the direct project @ quantified self
TRANSCRIPT
Quick History of the Direct Project
04/13/2023
Launched just after HIMSS 2010
Response to community frustration about state of exchange
Collaboration across the industry: government, vendors, advocates
Today: real production use in multiple programs across the country
Why is there a need for Direct?
04/13/2023
Current methods of health information exchange are inadequate
Communication of health information among providers and patients still mainly relies on mail or fax
– Slow, inconvenient, expensive– Health information and history is lost or hard to find in paper charts
Current forms of electronic communication may not be secure– Encryption features of off-the-shelf e-mail clients not often used in
healthcare communications today
Physicians need to transport and share clinical content electronically in order to satisfy Stage 1 Meaningful Use requirements.
– Need to meet physicians where they are now– Direct will be one of the communication methods in the Nationwide
Health Information Network
Direct Project Secure Internet-based Direct Communications
» Simple. Connects healthcare stakeholders through universal addressing using simple push of information.
» Secure. Users can easily verify messages are complete and not tampered with in travel.
» Scalable. Enables Internet scale with no need for central network authority.
» Standards-based. Built on common Internet standards for secure e-mail communication.
Direct Project specifies a simple, secure, scalable, standards-based way for
participants to send encrypted health information directly to known, trusted
recipients over the Internet.
Direct ProjectHigh quality open source libraries
» The history of the Internet shows the power of permissively licensed open source in driving standardization:
• TCP/IP: Berkeley TCP/IP stack• DNS: BIND• HTTP: Apache
» Successful open standards have easily accessible high-quality libraries trivially available to developers, including high quality documentation
» A key deliverable of Direct Project is a BSD-licensed software stack enabling:
• Client-side connectivity, for EHRs, EHR Modules, PHRs, etc. and• Server-side connectivity for “out of the box” HIOs and Health
Information Service Providers (HISPs)
Protocols and Technology
» SMTP Gateway• Direct uses SMTP as its transport protocol.
» S/MIME• Messages are signed and encrypted using the S/MIME standard. • A decades old protocol for ensuring authenticity, non-tampering,
confidentiality, delivery only to intended recipients. » DNS
• Used to serve up certificates bound to an e-mail address or organization.
• The highest scale distributed directory on the planet. Powers internet addressing.
» Configuration Web Service and DB• Storage and access to org’s certs, private keys, trust anchors
HISP
ConfigurationWeb Service
Security & Trust Agent
SQL
Configuration Web UI
Email Server
XD* SOAP Endpoint
XD* Agent
HTML/HTTPAdmin
SMTP Gateway
Internet
Internet
DNS Server
SOAP Client
MIME+ TLS
HTTPGateway
DNSGateway
Firewall
Scenario: Doctor to patient messaging
» Dr. Alex wants to send a visit summary to patient Jill.
From: [email protected]: [email protected]: Your health visit summary
Jill,
Here is the summary information from your visit.
- Dr. Alex
<Summary Attached>
Sending a message
» Alex creates and sends the message using his favorite e-mail client.• Or his hospital’s EHR software.
» A Direct gateway is installed at ahospital.org. Secure e-mails at ahospital are relayed through this gateway.
» The gateway receives the message and determines it needs Jill’s certificate in order to send the message. It uses DNS to resolve it.
» The gateway:• Signs the message with Alex’s private key. • Encrypts the message with Jill’s public key.• Sends the message over SMTP to Jill’s gateway.
04/13/2023
Receiving a message
» Jill is using a PHR system that provides her with a Direct address. • Microsoft HealthVault is one such PHR system.
» The PHR’s Direct gateway receives the message from ahospital.org.
» The gateway looks up Jill’s private key from its local configuration backend.
» Jill’s Gateway:• Decrypts the message using Jill’s private key. • Verifies the signature on the message is valid. • Verifies that the signer is trusted. ie. Jill trusts Dr. Alex. • Forwards the message to Jill’s inbox.
04/13/2023
More scenarios
» Provider-to-Provider scenarios have equivalent flow. • Scenario: Referring doctor sends patient information to another
doctor.
» Patient-to-Provider scenarios are just as easy!• Gateways can be configured to allow incoming messages,
outgoing messages, or both for a given address or domain. • Example: Doctor wants to send to patients but NOT receive.
Direct ProjectThe Process
Direct standards and specifications are developed by a group of public-private stakeholders. Weekly teleconferences and periodic face-to-face meetings facilitate active collaboration.
Direct Project Output:• Standards and Service Definitions• Implementation Guides• Reference Implementation• Pilot project testing and real-world
implementation
Vendors incorporate reference
implementation into HIT products
First phase grounded in real-world
pilot projects implemented
by early 2011
Incorporation of HITPC, HITSC, and ONC policy
guidance
Wide-scale adoption of Direct standards by late 2012
Momentum is Remarkable
Some vendors that have already announced plans to support the Direct Project include:· Allscripts· CareEvolution· Cerner Corporation· Covisint· eClinicalWorks· Epic· Greenway Medical Technologies· Kryptiq Corporation· MedPlus (A Quest Diagnostics Company)· Microsoft Corporation· NoMoreClipboard.com· OpenEMR· Siemens· Surescripts· VisionShare
CareSpark (TN)
Direct Project Real-world Implementation
- 14 -
Redwood MedNet (CA)
MedAllies (NY)
Rhode Island Quality Institute (RI)
Medical Professional Services (CT)
Direct Project is architected for rapid adoption by:• Thousands of hospitals• Hundreds of thousands of physicians• Millions of providers• Tens (or hundreds?) of millions of patients• Many other stakeholders in healthcare
Direct Project will be demonstrated in real-world pilots across the country
VisionShare (MN)
VisionShare (OK)
Links to Direct Project Resources
Get involved! http://wiki.directproject.orgC# Reference: http://wiki.directproject.org/CSharp+Reference+ImplementationJava Reference: http://wiki.directproject.org/Java+Reference+Implementation
For more informationMy e-mail: [email protected]