Yesterday was a big day for The Direct Project, which I’ve been pleased to be able to participate in. Kudos to those who have started demonstrating successful “pushing” of communication of clinical information across providers! As pointed out by many speakers, it’s great to see collaboration for the common good among many organizations that are competitors in the marketplace. There’s a quickening momentum as the trickle of information exchange grows to become a flood.
As ONC's Dr. Blumenthal aptly said, The Direct Project is “a lane in the information highway.” What he didn’t say was “but it’s not the cars, passengers, or cargo being transported down the highway.” That’s an important distinction that not everyone may realize, since the pilots really showcase much work that is outside the scope of Direct, such as “integrating patient data across provider settings and during transitions of care” as one pilot announcement said. Direct was used to transmit the data, but didn’t integrate it, because it’s the highway, not the cars or the place that the car is going to. It’s secure transport, not data content nor use of the content.
One beauty of Direct is that it is unbiased, neutral, toward the content it is transporting. It uses established standards to securely deliver any content to the right place so that only the intended recipient can read it (it’s an honest mailman who doesn’t read your mail). But the content had to exist in electronic form before Direct can encrypt and send it. The data could have come from EHR, or a scanner, or a person typing an e-mail message, but someone or something created it first, and someone else (not Direct itself) does something useful with it on the receiving end.
To the extent that something wonderful is done with the data that’s being sent securely through Direct, that’s done by innovative and usable applications of one sort or another, and while Direct didn’t make those applications, it sends them something to work with. Applications analogous to Quicken. Why do I say that? Well, I’ve often heard the healthcare industry unfavorably compared to other industries like banking, where everyone lauds the benefits of their interoperability through ATMs and the ability of banks to download data into personal financial software like Intuit's Quicken (which I’ve used for years). I'm sometimes skeptical of such comparisons because health data is so different than money. Nevertheless, there are some very useful parallels.
If my connection to the bank securely delivered images of paper bank statements as PDF files, and images of checks, it would have some value by saving postage, trees, drawer space, and a little time. But no one would be satisfied with only those benefits today. My account data is not just delivered as images of checks or my old monthly paper statements; it’s delivered in a discrete “consumable” form that I can use to write checks, transfer money, set up automatic payments, manage a budget, analyze my expenses, search, import into tax software – all while my ledger is automatically kept up to date and saves me from having to do the dreaded “reconcile the checkbook” chore that I thankfully abandoned long ago. The semantic standards are pretty basic compared to healthcare – we agree on dollars and cents and dates and times, not so much on the payees (I realize I’m oversimplifying).
So my message to end today’s post, which I’ll follow up with part 2 in another day or so, is that the flow of health information is quickening, and I’m happy that the Direct Project is playing an important role in doing that. But it’s health IT's Quicken counterpart at the other end that makes it really useful. I believe that to get the most value out of secure health transport, we need to increasingly send content that is human-readable but also appropriately structured and consumable at the receiving end. Deciding what that content should be is work for other projects ahead. Whatever it turns out to be, the Direct Project will help push it quickly where it needs to go.