Direct Project: A new way to transfer data

By Mike Miliard
02:14 PM

ORLANDO – Deputy National Coordinator Farzad Mostashari called it “a new way of doing business.” National Chief Technology Officer Aneesh Chopra called it “a great example of how government can work as a convener to catalyze new ideas and business models through collaboration.”

Todd Park, CTO of the Department of Health and Human Services, called it – deep breath – “a classic, fantastic, soon-to-be-legendary example of how the public and private sectors can come together in a collaborative, entrepreneurial explosion of mojo to improve and advance healthcare in America.”

‘It’ is the Direct Project. Spearheaded by the Office of the National Coordinator of Health IT, it's a simple, secure, scalable way to transfer medical data between clinicians via e-mail. It went live with two pilot projects in February, with more to follow soon.

And it appears, said Sean Nolan, chief architect and general manager of Microsoft’s Health Solutions Group, “to be the first technology that could really kill the fax in healthcare.”

It’s also an example of the speed and efficacy with which advancements can be brought to fruition when competitors put aside their differences and work together, under federal guidance, on a common goal.
Nearly 50 vendors came together to develop the specs for the Direct Project, representing the many facets of health IT: 4Medica, Allscripts, eClinicalWorks, Epic, GE Healthcare, Greenway, IBM, Intel, Kryptiq, NoMoreClipboard, Siemens, Surescripts, and more.

In the words of ONC head David Blumenthal, they represent a crucial coming together of health IT vendors, “including competitors, to rapidly produce a system that supports basic clinical delivery and public health needs.”

No easy task to get that many different players together in the same room, let alone working together on the same project. But by laying open code and enabling communication via wiki, government officials were able to entice an impressive roster of participants to sign on.

Speaking to a crowded room of vendors at HIMSS11, Chopra emphasized that that sort of open-source collaboration – engaging in “pre-competitive R&D collaboration,” liberating data and delivering it for new uses, and making use of voluntary, industry-driven consensus standards – is key to the reason “today is the best time to be a healthcare entrepreneur in America.”

Tom Wagner, CTO of Mason, Ohio-based MedPlus, whose Care360 is the first certified EHR to include Direct Project specs, said he was impressed by the how ONC convened those vendors.

“They said leave your egos at the door,” he said. “They said, ‘we want to make it simple, we want to make it scalable. We want to make something that people can implement quickly.’ And they involved the companies at all different levels. They had business stakeholders, technology stakeholders, they had the whole gamut, so they were getting the true value from all these companies.”

“Aneesh and Todd and Farzad, they kind of do business differently,” said Nolan, of Microsoft, whose HealthVault record is now enabled to accept encrypted e-mails from providers via Direct protocols. “They’re engaged and excited, and they make people see stuff.”

It wasn't too long ago, he said, that vendors were consumed with keeping up with a steady stream of new specifications and focusing on their own business problems.

After the announcement of Direct Project last March – with an open invitation for anyone to join – there was a shift, said Nolan. “You started to see that there was this silent majority out there that really wanted to do something meaningful. They kind of just grabbed on and ran.”

Allscripts CEO Glen Tullman said his company’s participation is consistent with its vision of “a connected community of health” – of laying  the infrastructure by which information can be exchanged, and thus allowing an array of players to “create, collaborate and innovate.”

He’s not the only devotee of that idea. Speaking at the press conference announcing the pilot programs in Minnesota and Rhode Island, Mark Briggs, of the Minneapolis-based Ability Network – formerly known as VisionShare – said, “We're big believers in the Direct Project.”

Briggs said his firm would make “an investment of up to $50 million over the next year to provide the ability for all physicians, hospitals and other healthcare providers across the country to join the network and transact over Direct.”

The quickness with which this “do-ocracy” (as World Economic Forum CTO Brian Behlendorf, who served as an adviser on the project, described it to the New York Times) was able to shepherd this technology to fruition is telling. It went from conception to launch in less than a year. That’s an object lesson in how the government can set the conditions for market-based innovation, its public- and private-sector participants say.

Indeed, said Nolan, “It's kind of weird that we haven’t been doing it for a long time.”


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