So far, Marcus and her colleagues in private practice have not been issued Direct secure e-mail addresses by the state HIE, so they don't really know what to expect yet. They also worry that the ground rules for granting access to those addresses by those who assist physicians, such as nurse practitioners and other designated staff, could make the doctors possessing the Direct addresses a potential bottleneck of information flowing to and from the HIE. Those rules have yet to be communicated.
While large institutions in Massachusetts and elsewhere have already ironed out the logistics of transferring large amounts of information via Direct, a lot of the rules governing how things are going to make it out to small practices haven't been determined yet, and rumors are swirling, Marcus says.
"One of the things I have found out [is] that even though the federal government has provided funding to write the interfaces, most vendors have not taken advantage of that," Marcus says. "They're writing interfaces, but in their own shop[s], without taking advantage of the funding that is available to help support that."
Small practices—those defined by CMS as containing from one to nine physicians—are particularly challenged to implement a technology such as Direct because they lack the stable of information technology resources available at larger practices and hospitals. Since Direct is one of the requirements of the not-to-be-delayed-after-all Meaningful Use Stage 2, physicians such as Marcus who lack sufficient Medicaid patients, and thus cannot qualify for Meaningful Use payments, view Direct as yet another unfunded mandate from the federal government.