With the initial model for the Direct Project, a streamlined version of the Nationwide Health Information Network (NHIN) in place, the federal Health IT Standards Committee has been evaluating how well it stacks up technically against other point-to-point data exchange methods.

The Direct Project, the new name for NHIN Direct, is a set of technical tools and services that will enable physicians and small practices to exchange secure messages in a one-to-one "push" with other providers and labs through the Internet. It's designed to offer physicians and small practices the ability to conduct the basic health record exchanges, such as referring a specialist or sharing patient summary data, required in the first stage of meaningful use.

The Office of the National Coordinator announced the first version of the Direct Project software Nov. 29. Arien Malec, coordinator of the Direct Project, then described the initial reference implementations of the Direct Project that would enable physicians to exchange information with a simple install and technical configuration.

The Health IT Standards Committee met Nov. 30 with exchange vendors such as Verizon and Covisint to begin its task of evaluating the activities and harmonized standards needed for the Direct Project.

It will analyze the Direct Project's technical descriptions of how it is to be deployed to make sure that the specifications meet the design requirements for "simple, direct, scalable and secure transport for the little guy," said John Halamka, MD, co-chair of the standards committee.

The vendors described their "push" products and services at the meeting and all included some concept of a routing method, a provider directory, certificate management for identification, auditing, and acknowledgement of message delivery, he said.

Identity and trust are foundational in those, and there is a set of technologies and management processes that ensure identity and provide a trust fabric that are essential attributes, said Halamka, who is also CIO at Beth Israel Deaconess Medical Center.

The Direct Project provides end-to-end encryption between networks to ensure security and privacy but allows for flexibility for how those networks connect, according to Malec. The Direct Project community selected common e-mail standards - the Simple Mail Transport Protocol (SMTP) in Multipurpose Internet Mail Extension (MIME) format - for its secure transport.

"But we probably should be directing our energy to policies and technology platforms that will allow us to scale trust," he said.