Assessing present, future plans for the Direct Project

The Direct Project is an initiative led by the Office of the National Coordinator for Health Information Technology (ONC) that is creating standards for health information exchange. At this year's Health Information and Management Systems Society's HIMSS 2011 conference, Dr. Doug Fridsma, the ONC's director of standards and interoperability, discussed the Direct Project pilots on display at the HIMSS 2011 Interoperability Showcase, and the future of the project.

Let us know what you think about the video; email Brian Eastwood, Site Editor.

Read the full transcript from this video below:

Assessing present, future plans for the Direct Project

Brian Eastwood: Hello. This is Brian Eastwood, the Site Editor for
. Within the office of the National Coordinator for Health IT,
there is a team working on the Direct Project. This is an effort to create
standards to define the way that clinical information is transported from
one organization to another. Prior to the HIMSS 11 conference, the Direct
Project team announced two pilot programs; one in Minnesota, and one in
Rhode Island. At HIMSS those two pilots, as well as several others were
being demonstrated at the show’s Interoperability Showcase. It was there
that I had a chance to sit down with Dr. Doug Fridsma, the Director of
Standards and Interoperability for the ONC. In this video we discussed
those pilot programs and some of the future plans for the Direct Project.

We would like to get some background on the Direct Project pilots that
are being demonstrated at HIMSS this year. What can you tell us about what
the attendees have been seeing?

Dr. Doug Fridsma: The Direct Project is an effort to create a low cost, simple,
and scalable secure transfer mechanism to send patient information from one
physician to another provider, or between organizations and so within the
Direct Project, we went from the initial conception all the way through to pilots
in about 10 months, which is pretty fast for government work. This is really driven
by the community; they are the ones who really helped us get there. Some of the
early pilots are with Minnesota, Hennepin County, actually being able to
exchange immunization information. We have some primary care providers
and specialists that are exchanging consult information in Rhode Island. Then
there is a series of other  initiatives that are going on across the country,
including California, Tennessee, and other places that are expanding the kinds
of information that is being sent, and expanding the coverage that we have across
the country.

Brian Eastwood: What has been driving the innovation that is going into some
of these projects? What has been the impetus for them to get started on these

Dr. Doug Fridsma: I think there are a couple of things that drive the innovation.
One is people adopt standards that solve real problems; Direct project solves
that secure transport problem, to securely exchange information between two
parties. I think the other thing is that it has to be simple. Complicated things take
longer for people to learn how to use and to figure out the value. Innovation is
really driven around things that are easy to do, that produce value, and that there
is an engagement within the community that has a  sense of ownership, and I
think Direct had all three of those things.

Brian Eastwood: One of the things I have noticed about these pilot projects
and a lot of the announcements that have been coming out is, you have gotten
a lot of support from a lot of different electronic health record vendors. How
have you been able to convince them to participate in this process?

Dr. Doug Fridsma: When we started the project, we actually just sent out an
invitation to people, to participate, and we were fortunate that a lot of people
responded. Right now, a year after the project started, we have over 60 organizations
that have announced that they will be supporting the Direct Project as part of
their production systems, and we anticipate that will likely continue. I think
that if you got something that people feel an ownership about, that solves
a really important problem and does it in a simple way, adoption becomes
much easier, as a result.

Brian Eastwood: As this goes forward and some potential naysayers may emerge,
how will you convince them that this is a project that is worth their investment?

Dr. Doug Fridsma: Well, I think Direct is trying to solve a very specific problem;
it is not going to solve every problem that is out there and so some people, if
they try to apply this solution to a different problem, may not find the amount
of value that others have seen. There is nothing that is inherent about the
standard or specification that I think people are going to react to. We have
been able to demonstrate that it is successful. Those that are naysayers or that
do not want to do that -- or want to provide another way of doing things --
we encourage that. That is how we get innovation. I think by having multiple,
different ways to solve different problems, as long as there is a compatibility
and the ability to exchange that information and have it all work together in an
ecosystem, I think those are some of the things that will drive innovation.

Brian Eastwood: As the Direct Project continues to move forward and those
potential alternatives emerge, do you see sort of working with them to further
integrate them and bring them into the fold?

Dr. Doug Fridsma: What we have done is we have defined a Nationwide Health
Information Network as being the standards, the services, and the policies
that allows us to use the Internet to exchange information. We see it more
like a toolkit of all the different things that you might need if you were going
to enable information exchange. Just like if you were going to build a house,
you would not just have a hammer, you are going to need a lot of different tools.  
Healthcare is complicated enough that we need to have all the different tools
we have available to us. What we want is to create the elemental building blocks,
the things that people can compose in interesting ways that will allow us to
support new things that we have not even thought of at this point. If you think
about the way in which you communicate with your family, we use Facebook,
Web pages, e-mail, cell phones, land lines; there is a variety of ways in which
we communicate. If what we are trying to do is improve the way in which healthcare
information is communicated to others, we need to recognize that there has to be
different ways to do that, that all work together and support the goals that we have.

Brian Eastwood: That is great. I know you have made a lot of progress in the
last year since your last appearance at HIMSS. What do you foresee for the
Direct Project as the next 12 months progress?

Dr. Doug Fridsma: I think, and I have said this before, not only about Direct
but about some of the other standards that we work on, and the other sorts
of services that we have defined as part of the Nationwide Health Information
Network. Success, for us, is when people stop talking about the standards or
about Direct, but you have a physician in their practice that says, ‘Gee, if I
could just send this information to my consultant, and they get it, and it is secure,
and I know they got it because I get an acknowledgment back.’ Success, for us,
is when it becomes ubiquitous and we do not talk anymore about the protocols
and standards, but just the interesting, novel, good things that we can do with it.  

Brian Eastwood: I know you have been a very busy man at HIMSS.
Thank you very much for your time, Dr. Fridsma.

Dr. Doug Fridsma: Thank you.

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