  • When the HISP is a separate entity from the sending or receiving organization, best practice guidance for the HISP has been developed for privacy, security and transparency.
The demonstrations will likely take place early next year at the HIMSS Annual Conference in Orlando

What is a Unicorn?

When I was much younger and extending into my early 20’s, I loved the concept of and collected Unicorns. While I still love the concept of Unicorns, I no longer collect them, so you can imagine my surprise to hear from one of the CareSpark stakeholders that I was leading and helping to build the region’s Unicorn
During the last CareSpark Board meeting, a CIO from one of the hospital systems in the region mentioned that he could share his vision of a Unicorn to support the needs of his providers for Health information exchange (HIE). He went onto mention that an HIE is like a Unicorn…we all know what we think one should look like, but who’s to say my unicorn looks like your unicorn. What does your Unicorn look like?  
I would like to think my Unicorn would be golden and sparkly…something like this…  
“Now I will believe that there are unicorns…” William Shakespeare – The Tempest

As the common fare of little girls' fantasies, the origin in histories becomes quite ironic. In thinking about this blog topic, I thought it was interesting to correlate that the Unicorn is known for the healing power in it’s horn.  A fabulous beast born of man’s imagination, the unicorn form and function are as variable as the minds and religions of mankind;  but whatever its shape – and it has been described as an ox, ram, goat, bull, antelope, wild ass, horse,  rhinoceros, serpent or fish, - a one-horned beast was always a symbol of supreme power.

In the west, the unicorn was first mentioned in 398 BC by Ctesias, a Greek physician and historian of Persia and India.  He traveled to the Persian court and remained there working as a physician for 17 years under two rulers.  

Why did they go away, do you think? "Who knows? Times change –especially in health care today. Would you call this age a good one for unicorns?"  

For those of you who may not be aware yet, I stepped in as Interim CEO for CareSpark on September 30, 2010. One of my deliverables during my tenure will be to develop a sustainable business plan and I have spent the past several weeks helping to shepherd and lead CareSpark toward the evolution necessary to sustain them into the future and reduce the dependency on federal funding. 

Out of the 234 HIEs surveyed by the eHealth Initiative for 2010 only 18 are operational, not dependent on federal funding, and have broken even through operational revenue only. To date, CareSpark has been dependent on federal funding business plan will begin to wean them from the dependencies over the next several years with the support of the community and state.

In addition to the Carespark business plan, I have the pleasure of working with the State of TN and the state designated entity (HIP TN) to develop their sustainability plan and roll out the backbone connecting the various HIEs across the state beginning in 2011. 


At the beginning of this week, after the Thanksgiving holidays, I have much to give thanks for reflecting back over the past two years of business after starting Serendipity Health. I am doing what I set out to do and am working full time to help improve the quality of health care in my region and across the state. CareSpark has always had a place in my heart having followed the standards based approach for building the HIE which now has 33 signed data sharing agreements from providers in the region. Over the coming years, I look forward to working with health care provides to deploy connected health care, thus providing actionable information at the point of care.As the cartoon below depicts, I am pleading for all providers to give generously!