An association of health care providers and health information technology companies called DirectTrust, wants to improve the process of using clinical messaging in electronic health records, and is seeking commment on its plan to do so.
The group released for public comment a white paper, “Feature and Function Recommendations to the HIT Industry to Optimize Clinician Usability of Direct Interoperability to Enhance Patient Care,” with more than 50 recommendations to improve the usability of incoming and outgoing direct clinical messages from EHRs, which is the main function of DirectTrust's communications framework, dubbed Direct. “The integration of Direct into the system is well underway and being used but there are still a number of loose ends, problems at the endpoints,” says David Kibbe, M.D., president and CEO of Washington, D.C.-based DirectTrust. (Watch Kibbe in a video interview describe how the messaging works.)
These problems were not unexpected, since vendors and providers were under a lot of pressure to adopt EHRs due to the Meaningful Use program; now that providers are really beginning to use Direct for care coordination they are realizing that the current EHR products can’t accomplish what the clinicians want them to, says Kibbe.
Direct interoperability is offered by more than 350 EHR vendors, according to Kibbe, and more than 1.4 million providers have Direct accounts. “It’s the new fax. It works really well,” he says. However, users don’t always receive the information in a form that’s readable.
“There’s a lot of variability as to how vendors are creating features and functions for using Direct exchange,” says Kibbe.
The recommendations are ranked: some are urgent/required now, some are highly desired/needed in the next one to two years, and some advanced capabilities will be needed in the future. Some of the changes needed now include:
- EHRs need to be configured to trigger the sending of a Direct message based on specific orders, such as a patient discharge or once the hospital discharge summary has been completed
- All Direct interoperability messages should be sent in real time and not batched for timed sends
- Vendors should use all existing recognized standardized vocabularies
- EHRs must be able to automatically match incoming messages for patients that already exist in the recipient EHR
The deadline for submitting comments is March 30, 2017.
Kibbe hopes that the White Paper will provide an opportunity for collaboration among stakeholders to enhance usability. DirectTrust will also ask the Office of the National Coordinator of Health IT to hold an interoperability summit to resolve issues face to face.
Kibbe likened the situation to electronic prescribing, which took several years to fully integrate into EHRs.
“I’m very confident. We’ve been through this rodeo before,” he says.