The Direct Project<br />Ali Emami<br />Software Engineer<br />aliemami@microsoft.com<br />
Quick History of the Direct Project<br />5/28/2011<br />Launched just after HIMSS 2010<br />Response to community frustrat...
Why is there a need for Direct?<br />5/28/2011<br />Current methods of health information exchange are inadequate<br />Com...
Health information and history is lost or hard to find in paper charts</li></ul>Current forms of electronic communication ...
Direct will be one of the communication methods in the Nationwide Health Information Network</li></li></ul><li>Direct Proj...
Direct ProjectHigh quality open source libraries<br />The history of the Internet shows the power of permissively licensed...
Protocols and Technology<br />SMTP Gateway<br />Direct uses SMTP as its transport protocol.<br />S/MIME<br />Messages are ...
HISP<br />      Internet<br />Email Server<br />SMTP Gateway<br />Security & Trust Agent<br />MIME<br />+ TLS<br />XD* Age...
Scenario: Doctor to patient messaging<br />Dr. Alex wants to send a visit summary to patient Jill.<br />From: alex@direct....
Sending a message<br />Alex creates and sends the message using his favorite e-mail client.<br />Or his hospital’s EHR sof...
Receiving a message<br />Jill is using a PHR system that provides her with a Direct address. <br />Microsoft HealthVault i...
More scenarios<br />Provider-to-Provider scenarios have equivalent flow. <br />Scenario: Referring doctor sends patient in...
Direct ProjectThe Process<br />	Direct standards and specifications are developed by a group of public-private stakeholder...
Implementation Guides
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The Direct Project @ Quantified Self

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  • The Direct Project @ Quantified Self

    1. 1. The Direct Project<br />Ali Emami<br />Software Engineer<br />aliemami@microsoft.com<br />
    2. 2. Quick History of the Direct Project<br />5/28/2011<br />Launched just after HIMSS 2010<br />Response to community frustration about state of exchange<br />Collaboration across the industry: government, vendors, advocates<br />Today: real production use in multiple programs across the country<br />
    3. 3. Why is there a need for Direct?<br />5/28/2011<br />Current methods of health information exchange are inadequate<br />Communication of health information among providers and patients still mainly relies on mail or fax<br /><ul><li>Slow, inconvenient, expensive
    4. 4. Health information and history is lost or hard to find in paper charts</li></ul>Current forms of electronic communication may not be secure<br /><ul><li>Encryption features of off-the-shelf e-mail clients not often used in healthcare communications today </li></ul> Physicians need to transport and share clinical content electronically in order to satisfy Stage 1 Meaningful Use requirements.<br /><ul><li>Need to meet physicians where they are now
    5. 5. Direct will be one of the communication methods in the Nationwide Health Information Network</li></li></ul><li>Direct Project Secure Internet-based Direct Communications<br />Direct Project specifies a simple, secure, scalable, standards-based way for participants to send encrypted health information directly to known, trusted recipients over the Internet.<br />h.elthie@direct.ahospital.org<br />b.wells@direct.aclinic.org <br />Simple.Connects healthcare stakeholders through universal addressing using simple push of information.<br />Secure. Users can easily verify messages are complete and not tampered with in travel.<br />Scalable. Enables Internet scale with no need for central network authority. <br />Standards-based. Built on common Internet standards for secure e-mail communication. <br />
    6. 6. Direct ProjectHigh quality open source libraries<br />The history of the Internet shows the power of permissively licensed open source in driving standardization:<br />TCP/IP: Berkeley TCP/IP stack<br />DNS: BIND<br />HTTP: Apache<br />Successful open standards have easily accessible high-quality libraries trivially available to developers, including high quality documentation<br />A key deliverable of Direct Project is a BSD-licensed software stack enabling:<br />Client-side connectivity, for EHRs, EHR Modules, PHRs, etc. and<br />Server-side connectivity for “out of the box” HIOs and Health Information Service Providers (HISPs)<br />
    7. 7. Protocols and Technology<br />SMTP Gateway<br />Direct uses SMTP as its transport protocol.<br />S/MIME<br />Messages are signed and encrypted using the S/MIME standard. <br />A decades old protocol for ensuring authenticity, non-tampering, confidentiality, delivery only to intended recipients. <br />DNS<br />Used to serve up certificates bound to an e-mail address or organization. <br />The highest scale distributed directory on the planet. Powers internet addressing. <br />Configuration Web Service and DB<br />Storage and access to org’s certs, private keys, trust anchors<br />
    8. 8. HISP<br /> Internet<br />Email Server<br />SMTP Gateway<br />Security & Trust Agent<br />MIME<br />+ TLS<br />XD* Agent<br />Firewall<br />SOAP Client<br />HTTP<br />Gateway<br />XD* SOAP Endpoint<br />Configuration<br />Web Service<br />SQL<br />HTML/HTTP<br />Admin<br />DNS<br />Gateway<br />Configuration Web UI<br />DNS Server<br />
    9. 9. Scenario: Doctor to patient messaging<br />Dr. Alex wants to send a visit summary to patient Jill.<br />From: alex@direct.ahospital.org<br />To: jill@direct.aphr.org<br />Subject: Your health visit summary<br />Jill,<br />Here is the summary information from your visit.<br />- Dr. Alex<br /><Summary Attached><br />
    10. 10. Sending a message<br />Alex creates and sends the message using his favorite e-mail client.<br />Or his hospital’s EHR software. <br />A Direct gateway is installed at ahospital.org. Secure e-mails at ahospital are relayed through this gateway. <br />The gateway receives the message and determines it needs Jill’s certificate in order to send the message. It uses DNS to resolve it.<br />The gateway:<br />Signs the message with Alex’s private key. <br />Encrypts the message with Jill’s public key.<br />Sends the message over SMTP to Jill’s gateway.<br />5/28/2011<br />
    11. 11. Receiving a message<br />Jill is using a PHR system that provides her with a Direct address. <br />Microsoft HealthVault is one such PHR system.<br />The PHR’s Direct gateway receives the message from ahospital.org. <br />The gateway looks up Jill’s private key from its local configuration backend. <br />Jill’s Gateway:<br />Decrypts the message using Jill’s private key. <br />Verifies the signature on the message is valid. <br />Verifies that the signer is trusted. ie. Jill trusts Dr. Alex. <br />Forwards the message to Jill’s inbox. <br />5/28/2011<br />
    12. 12. More scenarios<br />Provider-to-Provider scenarios have equivalent flow. <br />Scenario: Referring doctor sends patient information to another doctor. <br />Patient-to-Provider scenarios are just as easy!<br />Gateways can be configured to allow incoming messages, outgoing messages, or both for a given address or domain. <br />Example: Doctor wants to send to patients but NOT receive. <br />
    13. 13. Direct ProjectThe Process<br /> Direct standards and specifications are developed by a group of public-private stakeholders. Weekly teleconferences and periodic face-to-face meetings facilitate active collaboration.<br />Direct Project Output:<br /><ul><li>Standards and Service Definitions
    14. 14. Implementation Guides
    15. 15. Reference Implementation
    16. 16. Pilot project testing and real-world implementation</li></ul>Vendors incorporate reference implementation into HIT products <br />Wide-scale adoption of Direct standards by late 2012<br />First phase grounded in real-world pilot projects implemented by early 2011<br />Incorporation of HITPC, HITSC, and ONC policy guidance<br />
    17. 17. Momentum is Remarkable<br />Some vendors that have already announced plans to support the Direct Project include:<br />· Allscripts<br />· CareEvolution<br />· Cerner Corporation<br />· Covisint<br />· eClinicalWorks<br />· Epic<br />· Greenway Medical Technologies<br />· Kryptiq Corporation<br />· MedPlus (A Quest Diagnostics Company)<br />· Microsoft Corporation<br />· NoMoreClipboard.com<br />· OpenEMR<br />· Siemens<br />· Surescripts<br />· VisionShare<br />
    18. 18. Direct Project Real-world Implementation<br />Direct Project will be demonstrated in real-world pilots across the country<br />Rhode Island Quality Institute (RI)<br />VisionShare (MN)<br />MedAllies (NY)<br />Redwood MedNet (CA)<br />Medical Professional Services (CT)<br />VisionShare (OK)<br />CareSpark (TN) <br />Direct Project is architected for rapid adoption by:<br /><ul><li>Thousands of hospitals
    19. 19. Hundreds of thousands of physicians
    20. 20. Millions of providers
    21. 21. Tens (or hundreds?) of millions of patients
    22. 22. Many other stakeholders in healthcare</li></ul>- 14 -<br />
    23. 23. Links to Direct Project Resources<br />Get involved! <br />http://wiki.directproject.org<br />C# Reference: http://wiki.directproject.org/CSharp+Reference+Implementation<br />Java Reference: http://wiki.directproject.org/Java+Reference+Implementation<br />For more informationMy e-mail: aliemami@microsoft.com<br />

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