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Direct and Other HIE Alternatives


If you are looking to exchange data with other providers, but don’t want to pay HIE fees, here are a few alternatives.

You can only share secure health information electronically with another physician practice when they’re in your electronic community, said Noam Arzt, president and founder of San Diego-based HLN Consulting, which advises healthcare organizations on health information exchange (HIE) and other technical topics. In order to share this type of information with these practices, you’ll have to do a lot of “leg work,” he said.

An HIE alternative to consider is Direct Secure Messaging, said Arzt. Started by the Office of the National Coordinator for Health Information for Technology in 2011 as the Direct Project, Direct provides a secure, scalable, standards-based way for participants to send authenticated, encrypted health information directly to known, trusted recipients over the internet. Direct has participation from more than 30 EHR vendors, 45 HIEs and health information organizations, nine large healthcare delivery systems, and other healthcare-related organizations.

One of the good things about Direct is it’s easy to find a service provider, in fact, Arzt said it’s as easy as it is finding an e-mail provider. In order to share information with other physician practices, providers first need to get Direct Service e-mail addresses from them. This is what helps create an electronic community for sharing information between your EHRs.

The challenge is you have to do the “leg work” to make it all come together, he said. But that’s why some of the professional societies – such as the American Academy for Family Physicians – are offering the Direct for the solo physician providers with which they’re affiliated.

John Kansky, president of the Indianapolis-based Indiana HIE, said it’s important to distinguish between an organization that provides this service and the technology that allows physician practices to share secure health information with other physicians. He referred to Direct as a technology that enables the secure sharing of health information between providers.

“Your EHR-if it’s certified, which it should be because of Meaningful Use-is theoretically capable of using the Direct standard to send that to another physician,” said Kansky.

Where Direct becomes challenging is there’s no standard that says a physician practice must have a virtual “mailbox” to receive or send information to your practice, he said. On a practical level, that means that if you don’t have a physician practice’s Direct e-mail address, you can’t receive or send patient information to them.

Another alternative to an HIE is to see if your current EHR vendor has some interoperability services “out of the box,” said Arzt. “In some geographic areas, some EHR vendors are more dominant. What that means is if enough of the practices you’re trying to communicate with are using the same EHR, you may find that you have the services available to you -even without an additional fee -within your EHR vendor’s product.”

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