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DirectTrust Recommendations Encourage EHR Interoperability

A new set of recommendations released by a DirectTrust workgroup advises healthcare organizations and providers to streamline and standardize EHR interoperability.

DirectTrust MEssaging

Source: Thinkstock

By Kate Monica

- DirectTrust has issued a white paper for public comment consisting of 50 recommendations for over 350 EHR vendors and health IT companies providing Direct interoperability.

The recommendations focus on improving the usability of EHR and health IT applications using the Direct standard for health information exchange and messaging.

A DirectTrust workgroup comprising physicians and nurses with experience with Direct messaging authored a white paper released in the beginning of February with a comment period extending through March 30.

As a health IT standards and transport mechanism, Direct is intended to facilitate health record sharing for care coordination and transitions of care. The white paper outlines recommendations for vendors to consider for standardizing and enhancing user experience in handling inbound and outbound Direct clinical messages as well as the ways in which clinical information exchange during coordinated care is used.

The recommendations are ranked in three categories: required/urgently needed, highly desired, and advanced/future development.

Required recommendations include ensuring EHR software send Direct messages in real time as opposed to delayed or batch mode; allowing multiple, common structured and unstructured file formats to have the capabilities to be attached to any Direct message; and equipping all EHR systems with the ability to automate patient matching of incoming Direct messages for patients already present in the recipient EHR.

"Sharing patients' clinical information across commonly-encountered boundaries of health IT systems is critically important to clinicians and their teams who are coordinating their patients' care across different providers and organizations," said Steven Lane, MD, Clinical Informatics Director at Sutter Health and Co-Chair of the Clinicians Steering Workgroup, in a statement accompanying the request for public comment.

"Right now, in the typical medical community there is great diversity in the brands of EHRs and other health IT systems used by clinicians for Direct messaging,” he continued. “We're calling for all these vendors to make available more consistent and standardized software features to manage Direct clinical messages and their attachments. The existing variability in usability among different vendors' products is unacceptably high and poses a barrier to Direct interoperability, and thus to the adoption of secure messaging by clinicians to support common care coordination workflows."

Highly desired recommendations include ensuring the ability to customize templates for specific clinical circumstances (e.g., discharge, referral, specific diagnosis, encounter types) and implementation of industry-wide standardized discrete data terminology for additional data types including procedures and laboratory results.

"In a community where high risk patients receive care from multiple clinicians associated with diverse organizations using different EHR systems, Direct interoperability can put critical clinical information in front of the physician inside their own EHR," said Holly Miller, MD, Chief Medical Officer at MedAllies who co-chaired the Direct workgroup. "This has been found to prevent patient adverse events and to be potentially lifesaving. Direct interoperability has provided basic connectivity. Now the HIT community needs to enhance usability, and address deficiencies and inconsistencies of messaging content and functionality."

Deficiencies and inconsistencies of messaging content and functionality can be a hindrance to implementing industry-wide interoperability, which could negatively impact ease and quality of patient care.

Another priority is encouraging timely access to data for the sake of enhancing clinical efficiency. One way to push time-efficient health information access is through supporting EHR systems with automated patient identification to avoid confusion and speed up the Direct messaging process.

"Clinicians recognize the possibilities for clinical efficiencies through enhancements to their systems and are clamoring for these improvements,” added Miller. “Our hope is that this white paper will be used to help EHR and other vendors understand what clinicians need to support safe, secure, efficient and cost effective patient care as patients transition across their medical neighborhoods. This is about standardizing software features and functions so clinical personnel can reliably do their jobs and deliver high value patient care.”

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