On the 7th Day of #HITChristmas … Julie Maas and EMR Direct

Note: In case you missed the other 12 Days of #HITChristmas, you can start with the first day here along with the story behind #HITChristmas or read all 12 days here as they are published.

On the 7th Day of #HITChristmas we’re excited to feature, Julie Maas and EMR Direct.

Tell us more about EMR Direct…

EMR Direct is a private company based in San Diego, California. We provide interoperability services to thousands of healthcare organizations, hundreds of Health IT companies, and patients nationwide, mostly through connections to our services from EMRs.

We’ve built our software platform with integration in mind, so our team can operate as if we’re an extension of the customer’s own software and IT teams, bringing our subject matter expertise in Direct & FHIR right to the EMR vendors and other healthcare organizations choosing to outsource that expertise to us.

Is FHIR all it’s cracked up to be? What healthcare problems is it really going to solve?

Well, it certainly doesn’t cure cancer, but FHIR does allow for structured data to be transferred more easily—as if it were stored in a standardized database schema. And that enables the following:

1) App developers can build software—once & done—intended for a larger addressable market rather than one EMR vendor at a time. So, say a life-extending diabetes app is built to interact with one vendor’s systems; the potential of FHIR means that it’s not a heavy lift to adapt that app for any other EMR, even one developed by a different vendor that offers a FHIR API, and perhaps even no lift at all.

2) Data can be made available at the requestor’s level of granularity—just “Allergies”, for example. Data can also be secured at that level of granularity—much like “sign in with Facebook” can share only your email address, when done right. In other words, you don’t need to download the whole clinical record if you only need a small piece of it.

3) Those who need to can query data in place, instead of having to replicate it.

The list goes on…If you still aren’t yet on board with the significance of this, consider an example like airline reservations. It’s the use of common standards in reservations that allows me to go to the website I prefer, when purchasing tickets. Everyone who purchased airline tickets before 1997 understands the difference APIs have made to this experience. Drawing a parallel to healthcare, exposing public APIs allows healthcare apps to be more repeatably leveraged, effectively bringing down the cost of development for each of them and eliminating barriers to entry for app developers—and this promises to offer huge administrative and analytical advantages to the healthcare industry over time.

What’s EMR Direct doing with FHIR that’s special and unique?

As we’ve done for Direct, we make FHIR easy for our customers to deploy, while maintaining security. That’s foundational and is always our starting point with any of our new products. Our customers don’t need to be experts in FHIR and OAuth in order to enable a state of the art FHIR API.

We believe great interoperability is like great usability—it works right, without getting in the way, more easily than alternatives, and with better results for all parties.

Security is also tough to do well, and we strive to make it easy for our partners to do it right. Along these lines, we’ve taken on an active role in the design of a secure, scalable FHIR community ecosystem. Even though the idea to make public healthcare APIs broadly available is a good one, implementing them can involve significant new risks that must be managed properly. One way we are hoping to move the needle and make this turn-key for our partners and others in the community is through a new set of technical profiles we’ve written. This work helps tie several related security standards together to enable reuse of digital credentials that can increase confidence in FHIR transactions and help them to scale well. The idea is similar to the way Direct networks were established several years back. We’ve recently made a few more new Unified Data Access Profiles (UDAP) publicly available. More discussion about what can be done with these profiles is in another blog post.

We’re continuing to add on to these ideas, so we hope to receive feedback on them and to soon welcome additional collaborators from Health IT and other industries.

You do a lot with Direct. Give us an idea of how much Direct is being used in healthcare.

Thanks for a softball. 🙂 The total number of Direct messages sent each quarter continues to grow, as does the number of messages sent per Direct address, according to DirectTrust. A record-breaking 170 Million Direct messages were exchanged in 2017, and about 163 Million have already been sent just in the first nine months of 2018, so we’re on track to set a new record again this year.

And Direct is poised for continued growth in the years ahead, too…

In the past, many implementers focused only on a single use case for Direct—transitions of care. Direct is clearly capable of more than that. I always compare it to the way email really made e-commerce possible back in the mid-90’s, because Direct is a lot like email, and we all know we can do a lot more with email than receive electronic receipts instead of paper ones from stores.

Direct has a similar role to play for any electronic data transaction that demands a higher level of security (and yes, I definitely mean not just in healthcare). With that in mind, we’ve collaborated on the development of an implementation guide for including more metadata in a Direct message. This can be used for sharing patient attributes (a variety of identifiers to be used for matching), workflow specifics (this message contains an image for consultation and report), or any other metadata that makes the recipient better able to process what’s inside, programmatically when possible. This work is gaining an audience and implementers, and it’s acknowledged in the ONC’s Interoperability Standards Advisory.

And since everyone likes a visual, here’s a map of nationwide Direct service coverage.

What are the big holes that current interoperability protocols like Direct and FHIR don’t address?

Good question, and we’ll see work on these in the immediate short term because all hands are on deck, so to speak:

  • Directory (Direct and FHIR endpoint discovery)—a few directories exist today; they’ll become more usable and accessible over time and may even be increasingly accessible by patients. The map at the link above is actually based on a national provider directory for Direct addresses and FHIR endpoints.
  • Patient and Provider Identity matching—when data traverses systems, it’s important to be certain that information is about the right patient, and to recognize the same covered entity user across different organizations’ platforms. UDAP can help with this, too.
  • Use cases—the Direct and FHIR standards need more champions, to advance them beyond transitions of care and growth charts. Plus, standards are not either/or. You didn’t throw away your cell phone when you got a Twitter account, for example. One standard can’t solve everything.
  • Trust—A need for additional user and app assurances is anticipated, to help establish confidence in general, and particularly for cross-organizational FHIR queries; check out the UDAP specs on Tiered OAuth and Dynamic Client Registration for more details.

What can the healthcare IT community do to help EMR Direct?

To help make healthcare better through interoperability, what the world needs now is love…

Err…that is, more early adopters of these relatively new technologies!

We can all agree that all-digital, structured data allows Health IT to do its best work, and we’re well on our way in that regard, but there is certainly more to do. Often, new use cases need little more than formalization and recognition. They need to be socialized. Like a puppy.

So, those in healthcare IT, including providers, payers, and patients, can help by joining the conversation. Because interoperability requires collaboration by definition. There are a number of ways to participate depending on interest and skill set.

Here are a few ideas as starting points. Help make 2019 Health IT’s best year yet!

-Include the #patientjourney hashtag, when relevant, on Twitter (and/or search for it) for tweets highlighting important information relating to the patient experience and how patients can better be considered in healthcare delivery and in related software product design

-Participate in or observe an upcoming HL7 FHIR Connectathon. Here is the link to the Direct/Certificates track page: http://wiki.hl7.org/index.php?title=201901_Direct/Certificates_Track

And if that one isn’t up your alley, there are many others.

-Join the conversation in the Direct Project Implementer’s Workgroup about adding contextual information to Direct messages: http://wiki.directproject.org/Implementation_Guide_for_Expressing_Context_in_Direct_Messaging

-Join the UDAP conversation on Google Groups: https://groups.google.com/forum/#!forum/udap-discuss, Twitter: @udapTools, or via email to: collaborate@udap.org and try out the profiles!

-Visit http://chat.fhir.org for a compendium of conversation streams about everything “on FHIR” via Zulip

-Finally, in keeping with the general theme of this post, please enjoy this fun video about the Twelve days of Christmas: https://www.facebook.com/cbcymbellevue/videos/585866588158714/

Wishing a warm and bright holiday season—whether five, eight, twelve, or just one day—to all those celebrating end-of-year traditions from around the world!

Be sure to follow all of the 12 Day of #HITChristmas.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

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