The QHN April 17 Transitions in Care (TOC) conference offered participants the opportunity to explore the role of HISP and Direct in MU Stage 2 and how QHN Direct supports providers in qualifying for EHR Incentive Payments. QHN Direct offers a secure, standards-based way to send encrypted health information directly to known, trusted recipients over the Internet. QHN Direct is being offered to QHN Users as part of their current subscription if they enroll before July 1, 2014.
As part of the day's events participants explored various HISP /Direct use cases and solutions. In order to attest for MU Stage 2, providers need to perform certain activities using certified EHR technology (CEHRT) which includes Direct secure messaging. Leveraging the Direct protocol for data exchange requires the use of a Health Internet Service Provider (HISP). QHN is a HISP and will be offering HISP to HISP connectivity. Learn more about HISP.
Participants looked at the option of a decentralized model were providers must manage the significant inconvenience of multiple logins, one for each of their referring provider's HISP services, and the advantages of creating a communitywide "hub and spoke" solution with one login and a centralized Direct address book offered by QHN.
"We are looking at using QHN Direct as a solution within our EHR. To not look at a solution using the QHN Direct hub and spoke model, which has worked so well for us in the past, is a huge step backwards," said Michael Miller, IT Director for Primary Care Partners. "As I look at the solutions offered by the various EHRs I just can't help but think how confusing and fragmented this communication could be, without QHN Direct, especially for specialists. They could be receiving messages from, and having to login into, 20-25 different Direct accounts."
HISPs perform two key functions that support scalability of exchange using the Direct standard: 1) Issue security certificates to establish trust networks by defining policies for network participation, 2) Issue direct addresses (QHN is creating and maintaining a community address book) in accordance with conventions defined by the Direct standard.
"I'm also uncomfortable with some of the EHRs messaging solutions; I don't want PHI traveling in the public sector. Through QHN I know trust agreements are in place with all participants (ecommerce and BAA agreements) and the information is secure and encrypted," says Miller.
Direct facilitates only the simplest form of "push" health information exchange. It does not support more sophisticated data queries that involve the "pulling" of data from a repository (Virtual Health Record) by clinicians seeking integrated data from multiple clinical sources.
These more complex data exchange requirements will become more important in MU Stage 3, however not all providers are thinking that far ahead. Some clinicians see Direct messaging as a shortcut to achieving MU Stage 2 data exchange requirements, but may overlook how to accomplish more complex meaningful data sharing required as the MU continuum progresses.