We explored in the depth the details of the Direct standard and its supporting components including S/MIME clients/servers, XDR (SOAP), Webmail (Secure web-based messaging), use of gateway appliances that act as middleware between existing EHRs and Direct compliant HISPs, certificate lookup via web services/DNS, and provider directory standards.
We reviewed these slides
Here's what we decided:
All our early participants - Partners, BIDMC, Childrens, Baystate, Atrius, Network Health, Holyoke, Vanguard, and a solo practioner declared that the gateway appliance or XDR would meet their needs.
The gateway appliance supports simple EHR integration via file drop, FTP, XDR, HL7 via TCP, West Services and REST. The XDR approach enables automated routing to XDR or SMTP recipients - the Massachusetts HIE provider directory query will return the XDR address of XDR capable recipients or the state's Direct gateway address for XDR to SMTP translation and forwarding for those organizations which can only receive SMTP. This moves the complexity out of the EHRs and into the HISP for protocol conversion and routing services.
We reviewed the draft HIE participation agreement and received broad support for the document and its supporting addendum.
Next, we reviewed pricing. The principles we discussed included
*All participants should pay some subscription fee to cover the private sector share of operating costs, but prices should be tiered like a progressive income tax - wealthier organizations pay more to reduce the burden on organizations with fewer resources
*Participants will pay only for the service level they consume
*Fees will be adjusted periodically as circumstances change, recognizing that the first year costs are an estimate
Finally we discussed the effort to ensure the 14 vendors which constitute 90% of the Massachusetts marketplace will be connected to the HIE as needed.
A very exciting time for HIE - the energy of the early adopter stakeholders is palpable. I'll provide several updates over the next two months as we countdown the days until go live.