Six organizations are ready to test the Direct Project’s software, moving the Nationwide Health Information Network (NHIN) vision of integrated information exchange to a critical juncture, said Arien Malec, Coordinator of The Direct Project (formerly NHIN Direct), during a recent NHIN University presentation, “The Direct Project: Where We Are Today.”

The Direct Project is creating standards and services to enable simple, directed, routed and secure transport over the internet for meaningful exchange among known participants within a policy framework that protects their privacy and security, said Malec. “The Direct Project fits into the larger ecosystem of health information exchange. The specifications we’re creating are important tools in a much larger toolkit,” he said.

The Direct software stack aims to broaden exchange by supporting simple use cases and attempting to support adoption. It’s designed to coexist gracefully with more sophisticated information exchange models across a variety of networks, according to Malec.

“At its core, the Direct Project is signed and encrypted information exchange using SMTP as underlying transport,” he said. “There has been an impressive amount of adoption of underlying [Integrating the Healthcare Enterprise] standards for SOAP-based information exchange. We wanted to accommodate a common network but also accommodate EHR vendors that had adopted additional standards. The common underlying standard is SMTP stack, but we do support additional edge connectivity and additional end-to-end connectivity.”

Malec said two Direct reference implementations are at “1.0” status, one on a Java-based stack and .Net stack, and are slated for real-world pilot projects.

Six organizations are pilot-testing implementations of the Direct software stack in range of uses:

• The Rhode Island Quality Institute, a state-designated HIE/Beacon Community/Regional Extension Center, will pilot the process for transition of care as well as pushing health information to the longitudinal record in support of the Beacon Community.
• Connecticut’s Medical Professional Services, a REC, will test a process for exchanging lab reports as well as continuity of care and transitions of care, with EHR and non-EHR participants and select EHR modules.
• MedAllies of New York will conduct a pilot program using connecting off-the-shelf health record products using IHE standards and SMTP connections for providers who don’t have EHRs, in support of continuity of care using C-32 documents in transitions of care.
• CareSpark, Tennessee’s HIE, will pilot-test a fee-basis service process for the Veterans Administration, where care is provided in the community and needs to be tracked longitudinally back to VA. The CareSpark pilot is looking at subset of fee-based services for mammography, and looking at tracking mammography orders and reports end to end.
• Minnesota’s VisionShare, which already connects a wide variety of providers, is building an adapter to public health reporting transport standard, and will pilot-test a way to bring immunization reports from care providers to Minnesota and Oklahoma state immunization registries.
• Redwood MedNet, an HIE serving northern and primarily rural California, is pilot-testing exchanges of information at transitions of care as well as lab reporting and potentially also immunization registries.

These projects will provide feedback to the ONC’s HIT Policy Committee and Standards Committee, to inform possible wider-scale adoption in 2011 and 2012. “As we prove out the case of the Direct Project specifications, we’ll see wider deployment,” said Malec.