We are beginning an implementation of the Cloverleaf Direct Adapter which is currently in beta. I will ask the consultants to share whatever details they think are appropriate within the beta agreement. I will tell you what our goal is – to use the Direct Adapter as a new thread protocol, to connect to our local RHIO, who hosts a HISP. This is to satisfy Meaningful Use objectve C12 – Transition of Care – to transmit CCDAs to the referred-to providers electronically.
Some software vendors have incorporated CCDA consumption in their offerings, including our HIS Siemens Invision. Also, a local EHR vendor has included CCDA consumption into their package. Many of our referrals go to providers using their system. We will use the Direct protocol to send emails with CCDA attachments to our RHIO, who will forward the Direct email to SureScripts, another HISP, who then will forward the email to the EHR. The Direct STMP standard requires delivery receipts be sent back to the sender. We will use another Direct protocol thread to read incoming receipt messages, and use a unique correlation ID in the header to match the receipt to the original CCDA message, and therefore prove our numerator for the MU measure.
Our RHIO uses Mirth Mail. I believe that includes the HISP, but I’m not totally sure about that. Siemens also hosts a HISP, and they also provide Direct capability. We are finding that there are many implementations of Direct, some providing mailboxes, some providing CCDA consumption from Direct into their software and some just providing Direct connectivity. So there are many flavors out there.
We decided that we do not want to host a HISP – we do not want to be in that business. However it would be good if we could integrate Direct mailboxes into our HIS – something we have not decided on. We are concentrating on using Direct to send, not to receive (except for receipts), but we will be going there someday. Now, our recipients are either providers on EHR software that can receive Direct emails, or providers that we coax into signing up for a Direct mailbox with our RHIO (or another HISP, like SureScripts or Microsoft Medical Vault). One significant hurdle is getting providers signed up, or discovering providers Direct addresses.
We are using this approach because we want the CCDA delivery to be automated. This requires that we parse the CCDA to pull out the referred-to provider names and then look them up in a table that we maintain to get the Direct address.
It is my personal opinion that we should be able to provide both automated and ad-hoc sending of CCDAs and other documents using Direct, for both sending and receiving. I think integration with our software is important.
hope this helps.
Peter
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