Transcript DirectTrust All Members Meeting

1:00 pm EDT, September 5, 2014
https://global.gotomeeting.com/meeting/join/930802605
(626) 521-0013 -- 930-802-605#
www.DirectTrust.org
1101 Connecticut Ave NW, Washington, DC 20036
1
Agenda
“You are the most trusted names in Healthcare Exchange”
•
•
•
•
Welcome and new member greetings
DTAAP, industry update, and news from members.
Member Resources
Presentation from Jean Doeringsfeld at WISHIN
– DIRECT Messaging: Challenges and Recommendations
• Workgroup updates
• Open discussion and comment
www.DirectTrust.org
1101 Connecticut Ave NW, Washington, DC 20036
2
DirectTrust Members 138 and
counting…
www.DirectTrust.org
1101 Connecticut Ave NW, Washington, DC 20036
3
3
DirectTrust Members 138 and
counting…
www.DirectTrust.org
1101 Connecticut Ave NW, Washington, DC 20036
New Members
• HealthNautica
• iShare Medical LLC
• Tascet Inc
www.DirectTrust.org
1101 Connecticut Ave NW, Washington, DC 20036
Renewing Members
www.DirectTrust.org
1101 Connecticut Ave NW, Washington, DC 20036
Newest Accreditations
• NextGen
Healthcare
www.DirectTrust.org
1101 Connecticut Ave NW, Washington, DC 20036
8
Calendar of Events
• September 4th – eHI Executive Summit
• September 15th – Consumer Health IT Summit in Washington,
DC.
• September 15th – 19th – National Health IT Week
–
–
–
–
Collaborative Panel Discussion with the Senate Special Committee on Aging – On Tuesday, Sept. 16, at10:00-11:45 a.m. ET HIMSS
Foundation’s Institute for e-Health Policy, in collaboration with Senate Special Committee on Aging, will host a panel discussion to
focus attention on the potential of health data analysis to better care for the aged. The discussion will be held at the U.S. Senate
Office Building.
Capitol Hill Technology Showcase – On Wednesday and Thursday, Sept. 18-19, HIMSS will hold its annual technology showcase,
featuring displays and demonstrations of the latest health IT technology. Exhibitors include API Healthcare, Leidos Health, Perceptive
Software; LexisNexis, Quammen Health Care Consultants, Infor, HEALTHEC, LLC, Verizon, Vecna/Vecna Cares, LifeWIRE Corp and
Northrop Grumman, to name a few. The showcase is free and open to the public (Reserve Officers Association Building, 1
Constitution Avenue, NE, Washington, DC 2002).
NHIT Week Press Conference -- On Thursday, Sept. 18 at 11:00 a.m. ET members of Congress and Office of the National Coordinator
for Health Information Technology will hold a press conference to discuss health information technology and achieving value through
Interoperability at the Reserve Officers Association Building (1 Constitution Avenue, NE, Washington, DC 2002). To RSVP, please
contact [email protected].
Dr. Karen DeSalvo Breakfast Keynote – On Thursday, Sept. 18 at 8:00-8:45 a.m. ET National Coordinator for Health Information
Technology Dr. Karen DeSalvo will discuss the progress that has been made transforming healthcare through information technology
and where she sees the country going in the near future at breakfast hosted by HIMSS and the HIMSS Public Policy Committee at the
Grand Hyatt Washington (1000 H Street, NW, Washington, DC
• Other events from membership?
www.DirectTrust.org
1101 Connecticut Ave NW, Washington, DC 20036
9
Member Resources
Resources on
www.DirectTrust.org
Workgroup Meeting
Minutes and Recordings
Discussion Boards
Presentations
Members in the News
Members logo splash
page
Other Resources
Wiggio
[email protected]
www.DirectTrust.org
1101 Connecticut Ave NW, Washington, DC 20036
10
Challenges with Direct
7/7/2015
11
Challenges with Direct
Background
• Two standards allowed for Direct messages:
– SMTP/SMIME (required for certification, but may not be
used)
– SOAP/XDR (optional for certification, but may not be
used)
• EHR vendors choose which standard they want to use
www.DirectTrust.org
1101 Connecticut Ave NW, Washington, DC 20036
Challenges with Direct
Problem #1: Sending messages between providers when the
provider’s systems use different standards
• Fundament flaw in the guideline for translating between the two
standards:
– SMTP only requires a Send To and From address.
– XDR requires a Patient ID without actually needing to know the To and From.
– XDR was amended to support Direct with a Send To and From attribute as
part of the meta-data, but Patient ID remained required.
• XDR requirement for Patient ID is problematic when the message from
the SMTP system does not contain a CCDA or some other object from
which to obtain the Patient ID.
www.DirectTrust.org
1101 Connecticut Ave NW, Washington, DC 20036
Challenges with Direct
What this means:
– Many providers receiving a Direct message can only receive the message if it
contains a Care Summary (CCDA)
– Providers sending a Direct message will not know what the receiving provider
can receive
– Messages that do NOT contain a Care Summary will be dropped and the
message will not be delivered
– Providers will not know if a message was dropped and the provider that
sent the message will think it was delivered
Providers may never see important clinical
data sent to them about their patients from
another provider!
www.DirectTrust.org
1101 Connecticut Ave NW, Washington, DC 20036
Challenges with Direct
Problem #2: Care Summary format not supported by all systems
• XDR standards require the CCDA be in .zip format
when sent via Direct.
• Some EHRs using SMTP can’t handle the .zip
format when they receive the Direct message
– Some can only take XML and are not able to find it in
the .zip
www.DirectTrust.org
1101 Connecticut Ave NW, Washington, DC 20036
Challenges with Direct
What this means:
– Providers sending a Direct message with a Care Summary will not know if the
receiving provider can receive the Care Summary in the format they send it in
– Messages that contain a Care Summary will be delivered but the Care
Summary can’t be opened if the receiving provider’s system does not
support the .zip format
• Some systems will show an error and others will not
– The provider that sent the message will think that the receiving provider
received the Care Summary
Providers may never see important clinical
data sent to them about their patients from
another provider!
www.DirectTrust.org
1101 Connecticut Ave NW, Washington, DC 20036
Challenges with Direct
Problem #3: Direct Project fundamental concept of sharing health
information between any providers with a Direct
address no longer applies
• Some EHRs/HISPs require that any EHR/HISP they exchange messages
with be part of DirectTrust
– Will not exchange Direct messages with EHRs/HISPs that are not part of
DirectTrust
– Messages are dropped
– No errors or warnings are provided
• Some EHRs/HISPs will establish trust through one-off trust relationships
– These one-off relationships are required for messages exchanged between
DirectTrust and non-DirectTrust EHRs/HISPs
– Not every EHR/HISP allows one-off trust relationships
• Some forbid it!
• Some require special contracts that enforce policy around vetting and managing users
www.DirectTrust.org
1101 Connecticut Ave NW, Washington, DC 20036
Challenges with Direct
What this means:
– Providers don’t know if they are part of DirectTrust or if the party they are exchanging with is part of
DirectTrust
•
Providers must now have knowledge about the systems of the other providers they exchange with
– Messages will drop, and the receiving provider will not know; the sending provider may get an error
message
– Instead of every provider with a Direct address being able to send to any other provider with a Direct
address, there is now a split world of:
•
•
•
Those that are part of DirectTrust
Those that are able to establish trust relationships outside of DirectTrust
Those that are left out – they aren’t part of DirectTrust and they can’t establish a relationship with those that are
(because the DirectTrust organization prevents it)
– We now have a new set of point-to-point relationships that must be managed
Providers may never see important clinical
data sent to them about their patients from
another provider!
www.DirectTrust.org
1101 Connecticut Ave NW, Washington, DC 20036
How WISHIN is Handling the Challenges
with Direct
•
WISHIN supports both SMTP/SMIME and XDR
•
WISHIN Direct+ is part of DirectTrust
•
WISHIN has established trust relationships and exchanged trust anchors with:
– Marshfield Clinic’s EHR/HISP
– MedHost’s EHR/HISP
•
WISHIN will continue to establish trust relationships with entities willing to
establish contract/policy around vetting and managing users
– WISHIN would lose its DirectTrust status if we did not require these protections
•
WISHIN manages the one-off point-to-point relationships so our customers have
the broadest network for exchange
www.DirectTrust.org
1101 Connecticut Ave NW, Washington, DC 20036
Questions
www.DirectTrust.org
1101 Connecticut Ave NW, Washington, DC 20036
Workgroup Reports
• Patient and Consumer Participation in Direct – Lucy Johns and
Leslie Kelly Hall
• Directory Policy – Bruce Schreiber and Jim Fisher
• Security and Trust Compliance – Luis Maas and Jeff McDonald
• Trust Anchor Bundle Operations – Greg Meyer
• Certificate Policy and Practices – Don Jorgenson
• New! Clinical Transitions of Care – Holly Miller and David
Kibbe
www.DirectTrust.org
1101 Connecticut Ave NW, Washington, DC 20036
21
Discussion
David C. Kibbe MD, President and CEO DirectTrust.org
[email protected]
[email protected]
913.205.7968
Brian Ahier, Director of Standards and Government Affairs
Medicity
[email protected]
541-288-1066
www.DirectTrust.org
1101 Connecticut Ave NW, Washington, DC 20036
22