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Vendors Cry Foul on HIE Plan

By Richard Martin Comments

Richard MartinIn a tweet, Brian Ahier, the Health IT Evangelist for Information Systems (I think that’s like IT director, kinda) at Mid-Columbia Medical Center, in Oregon, stated that the Direct Project – the healthcare information messaging system developed under the Office of National Coordinator for Health IT – “is becoming ubiquitous in HIE (Healthcare Information Exchanges] – but some pilots seem disconnected from state planning efforts."

Since Ahier was one of the volunteers on the Communications Workgroup that helped develop the protocol for the Direct Project, that’s a strong statement. But it’s not the only conflict inherent in the Direct Project architecture.

On the plane on the way back from the HIMSS show, in Orlando, I sat next to one of the directors of healthcare IT solutions at a major vendor. I’m not quoting him by name because our conversation was not on the record. What he told me, essentially, was that the Direct Project, which as you might guess uses a direct, point-to-point, email-like architecture for exchanging patient data and lab results, is in direct conflict (pardon the pun) with the work of, which for a decade or so has been working on an Internet-like, network-of-network structure for connecting disparate HIEs. U.S. CTO Aneesh Chopra, he said, “wants to scrap all the work the vendors have done on IHE." The vendors, despite public statements of support for the Direct Project, are not having it, as you might expect.

Here’s another view of this imbroglio, from a healthcare IT consultant with an inside view of the process:

“1) The Direct Project was developed in response to the original [National Healthcare Information Network] CONNECT stack, which Aneesh [Chopra] had a hand in and is basically a Beltway Bandit failure.

“2) The Admin also wants some wins in the field with regards to information exchange and are getting a lot of push-back from healthcare orgs who are struggling to meet Stage One [meaningful use requirements], let alone Stage 2 -- and Stage 1 has almost nothing with regards to info exchange. To date, many have been pushing the IHE stack of standards that many vendors have built, and still are building, their platforms to support. Problem is, these standards can be complex to implement in the field so now there are some rumblings coming out of ONC to begin pulling back on the push for IHE protocols."

The truth in all this lies somewhere amidst these shifting perspectives; but you can bet that the Direct Project, whose first pilots have been unveiled with plenty of fanfare, will run into further pushback.


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