The Rhode Island Quality Institute (RIQI) announced the launch of the nation’s first statewide Direct Adoption project earlier this month.
RIQI’s Regional Extension Center is the first of the 62 RECs to create a program focused on helping providers understand and adopt Direct Messaging, a simple, secure and cost-effective way for sending patients’ protected health information (PHI) directly to known, trusted recipients over the Internet.
Direct Messaging is secure email messaging that allows providers the ability to safely and securely send information to other providers, specialists or hospitals that have a Direct email account. By using an industry-standard technical infrastructure and legal framework, Direct Messaging ensures sensitive information is transported securely and delivered correctly.
Educating physicians and healthcare organizations about the benefits of Direct Messaging has been one of RIQI’s top priorities.
“Providers have a misconception that Direct Messaging is a complex technical project that they’re going to have to buy special equipment for,” Gary Christensen, RIQI’s CIO/COO tells Inside Healthcare IT. “The real truth is that from a physician standpoint, it’s about as complicated as signing up for cable TV. You chose your Health Internet Service Provider (HISP) and as long as you have an internet connection, you’re good to go.”
The concept of “technologically easy” is one that has resonated with providers feeling to achieve Meaningful Use. However, Christensen says they are still worried about the prospect of having to spend more time logging into yet another system.
“We respond to that concern by asking them how much time and energy is involved with their fax queues,” he says. “Our goal is to help them understand that using Direct Messaging is a whole lot easier, secure, and auditable than using a fax machine.”
Christensen says that unlike sending a message via fax, even if a message is sent to the wrong Direct Messaging address, it will still end up in the office of someone who is a trusted Direct partner and understands issues around privacy and healthcare data.
“There are protections built into the model,” he says. “If you send something to the wrong fax number, you could be sending it to a non-healthcare entity.”
“Trust” is a key concept for the success of Direct Messaging, according to Christensen, who has been involved with the Direct Project since its inception. In addition to ensuring that a message travels securely, Direct Messaging also validates that messages are delivered to the intended recipient.
To help Rhode Island providers set up and manage their trusted contacts with whom they exchange PHI using Direct Messaging, RIQI has established the Rhode Island Trust Community (RITC), a community of verified Rhode Island providers. RITC membership is available and free to all Rhode Island REC members and provides a number of value-added services including education opportunities and technology support.
RITC helps make adoption easier, Christensen says, because it eliminates much of the legwork for providers.
“You could do everything on your own and set up a trust store and get your own certificate. Or you could go the easy route with RTC where we’ve already done the work. If we can make it adoption easy, we think we’ll begin to see lots of innovation and exchange of information.”
Rhode Island patients have already started to see the benefits from enabling providers to share information.
As a result of RIQI’s work with Aquidneck Medical Associates and Newport Hospital, the two entities were able to use Direct Messaging to exchange critical information prior to a patient’s ER admittance . The patient had visited Aquidneck Medical Associates complaining of numbness in her arm. She was triaged by the nurse who immediately sent her to Newport Hospital’s ED. While the patient was en route to the hospital, the nurse created an industry-standard Continuity of Care Document (CCD) and sent it to the hospital via Direct Messaging prior to the patient’s arrival. The hospital had all of the patient’s most up-to-date health information for treating her immediately.
Once the patient was discharged, Newport Hospital used Direct Messaging to electronically send back an updated CCD for the patient to Aquidneck Medical Associates. The nurse reviewed the information, added it to the patient’s electronic health record, and then followed up with the patient to establish a plan for her care.
“This was a case of helping providers get the tools and once they had those tools, they figured out how to use them in a very profound way that affected the patient’s life,” says Christensen. “This wouldn’t have happened without Direct Messaging.”
Direct Messaging is the foundational technology for several other RIQI initiatives which will help to improve continuity of patient care through improved communication.
RIQI and Cumberland Primary Care recently completed a pilot project to connect the practice’s EHR with currentcare, Rhode Island’s Health Information Exchange. Through an automated process, clinical data for consented patients is sent via a Direct Message from the EHR to currentcare, where it is added to the patient’s longitudinal health record. As part of its Beacon initiative, RIQI will soon launch a service to notify Primary Care Providers via Direct Messaging when their patients are admitted or discharged from the hospital, something which Christensen says is long overdue in his state.
“Rhode Island is 47th in the country for readmissions. If the primary physician follows up with the patient a few weeks after that patient is discharged from the hospital, the readmission rate goes way down,” he says. “Those transitions of care between the facilities and the places where information needs to flow are critical and Direct will be a backbone for us to deliver those messages.”
Being the first to implement a statewide Direct initiative hasn’t been easy, Christensen admits, but he expects it will get easier, both for his organization and others nationwide. “There weren’t any models for us to copy from. When you’re building any new product, it’s very entrepreneurial and we didn’t know what we didn’t know until we got to the next stage and realized we needed to think about a particular problem.”
Christensen says his team has daily conference calls with other regions and entities that are creating and implementing their own projects. “We share all of our documents, contracts, and training materials with everyone who asks for them. This is being paid for through the federal government so it belongs to all of us.”
The beauty in Direct is its simplicity, Christensen says, and for that reason, he advises his counterparts in hospitals and other healthcare entities not to get too complicated as they think about information sharing.
“I would look at Direct as a service that I could use to move my business forward,” he says. “I wouldn’t be bothered trying to create my own HISP or making things more complicated than they need to be. Leverage what’s already there and concentrate on building something that will allow you to communicate simply and securely with the folks you need to communicate with.”
Copyright 2011 Algonquin Professional Publishing, LLC
