THE DIRECT PROJECT UPDATE FOR THE FEDERAL HIT WORKGROUP

1. THE DIRECT PROJECTUPDATE FOR THE FEDERAL HIT WORKGROUP Arien Malec Coordinator, NHIN Direct Project

2. The NHIN Direct Project A project to create the set ofstandardsand services that with a policy framework enable simple, directed, routed, scalable transport over the Internet to be used for secure and meaningful exchange between known participants in support of meaningful use

3. The Direct Project Secure Internet-based Point-to-Point Messaging The 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. h.elthie@direct.ahospital.org b.wells@direct.aclinic.org • Simple.Connects healthcare stakeholders through universal addressing using simple push of information. • Secure. Users can easily verify messages are complete and not tampered with in travel. • Scalable. Enables Internet scale with no need for central network authority. • Standards-based. Built on common Internet standards for secure e-mail communication.

4. The Direct Project Facilitates Meaningful Use The Direct Project facilitates the communication of many different kinds of content necessary to fulfill meaningful use requirements. Examples of Meaningful Use Content D I R E C T b.wells@direct.aclinic.org • 1) Get a Health Internet (email-like) address and a security certificate • 2) Send mail securely using most e-mail clients OR contract with a HIO or HISP that performs authentication, encryption and trust verification on your behalf • Patients: • Health information • Discharge instructions • Clinical Summaries • Reminders • PublicHealth: • Immunization registries • Syndromic surveillance • Other Providers/Authorized Entities: • Clinical information • Labs – test results • Referrals – summary of care record

5. The Direct Project Facilitates Meaningful Use The Direct Project facilitates the communication of many different kinds of content necessary to fulfill meaningful use requirements. Examples of Meaningful Use Content DIRECT b.wells@direct.mclinic.org • Other Providers/Authorized Entities: • Clinical information • Labs – test results • Referrals – summary of care record • Patients: • Health information • Discharge instructions • Clinical Summaries • Reminders • Public Health: • Immunization registries • Syndromic surveillance

6. Open Government and Focused Collaboration CORE PRINCIPLES Prioritization Transparency Engagement Rapid Results Focused Collaboration Commandand Control Focus Classic Trade-Off Low High A Thousand Flowers Bloom Low High Participation

7. Wikis, blogs, open code repositories, oh my…

8. The Importance of High Quality Open Source Libraries • The history of the Internet shows the power of permissively licensed open source in driving standardization: • TCP/IP: Berkeley TCP/IP stack • DNS: BIND • HTTP: Apache • Successful open standards have easily accessible high-quality libraries trivially available to developers, including high quality documentation • A key deliverable of the Direct Project is a BSD-licensed software stack enabling: • Client-side connectivity, for EHRs, EHR Modules, PHRs, etc. and • Server-side connectivity for “out of the box” HIOs and Health Information Service Providers (HISPs)

9. Close to 200 Implementation Group Participants • Alere • Allscripts • American Academy of Family Physicians • Argonne National Laboratory • Atlas Development • Axolotl • CareSpark/MobileMD/Serendipity Health • Cautious Patient • Cerner • Clinical Groupware Collaborative • CSC • eClinicalWorks • EHR Doctors • Emdeon • FEI • GE • Google • Greenway Medical Technologies • Harris Corporation, • High Pine Associates • HLN Consulting, LLC • IBM • ICA • Inpriva • Intel • Kryptiq • LabCorp • Massachusetts eHealth Collaborative • MedAllies • Medical University of SC, • Medicity • MedNet • MedPlus/Quest Diagnostics • Microsoft • Mirth Corporation • MOSS • Nationwide Health Information Technology • NIH NCI • NIST • NYC Dept. of Health and Mental Hygiene’s PCIP • Oregon HIE Planning Team • Redwood MedNet • RelayHealth • Rhode Island Quality Institute • Secure Exchange Solutions • Siemens • South Carolina SDE • SureScripts • Techsant Technologies • TN State HIE • VA • VisionShare Most of the top EHR and HIE technology vendors, national service and IT providers (Surescripts, Quest, LabCorp, Microsoft, Google etc., good participation with states), VA strongly involved as a federal partner

10. Development Progress • All volunteer team • Rapid and consistent growth on the C# side • C# team had to write much more code (DNS, MIME) than Java team due to better libraries on the Java side • API documentation in good shape, unit testing lagging behind • Java team has excellent progress on engineering quality (unit tests, documentation) • 3-5 active developers/day

11. NHIN Direct High-Level Project Plan Aug 2010 Sept 2010 Immediate Next 90 Days Short Term 3 to 9 months Long Term 9 to 36 months Draft Specification Complete Transition to an SDO Ongoing Maintenance Initial Pilot Implementation Expansion of Pilots Wide-Scale Deployment Evaluation for inclusion by NHIN and ONC Endorsement Evaluation by HITSC HITPC Tiger Team Framework and Policy Review Feedback to NHIN Governance Feedback on initial lessons learned Ongoing Review and Feedback Immediate Initiatives Short Term Initiatives Long Term Initiatives

12. Direct Project Real-World Implementation The Direct Project will be demonstrated in real-world pilots across the country MedAllies (NY) Rhode Island Quality Institute (RI) Redwood MedNet (CA) Medical Professional Services (CT) CareSpark (TN) Carolina eHealth Alliance (SC) • The Direct Project is architected for rapid adoption by: • Thousands of hospitals • Hundreds of thousands of physicians • Millions of providers • Tens (or hundreds?) of millions of patients • Many other stakeholders in healthcare

13. Questions?