Today let’s reflect a little on a quote from a highly respected imaging specialist – David Avrin, M.D., Ph.D at UCSF in an article entitled “Informatics Expert on Interoperability: ‘We’re in the Dark Ages'”.

We also receive patients from community physicians, and in spite of meaningful use, we still have a terrible time with electronic records or any records across care boundaries from the outpatient world into the inpatient world and back again […]

We are still in the dark ages.

Assuming David’s right, why is it such a pain to get records across care boundaries using MU2 compliant systems?

MU Stage 2, EHR criteria 15, Measure 1 requires that 50% of transition of care and referrals provide a summary of care record.    Measure 2 requires that 10% of these be sent electronically or through an exchange.

The problem I’ve always seen with the second measure is that it takes a certain head of steam to cross the starting line.  You have to exchange with someone, but that person needs to be able to receive, and you need to be able to find their address.

I’m starting to dig into CMS’s data feeds and trying to break out how much of Measure 2 has been satisfied *nationally* using Regional Health Organizations – my guess is a lot of it.  If both participants are in the exchange, the “who can receive question” is simply a question of who’s in the HIE.

If a HIE is not being used, then the exchange will probably occur using direct messaging.  How does that stack up?

There are 893,851 active physicians in the US (as of Sept 2014), but nobody truly knows how many have direct addresses, and how many of those addresses are really used.  Unfortunately, the NPI doesn’t collect this information (see the NPI  application form).

We do know DirectTrust provides around 650 thousand addresses – not that many when you consider physicians may have multiple addresses.  We also know 23 million messages were sent in 2014 through just the DirectTrust network.

Most importantly, DirectTrust is working on a national provider directory of their own that should be available imminently.  I don’t know if  the directory will only be available to member organizations, but I’d be surprised if that’s not the case.

So, on the direct front, things are promising.  Direct Trust as been a big winner.

With HIEs ,Direct, and CDA we really do have everything we should need for the current MU2 transition of care process to work.  Let’s keep pushing.  Make it easier to find people with a national directory that contains direct addresses.  Build out the HIE’s.  Get the documents transferred.

Then the real work of semantic interoperability and workflow integration can begin.

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