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Direct messaging enables smoother transitions of care in Tenn.

By Jennifer Bresnick

A landmark 1000 providers in Tennessee are experiencing improved communication, better information exchange, and smoother transitions of care thanks to the efforts of the Tennessee Health eShare Direct Project.  Combining the efforts of the Office of eHealth Initiative and QSource, the state’s Regional Extension Center (REC), Tennessee has been able to extend secure messaging to rural and urban providers alike.  Dawn FitzGerald, CEO of QSource, told EHRintelligence how targeting their services to providers based on their patient populations and community needs contributed to the success of the project after only four months.

How has your strategic plan contributed to your success?

Rather than focusing on trying to get big numbers as rapidly as we could, we wanted to really test effective use cases for Direct technology so that when we did roll out statewide, we would not only be able to garner support for the initiative, but usability would not suffer.

The first six months of our contract were really focused on individual interviews and focus groups with providers to understand their special needs and circumstances.  Then we utilized that to build our statewide marketing and communications plan.  And I think that’s really been the marker of our success and why we’ve been able to garner so much adoption and uptake in such a short period of time once the statewide rollout occurred. We’re selling a product that has a use that people can understand.

We’ve also been focused on looking at ways that we can grow usability organically by identifying those connectors in the community that want to utilize the system and then pairing them with their trading partners.  So once you have the system in place, you actually have someone with whom you are interested and want to communicate with.

The reality is that the true use cases occur in terms of identifying opportunities for better care transitions: referral of patients to a specialist for follow up; labs being exchanged between two healthcare providers that share a patient population, for example.  And so it’s not really the physician to physician communication.  It’s office manager to office manager or case manager to other care provider to assist in hand offs.  Those are really the scenarios that have been most effective from a community perspective.

Do you view Direct as a first step towards more robust HIE, or is it a standalone product?

It is definitely a first step.  I think it’s better than what we have now, which are communication systems that stay within the organization’s four walls and doesn’t go across care settings.  So that ability to cross platforms is going to be critical and it does provide that first mile. I think that you will see more robust health information exchange where you have both the capacity to push information and pull information will ultimately take over.  But this may exist for many providers for a number of years before that technology evolves in their community, particularly in rural areas.

It’s taking root in both urban and rural areas and frankly, most of our success has been in urban areas where there’s a lot larger trading zone.  But you are right, in terms of why we went the direct route or at least my perception of why the state went in the direction of Direct is because it was more saleable to rural settings that sort of trying to figure out how to create a health information exchange that could outreach to such a broad spectrum of the community.

What sort of financial investment is required for providers to get on board with this?

Well, if you’re going with something as simple as a portal-based product it can be as inexpensive as a couple hundred dollars a year.  And the state of Tennessee offers an incentive for provider participation in the first year of up to $500 per address.  So it more than offsets the initial cost for that portal based product.  Where the costs are a little more challenging is in integrating Direct into an EMR technology, which requires your vendor to determine how they’re going to price that for you.  It’s an affordable proposition, though.  We joke all the time it’s cheaper than cable and hopefully better for patients.




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