The Office of the National Coordinator will start real-world testing of clinical information exchanges between healthcare providers using "NHIN Direct" standards and services in late December or early January, according to the connectivity project's director.

NHIN Direct will enable providers to share secure messages, such as patient referrals and care summaries, in one-to-one "push" exchanges with other providers.

Arien Malec, NHIN Direct's project director,  told the Health IT Standards Committee Oct. 27  that draft technical descriptions of standards for transporting messages will be ready next month, and that healthcare organizations are gearing up to test them in seven pilots around the country.

A streamlined version of the more robust nationwide health information network standard set, NHIN Direct will offer physicians and small practices the ability to conduct the basic health record exchanges required in the first stage of meaningful use. 

"We need to meet physicians where they are now," Malec said, referring to essential exchange services the pilots will address so that physicians can advance from communicating via paper mail and fax.

The standards committee will evaluate the effectiveness of the pilots in March, Malec said.

Three of the testing organizations – MedAllies, an EHR provider in New York; the Rhode Island Quality Institute, a collaboration of state organizations that promote EHRs; and Redwood MedNet, a health information exchange in northern California – will use NHIN Direct exchange tools for referrals and transitions of care to support continuity of care, he said.

The Rhode Island group will take the exchange one step further and use NHIN Direct standards to route provider data to the Institute's quality registry.

"This is an exercise in recognizing that the same push specifications can be used for exchange of data between providers in support of meaningful use as well as for long-term longitudinal analysis and quality improvement," Malec said.

CDC connection

In another pilot, VisionShare, a developer of healthcare software for secure Internet transmissions, will connect providers with state immunization registries, starting with Minnesota and Oklahoma. The firm is developing an adaptor or interface between the Centers for Disease Control and Prevention system, to which the immunization registries are connected, and the NHIN Direct specifications.

State immunization registries tend to have many variations. "It's useful to have organizations that can provide uniformity to providers and health IT systems and meet the diverse set of needs that immunization registries have," Malec said.

In Tennessee, regional HIE Carespark will support care coordination between Veterans Affairs Department clinics and purchased healthcare services from private clinics. 

The pilot will track physician orders and workflows across such care settings and other institutional models.

Malec said that NHIN Direct developers are also exploring how to integrate transport standards and content standards.

"Although we started with the focus on transport, in the context of the pilots, we're wandering into areas that involve how you plug that transport into content standards and specifications and how you integrate the transport specifications with elegant provider workflow," he said.

About 200 participants from 60 organizations have been collaborating online to develop the NHIN Direct tools. They include IT firms, public and private organizations, including EHR vendor Epic, the VA, the Indiana State Department of Health and the American Academy of Family Physicians.