I have been working on a contract to help the Office of the National Coordinator (ONC) State HIE Program host a Direct Boot Camp in Chicago, IL on April 12 – 14, 2011. So I spent a few days this week working at the Boot Camp helping the ONC bring states up to speed on the Direct Project. But the Boot Camp went well beyond Direct basics to focus on implementation details to help States who are planning on implementing Direct learn from experiences in the field and take their next implementation steps. The Boot Camp was geared explicitly toward states that are implementing Direct as part of their strategic and operational plans under their cooperative agreement with the ONC. I was pleased to be part of the excellent team of ONC staff and consultants that organized and facilitated the event. The meeting agenda and materials are now posted on the Direct Project wiki and there was some good discussion using the #ONCDirect hashtag on Twitter. There was also some rich discussion during the Q&A portions of each session and I encourage you to read through the session notes available on the wiki.
Much of the impetus for incorporating the Direct Project into their state plans was the result of the Program Information Notice (Document Number: ONC-HIE-PIN-001), known as the PIN, sent to the states on July 6, 2010. One section of the PIN requires the states to:
Set Strategy to Meet Gaps in HIE Capabilities for Meaningful Use — Develop and implement a strategy and work plan to address the gaps in HIE capabilities as identified in the environmental scan with a focus on delivery of structured lab results, e-prescribing and sharing patient care summaries across unaffiliated organizations. Gap-filling strategies might include:To meet these requirements many states have plans to use direct messaging in a phased approach as an onramp towards more robust HIE services. But due to the flexible nature of a cooperative agreement, as opposed to being a straight grant, the states have been working with the ONC to fine tune their plans. Many of these states had their plans approved before the Direct Project was able to provide working code. As the Direct Project has developed, some of the states thinking around deploying direct messaging services has evolved. And there is also continuing maturity in the marketplace, with vendors offering services that have allowed the states to back away from providing centralized services themselves and moving towards a more market based approach.
- Policy, purchasing and regulatory actions, such as requiring e-prescribing or electronic sharing of lab results in state or Medicaid contracts with pharmacies and clinical labs.
- Core services to reduce the cost and complexity of exchange including authoritative provider and plan directories and authentication services that would support both simplified and comprehensive interoperability.
In filling these gaps, the state is not required to directly provide or construct technology infrastructure or services. A key role for states can be to provide leadership and direction to public and private stakeholders. States may also use policy and purchasing levers to extend and enhance existing HIE activities in the state so as to encourage key trading partners such as pharmacies and clinical laboratories to participate in electronic service delivery and to enable providers to meet meaningful use requirements.
- Targeted infrastructure for gap areas such as shared services for small labs or pharmacies, or to serve rural providers, which could utilize both simplified and comprehensive interoperability solutions.
States shall also establish a strategy and immediate next steps to address the following over the course of the project:
- Building capacity of public health systems to accept electronic reporting of immunizations, notifiable diseases and syndromic surveillance reporting from providers.
- Enabling clinical quality reporting to Medicaid and Medicare.
Therefore, many states that were originally planning to to act as a Health Information Service Provider (HISP) themselves are now moving towards creating a preferred vendor list for HISPSs and monitoring the market to ensure coverage for all the providers in their state. A HISP is an entity that provides services that are required for Direct Project exchange, such as the management of trust between senders and receivers. Using the HISP model, offerings are emerging that provide some of these services:
- Provisioning of health domain addresses
- Certification issuance and management
- Global routing services
There are also states planning to use Direct to help with interstate exchange. This is an area that will need further development, as we weave through the spaghetti of various consent laws around the country, but ultimately getting exchange happening at a broad scale will obviously include interstate exchange. Some of the nation networks being launched, such as AAFP/Surescripts and Verizon presented during the boot camp and helped the states to shape some of their thinking in this area. There was a lot of discussion about Provider Directories as well, which I will leave to a future post. It was a very interesting experience to work with the ONC and the various states to further integrate the Direct Project into their plans and I expect we will see this help to drive further adoption and use of these standards and specifications.
The list below shows the currently approved state specific strategic and operational plans for creating health information exchange capacity. Not all of these states are incorporating Direct Project into their plans.
|State||Strategic /Operational Plans and State Summaries||Entity Responsible for Grant||Plan Approval Date|
|Alabama||Strategic and Operational Plans |
State HIE Plan Summary
|Alabama Medicaid Agency||02/12/2011|
|Arizona||Strategic and Operational Plans||Arizona Governor’s Office of Economic Recovery||03/18/2011|
|Arkansas||Strategic and Operational Plans||Arkansas Department of Finance and Administration||02/24/2011|
|California||Strategic and Operational Plans |
To view the documents separately click here (easier download)
|California Health and Human Services Agency||06/16/2010|
|Colorado||Strategic and Operational Plans||Colorado Regional Health Information Organization||12/3/2010|
|Connecticut||Strategic and Operational Plans||State of Connecticut Department of Public Health||03/18/2011|
|Delaware||State Summary||Delaware Health Information Network||05/17/2010|
|Florida||Strategic and Operational Plans||Florida Agency of Health Care Administration||02/04/2011|
|Georgia||Strategic and Operational Plans||Georgia Department of Community Health||03/23/2011|
|Hawai’i||State Summary||Hawaii Health Information Exchange||02/02/2011|
|Idaho||Strategic and Operational Plans||Idaho Health Data Exchange||12/07/2010|
|Illinois||Strategic and Operational Plans||Illinois Department of Healthcare and Family Services||12/10/2010|
|Indiana||Strategic and Operational Plans |
|Indiana Health Information Technology, Inc||01/21/2011|
|Iowa||Strategic and Operational Plans||Iowa Department of Public Health||01/25/2011|
|Kentucky||State Summary||Cabinet for Health and Family Services||02/17/2011|
|Maine||State Summary||State of Maine/Governor’s Office of Health Policy & Finance||08/16/2010|
|Maryland||Strategic and Operational Plans||The Maryland Department of Health and Mental Hygiene||05/14/2010|
|Massachusetts||Strategic and Operational Plans||Massachusetts Technology Park Corporation||11/03/2010|
|Michigan||Strategic and Operational Plans |
|Michigan Department of Health||11/29/2010|
|Minnesota||Strategic and Operational Plans||Minnesota Department of Health||02/24/2011|
|Mississippi||Strategic and Operational Plans||State of Mississippi||02/24/2011|
|Missouri||Strategic and Operational Plans||Missouri Department of Social Services||01/25/2011|
|Nebraska||Strategic and Operational Plans |
|Nebraska Department of Administrative Services||11/05/2010|
|New Hampshire||Strategic and Operational Plans |
|New Hampshire Department of Health and Human Services||12/10/2010|
|New Jersey||State Summary||New Jersey Health Care Facilities Financing Authority||01/13/2011|
|New Mexico||Strategic and Operational Plans |
|LCF Research, New Mexico||01/25/2010|
|New York||Strategic and Operational Plans||New York eHealth Collaborative||11/22/2010|
|North Carolina||Strategic and Operational Plans |
|North Carolina Department of State Treasurer||11/03/2010|
|Ohio||Strategic and Operational Plans |
|Ohio Health Information Partnership||01/25/2011|
|Oregon||Strategic and Operational Plans||State of Oregon||12/10/2010|
|Pennsylvania||Strategic and Operational Plans||Commonwealth of Pennsylvania||3/23/2011|
|Rhode Island||Strategic and Operational Plans||Rhode Island Quality Institute||12/06/2010|
|South Carolina||Strategic and Operational Plans||South Carolina Department of Health & Human Services||08/30/2010|
|South Dakota||Strategic and Opeational Plans||South Dakota Department of Health||02/24/2011|
|Tennessee||Strategic and Operational Plans |
|State of Tennessee||09/17/2010|
|Texas||Strategic and Operational Plans |
|Texas Health and Human Services Commission||11/03/2010|
|Utah||Strategic and Operational Plans||Utah Department of Health||05/12/2010|
|Vermont||Strategic and Operational Plans |
|Vermont Department of Human Services||10/26/2010|
|Virginia||Strategic and Opeational Plans||Virginia Department of Health||03/17/2011|
|Washington||Strategic and Operational Plans |
|Washington Health Care Authority||12/10/2010|
|West Virgina||Coming Soon||West Virgina Department of Health and Human Services||02/12/2011|
|Wisconsin||Strategic and Operational Plans |
|Wisconsin Department of Health and Family Services||12/10/2010|
|Wyoming||Coming Soon||State of Wyoming Office of the Governor||03/18/2011|