We May Finally Be Moving Beyond Faxing to Exchange Clinical Information

I had a very rewarding week in Washington D.C. last week dealing primarily with issues and projects related to being able to exchange clinical information. The highlight was the Press Announcement - American Academy of Family Physicians Unveils New Secure Electronic Messaging Service for Physicians Based on Surescripts Network for Clinical Interoperability


Here is my quote regarding this initiative:

“Medical record information exchange in the United States has not been able to expand beyond the fax machine for more than 90 percent of medical practices and their patients. This initiative by AAFP and Surescripts could prove transformational by finally overcoming most of the pervasive obstacles that have prevented progress up until now. Finally, here is an initiative that promises practical transfers of patient information at a fraction of the cost and hassle of most current efforts. AAFP Physicians Direct also can deliver working solutions in an almost immediate time frame, rather than having to wait for years. We simply do not have years to wait for positive change in our health care system.”

We, at SOAPware, Inc. have been facilitating and encouraging this more simple approach to information sharing for years, and publically demonstrated its feasibility years ago -
AAFP/SureScripts/MinuteClinic/SOAPware Provider-to-Provider Clinical Messaging Demo'd at TEPR

Here is a summary of what this initiative intends to deliver:
AAFP Physicians Direct is an affordable and easy-to-use electronic messaging service for physicians that:
• Enables physicians to share patient health data through a secure network.
• Breaks down communication barriers between health care providers.
• Accelerates the digital transformation of the nation’s health care system.
The Benefits
• Improve communication among providers
• Enhance continuity of care
• Support achievement of Meaningful Use
• Advance the Patient-Centered Medical Home
The Technology
AAFP Physicians Direct is built on the Surescripts Network for Clinical Interoperability, making the new service available to family physicians and other health care providers nationwide. The AAFP, Surescripts, and many other organizations have collaborated with the federal government to create the standard protocols to make this type of electronic clinical communication possible.
The Cost
Unlimited messaging per physician: $15 monthly


Even though this is being announced/sponsored by the AAFP, it will be available to any physician of any specialty. The only requirement is that the prescribing clinician be connected to the Surescripts network. Many physicians are already connected and using it now to prescribe electronically. Surescripts is opening the network to now share more than just prescriptions. It is anticipated that just about any document type can be shared, and this includes CCR, CCD, .pdf, Word documents, images, etc.
The protocols for sharing are being based on the NHIN Direct Project which is national in scope and part of the federal initiatives for information sharing. Most regional health information exchanges, such as state HIE projects are going to be required, to some extent, to also support message transfers using the Direct protocols. Undoubtedly, there is going to be confusion amongst physicians as to why they would be interested in the Physicians Direct initiative when they have been approached to participate in one or more regional HIE projects. This blog post - Direct Model or HIE Model – http://www.emrandhipaa.com/emr-and-hipaa/2011/02/15/direct-model-or-hie-model/ - IMHO, does a pretty good job of explaining the Direct vs the HIE approach. Realistically, in the short term, it is going to likely be a both/and for most. The PHR that is projected to be at the center of the Direct model in this blog post is not yet tied into the Physicians Direct project, but may well be an option at a later phase. The Physicians Direct project provides a secure means to directly transfer electronic information from one physician to another. So, for now, this project could soon deliver a practical, more immediate, lower cost means to accomplish transfers of information beyond the limited faxing of today. Tomorrow, it may very well provide the tools to meet the interoperability requirements of Stage 2 and 3 of meaningful use with far greater practicality and lower cost (with less risk of being victimized by connectivity extortion) than some other options.
I predict, in time, the more national, Direct approach will subsume the regional HIE models when the latter run out of government fundings. I don't anticipate medical practices will be eager to pay for more expensive, regional information sharing networks when simpler, lower cost, national options are going to be available.

Another good read regarding the Direct approach to information sharing can be found here -
Getting DIRECTly to the Point: The Role of the Direct Project in Fast-Tracking Health IT Interoperability - http://e-caremanagement.com/getting-directly-to-the-point-the-role-of-the-direct-project-in-fast-tracking-health-it-interoperability/

IMHO, Surescripts and the AAFP are to be commended on their efforts toward encouraging more patient-centric and physician-friendly approaches to information sharing.

The other major meeting I attended this week in D.C. was the hearings related to the PCAST report. A good summary is found here - Comments to ONC: PCAST HIT Report Becomes a Political Piñata
http://thehealthcareblog.com/blog/2011/01/23/pcast-hit-report-becomes-a-political-pinata/