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Top Features, Functions to Advance Direct Interoperability

The deadline for public comment on feature and function recommendations to advance clinical Direct interoperability is roughly a week away.

DirectTrust

Source: Thinkstock

By Kate Monica

- The comment period for a DirectTrust white paper outlining recommendations to the healthcare industry regarding the best use of Direct Interoperability is coming to a close on March 30.

The document comprising 50 recommendations seeks to optimize EHR and health IT application usability using Direct standards for health data exchange and secure messaging to improve several aspects of patient care.

In November of 2016, a DirectTrust workgroup of physicians and nurses drafted and organized the 50 recommendations into three priority levels, with the highest priority recommendations falling under the “required/urgent/now/current-next version” category.

Extensive rationale accompanied the following required priority recommendations explaining the significance of implementing these necessary functions in a timely fashion:

Healthcare providers should ensure Direct Interoperability messages are sent in real-time:

Direct interoperability has been demonstrated to be a critical capability for information sharing in support of patient care. This information sharing allows clinicians to continue using their preferred HIT system, while making locally stored information available to other members of the patient's care team. This supports best practice transition of care management, saves lives and prevents ADEs. Research has shown that 1/5 discharged patients experience an adverse event post discharge. This also encourages ambulatory care practices to arrange for appropriate patient follow up, particularly for high-risk patients. The send automation supports end users not wasting valuable time that could be devoted to direct patient care composing and sending messages. Clinicians, that have successfully used Direct, report the critical nature of the sending organization or provider, e.g. hospital, ED, specialist, PCP, BH organization, etc. sending the Direct message in “real-time” as opposed to via batch processes. 

Healthcare facilities sending Direct messages must know how to create a Direct template designed to automatically attach relevant document types specific to the clinical situation at hand:

Direct has been demonstrated to be a critical EHR capability for information sharing in support of patient care essentially virtualizing across the care team critical patient information. This information should include all clinically relevant document types in support of best practice and efficient care of patients as they transition across their medical neighborhoods. Virtualizing patient specific EHR information through the inclusion of a variety of document types also prevents duplicate testing or holes in clinical information required for patient care.

EHR and health IT developers should use standardized vocabularies to promote interoperability between systems and prevent information blocking:

Standardized use and transmission of discrete data would allow for exceptional end user functionality creating tremendous care and documentation efficiencies and preventing transmission error data entry. These efficiencies would further promote the desirability and use of Direct messaging and facilitate medical record reconciliation and EHR virtualization across the patient's care team. Medical record reconciliation can be lifesaving. 

Health IT systems should have the capabilities to support a variety of content types as attachments:

Direct has been demonstrated to be a critical EHR capability for information sharing in support of patient care essentially virtualizing across the care team critical patient information. This information should include all clinically relevant document types in support of best practice and efficient care of patients as they transition across their medical neighborhoods. Virtualizing patient specific EHR information through the inclusion of a variety of document types also prevents duplicate testing or holes in clinical information required for patient care. 

EHR systems should have the capabilities to match incoming Direct messages with their intended patients. If the message is intended for a new patient or an error occurs during automated matching, the message will be put into a work queue awaiting the patient’s registration or manual matching by a healthcare organization staff member:  

Without automated patient identification, Direct interoperability is basically functioning on the same level as an EHR integrated fax server. The ability for a Direct message to reach the appropriate clinician is significantly delayed if a manual patient matching process is required. Depending on EHR functionality, staffing models and volume of Direct messages delays may be over 24 hours, an unacceptable delay to efficient clinical care which might put the patient at risk for an adverse event. Direct has been demonstrated to be a critical EHR capability for information sharing in support of patient care. Patient matching must be automated to prevent impeding data flowing to the intended recipient, potentially creating a life threatening situation or patient ADEs. 

Users sending and receiving Direct messages must be able to identify the message context through a standard list preconfigured as part of the message template. 

Identifying the context and having this visible to the message recipient helps to expedite patient care. It also allows for messages of specific context types to be routed to the appropriate recipient within the recipient’s edge system.

These are just a few of the many top-priority recommendations DirectTrust issued to EHR vendors and health IT companies enumerating necessary features and functions providers must implement in order to use DirectTrust to its fullest potential for transitions of care, clinical messaging, and administration. 

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