1. THE DIRECT PROJECT UPDATE FOR THE FEDERAL HIT WORKGROUP Arien Malec Coordinator, NHIN Direct Project 8/28/2015

2. The NHIN Direct Project A project to create the set of standards and services that with a policy framework enable simple, directed, routed, scalable transport over the Internet to be used for secure and meaningful exchange between known participants in support of meaningful use 2

3. The Direct Project Secure Internet-based Point-to- Point Messaging »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. b.wells@direct.aclinic.org h.elthie@direct.ahospital.org

4. The Direct Project Facilitates Meaningful Use »Patients : Health information Discharge instructions Clinical Summaries Reminders »Public Health : Immunization registries Syndromic surveillance »Other Providers/Authorized Entities: Clinical information Labs – test results Referrals – summary of care record 8/28/2015 b.wells@direct.aclinic.org D I R E C T The Direct Project facilitates the communication of many different kinds of content necessary to fulfill meaningful use requirements. Examples of Meaningful Use Content 1) Get a Health Internet (email-like) address and a security certificate 2) Send mail securely using most e- mail clients OR contract with a HIO or HISP that performs authentication, encryption and trust verification on your behalf

5. The Direct Project Facilitates Meaningful Use »Other Providers/Authorized Entities: Clinical information Labs – test results Referrals – summary of care record »Patients: Health information Discharge instructions Clinical Summaries Reminders »Public Health: Immunization registries Syndromic surveillance 8/28/2015 b.wells@direct.mclinic.org The Direct Project facilitates the communication of many different kinds of content necessary to fulfill meaningful use requirements. Examples of Meaningful Use Content D I R E C TD I R E C T

6. Open Government and Focused Collaboration 6 CORE PRINCIPLES Prioritization Transparency Engagement Rapid Results Focused Collaboration A Thousand Flowers Bloom Command and Control LowHigh Participation Classic Trade-Off Low High Focus

7. Wikis, blogs, open code repositories, oh my… 8/28/2015

8. The Importance of High 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 the 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) 8/28/2015

9. Close to 200 Implementation Group Participants »Alere »Allscripts »American Academy of Family Physicians »Argonne National Laboratory »Atlas Development »Axolotl »CareSpark/MobileMD/Serendipity Health » Cautious Patient »Cerner »Clinical Groupware Collaborative »CSC »eClinicalWorks »EHR Doctors »Emdeon »FEI »GE »Google »Greenway Medical Technologies »Harris Corporation, »High Pine Associates »HLN Consulting, LLC »IBM »ICA »Inpriva »Intel »Kryptiq »LabCorp »Massachusetts eHealth Collaborative »MedAllies »Medical University of SC, »Medicity »MedNet »MedPlus/Quest Diagnostics »Microsoft »Mirth Corporation »MOSS »Nationwide Health Information Technology »NIH NCI »NIST »NYC Dept. of Health and Mental Hygiene’s PCIP »Oregon HIE Planning Team »Redwood MedNet »RelayHealth »Rhode Island Quality Institute »Secure Exchange Solutions »Siemens »South Carolina SDE »SureScripts »Techsant Technologies »TN State HIE »VA »VisionShare Most of the top EHR and HIE technology vendors, national service and IT providers (Surescripts, Quest, LabCorp, Microsoft, Google etc., good participation with states), VA strongly involved as a federal partner

10. Development Progress »All volunteer team »Rapid and consistent growth on the C# side C# team had to write much more code (DNS, MIME) than Java team due to better libraries on the Java side API documentation in good shape, unit testing lagging behind »Java team has excellent progress on engineering quality (unit tests, documentation) »3-5 active developers/day

11. NHIN Direct High-Level Project Plan Oct 2010 Aug 2010 Sept 2010 Immediate Next 90 Days Short Term 3 to 9 months Long Term 9 to 36 months Activity Standards and Specification Development Activity Real-world Implementation Activity Regulatory Activity Policy Activity Immediate Initiatives Short Term Initiatives Long Term Initiatives Initial Pilot Implementation Expansion of Pilots Nov 2010 Dec 2010 Draft Specification Complete Transition to an SDO 1 st Q 2011 20112012-2013 Ongoing Maintenance Evaluation for inclusion by NHIN and ONC Endorsement HITPC Tiger Team Framework and Policy Review Feedback to NHIN Governance Feedback on initial lessons learned Ongoing Review and Feedback Wide-Scale Deployment Evaluation by HITSC

12. CareSpark (TN) Direct Project Real-World Implementation - 12 - Redwood MedNet (CA) Carolina eHealth Alliance (SC) MedAllies (NY) Rhode Island Quality Institute (RI) Medical Professional Services (CT) The 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 The Direct Project will be demonstrated in real-world pilots across the country

13. Questions? 8/28/2015