The Direct Project – Gluing EHR’s Together

Most of us believe that the push towards Electronic Health Records (EHR’s) is a good thing and a necessary step along the road toward making each person’s EHR available for any healthcare provider who might need to treat that patient, whether the patient is in Los Angeles or Prairieville, LA. This goal of universal EHR availability is called the Nationwide Health Information Network (NHIN). Providers are certainly making progress towards the NHIN, prodded along by the governments “carrot and stick” approach under the HITECH Act (Meaningful Use) Stage 1 and the availability of better technology and more tech-savvy healthcare providers.  

Another step toward NHIN is enabling EHR’s to talk to one another. Until recently, communication between EHR’s from different vendors was a bit like people located in different countries and speaking different languages, not fluent in each other’s language, trying to converse by telephone. There is a standard called HL7 but it was designed to exchange transactional data, not an entire health record. HITECH Stage 1 provided for the use of either the CCD or CCR a standard, which is, effectively, a universal language. One other piece seems to have been neglected until this year, however – and was omitted from HITECH Stage 1 – a secure standard for exchanging CCD/CCR clinical data. Think of this piece as the phone line in the international conversation.
Although that was a major oversight, it is being quickly (relative to how quickly things happen in healthcare IT) addressed through something called the “Direct Project” ( According to a February 2, 2011 News Release from, the goal of the Direct Project is an:
“easy-to-use, internet-based tool that can replace mail and fax transmissions of patient data with secure and efficient electronic health information exchange”
Towards this end, there have been committees, meetings, etc. and some standards have emerged.
The Direct Project has widespread support. According to Dr. Doug Fridsma, on his March 21 “HealthIT Buzz” posting, “support for the Direct Project represents approximately 90% of market share covered by the participating health IT vendors”.
In the next post, we’ll address the technological underpinnings of the Direct Project.
  • CCD/CCR –The ASTM Continuity of Care Record (CCR) and the Continuity of Care Document (CCD) HL7 standard. The HL7 CCD standard actually resulted from a collaborative effort between HL7 and ASTM to harmonize the data format between ASTM’s Continuity of Care Record (CCR) standard and HL7’s Clinical Document Architecture (CDA) standard.
  • HITECH – In February of 2009, the American Reinvestment and Recovery Act (ARRA) allocated $19 billion in funding for hospitals and clinics that make “meaningful use” of certified Electronic Medical Record (EMR) systems. The Health Information Technology for Economic and Clinical Health (HITECH) Act lists criteria for eligible hospitals and vendor software