A Direct route to more pertinent patient information

A doctor in Rhode Island, per his daily routine, has just updated and closed a patient's chart in the practice's electronic health record. As he punches up the next record or heads to the exam room, a routine of another sort is underway between the EHR and the state's health information exchange database.

The EHR signals the HIE network to send what amounts to a self-addressed envelope, attaches the record and automatically moves the message to a gateway that applies the patient's pre-set consents to share information fully or with limitations. Then it's on to the HIE net, which detaches the record, breaks it into discrete data, checks for and eliminates elements previously entered in the database and uploads the rest. No interfaces were built between the two points of exchange; it's a direct, uncomplicated, securely conducted event.

"What's exciting about that is that it's all behind the scenes – no doctor has to remember to do it. It doesn't get involved in their workflow," said Laura Adams, president and CEO of the Rhode Island Quality Institute, which operates the HIE network. And it would not be possible without the technical capabilities built into a simple e-mail protocol called, aptly, Direct.