1. A Direct Directory
• Keep it simple – think big – start small and then build as you go
Will Rice
Office of eHealth Initiatives, State of Tennessee
2. Tennessee Direct Adoption Strategy
Private Sector Public Sector (State)
State HISP
HISP A
Hospital
Medicaid
Mental Health
Corrections
Public Health
ELR
IR
Provider Office
EHR
w/HISP
HISP B
Individual/Group Users
3. Tennessee Direct Adoption Strategy
Private Sector Public Sector (State)
State HISP
HISP A
Hospital
Medicaid
Mental Health
Corrections
Public Health
ELR
IR
Provider Office
EHR
w/HISP
HISP B
Individual/Group Users
4. Tennessee Direct Adoption Strategy
Public Sector (State)
State HISP Medicaid
Mental Health
Corrections
Public Health
ELR
IR
• Public health reporting
– Immunization registry
– Electronic reportable labs
– Cancer Registries
• Quality reports submissions to Medicaid
• Mental Health, Corrections, and other
State departments
• Create additional use cases for using
Direct HIE capabilities in the private
sector
“Direct Enable” State
Services
5. Tennessee Direct Adoption Strategy
Private Sector Health eShare
HISP A
Hospital
Provider Office
EHR
w/HISP
HISP B
Individual/Group Users
• Licensed professionals are in good
standing.
• Listed in the provider directory on the
Health eShare website.
• Establish at least one Direct account with
a DirectTrust Accredited solution.
• Send at least one non-test Direct
message for each user account.
• Comply with HIPAA and/or other
applicable regulations within each
participant’s professional roles and
responsibilities.
The financial incentives for participating is
$500 per participant assigned a unique
Direct email address.
Participants applying for the incentive must:
6. Tennessee Direct Adoption Strategy
Private Sector Public Sector (State)
State HISP
HISP A
Hospital
Medicaid
Mental Health
Corrections
Public Health
ELR
IR
Provider Office
EHR
w/HISP
HISP B
Individual/Group Users
Directory
Directory
(HPD+)
Directory
Directory
(HPD+)
Directory
7. Health eShare Directory
• Program requirements for participants include being
listed in the directory on the Health eShare website.
• Information collected during the incentive program
registration process can be used to populate a “White
pages”
– Supports use cases where referral is requested but “Direct
address” is not known
• Information collected modeled after HPD+ data model
for registering organizations and individuals
– Demographic information (Name, address, title, etc.)
– License type & numbers (NPI, State Licensure)
14. Health eShare Directory:
Potential Future Enhancements
• Enhanced geographic search
– Zip code
• Enhanced text search
– By license
– Additional NPI taxonomy
• Integration enhancements
– Export contacts using vCard/hCard formats
– Publish LDAP directory enabled for query
15. Issues and Considerations
Pros
• Low-cost, simple,
effective
• Supports referral use
case
• Helps drive adoption -
marketing and
adoption among
peers
Cons
• Ongoing maintenance
– user migrations,
technology changes
• Limited to users in
the Health eShare
program
• Requires web portal
look-up
Editor's Notes
We are implementing intersecting strategies of complimentary Direct programs aimed to bolster the efforts pursued under each strategy. By supporting adoption and enabling adoption and growth in one strategy helps support adoption and growth in the other.In the private sector, we are encouraging market-based solutions of EHNAC-DirectTrust accredited solutions to meet the needs of providers. We are already seeing some EHR technology vendors with Direct HIE capabilities as well as stand-alone Health Internet Service Providers (HISP) with commercially available services. our strategy includes using financial incentives to encourage adoption.With the number of private sector “Meaningful Use” hospitals and providers growing every month and with the anticipation of Direct Messaging becoming a secure health transport capability within Certified EHR systems, we believe the state/Public Sector must be prepared to meet the anticipated demand from these providers to use this technology as the “Default” communication vehicle for any number of communication needs. Just as the state has had to respond to market demands in the past with the introduction of the fax machine and the rapid adoption of email, a customer-focused government should also leverage Direct technology in response to the capabilities growing in the market.
To enable seamless point-to-point information sharing, implementers must collaborate on elements beyond the basic technical specification, including establishing consistent policies and practices on which all stakeholders agree. Today, most Direct implementations only allow users to exchange with other users who subscribe to the same Direct Health Information Service Provider (HISP), resulting in “islands of automation”. As an extension of the original Direct Project "Rules of the road", DirectTrust formed a trust community and developed accreditation criteria united around a common set of technology, security and operating policies in support of Direct. DirectTrust community is made up of a variety of health information exchange entities (HIE entities), health information technology vendors, and/or other stakeholders that have established a set of technical, legal, and business standards. However ultimately implemented, we were very clear in our desire to minimize the need for peer-to-peer agreements between individual HISPs and to promote the adoption of Direct in a way that would lead to a Scalable solution not constrained by geographical borders, organizational borders, or vendor implementations.
To compliment the efforts being launched in the private sector, the state is planning to “Direct enable” various services through its own HISP. A high priority is to enable public health reporting (Immunization registry, electronic reportable labs) over Direct as well as looking at other use cases involving mental health case reviews, quality reports submissions to Medicaid, and care coordination between corrections and private sector health care organizations.“Direct enabling” various services within state government, will create additional use cases for using Direct HIE capabilities in the private sector. To promote early adoption of Direct HIE in the private sector, it will be important to enable multiple uses cases to reinforce the value and use of Direct HIE services.
we are encouraging market-based solutions of EHNAC-DirectTrust accredited solutions to meet the needs of providers. We are already seeing some EHR technology vendors with Direct HIE capabilities as well as stand-alone Health Internet Service Providers (HISP) with commercially available services. Much like the match-maker role that Qsource/tnREC plays today in supporting providers in the selection of Certified EHR technology for the CMS EHR Incentive program, the state and tnREC will play a similar role in matching participants involved in the Health eShare pilots as well as other providers across the state with one or more commercially available, EHNAC-DirectTrust accredited Direct HIE service providers.To support the pilots and promote early adoption of Direct based HIE services across the state; our strategy includes using financial incentives to encourage adoption. Interested parties may register at the Health eShare program. If they adopt and use EHNAC-DirectTrust accredited Direct solutions, registered participants will receive a $500 incentive. We are providing a total of $2,000,000 in financial incentives in hopes to encourage up to 4,000 Direct enabled users across the state.
So what we end up with is a landscape of disparate directories without common abilities to network. There are directory data model standards (HPD+) that enable common data models and standards, but not all vendors have universally adopted these standards. This is mostly driven by lack of universal consensus as well as a careful business analysis of scope is necessary to ensure that the incremental benefits of expanded provider directories are equal to or greater than the incremental costs of building and maintaining the expanded features and data.The defining parameters of a provider directory are dictated by the purposes that it is designed to serve. A careful business analysis of scope is necessary to ensure that the incremental benefits of expanded provider directories are equal to or greater than the incremental costs of building and maintaining the expanded features and data.Direct specifies a mechanism to obtain a digital certificate or security information (public keys) - Certificate discovery. And DirectTrust outlines requirements to establish trust:1. Validation: Ensuring that information submitted by the individual is accurate (information is correct)2. Identity proofing: Confirming that the validated information belongs to the individual registering (“I am who I say I am”)So, if I know the “Direct address” of someone/some entity that I trust and want to send a message, my HISP should have ability to discover the public key of another trusted user from another trusted HISP and execute all the necessary security encryption. But, how do I “look up” the “Direct address” to initiate the communication if I don’t know the actual address?Common approaches for this is mostly “out-of-band”. Business cards, etc.How do we Keep it simple – think big – but start small and then build as you go
A patient is referred to an endocrinology specialist for an urgent lab test. The referring physician needs to get the contact data of close-by endocrinologists in order to ask whether one of them can perform this test in their own lab.
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