However, Schneider concedes that for now, sending CCDAs using Direct will probably involve hiring personnel in order for the organization to achieve its required meaningful use numbers. "On the receiving side, as a hospital, it actually is even more interesting, because we'll be receiving Direct messages from all over the country, potentially," he says. "Routing those becomes a huge challenge, and so initially what I'm envisioning is that the same person that I'm using to help send things out would also be monitoring the inbound queue, and then looking at each one of those and then figuring out sort of where these go."
The capability to send and receive Direct messages also lays the groundwork for a nearly endless flow of secure electronic exchanges of health information not only between providers, but also between providers and health information exchanges, public health departments, and other government agencies concerned with everything from disease control to medical research—and in the process, allows physicians to remain autonomous.
In northeastern Massachusetts, the 225 physicians in the Whittier IPA will be able to use Direct to transmit secure patient information to the statewide health information exchange, says Joe Heyman, MD, CMIO of Whittier IPA, as well as a gynecologist running his own solo practice.
"Regardless of what network we happened to be associated with, we didn't want to be forced into just using that network," Heyman says. "Just in our little area there are four different contracting networks for hospitals and doctors. There's Steward Healthcare, Partners Healthcare, Beth Israel Deaconess Medical Cooperative, and Leahy Healthcare.
"Patients, when they go to see us as doctors, they have absolutely no idea that we're in one health network or another. They just go to the doctor, and we wanted to be able to see everything that happened to that patient, regardless of which network they were seeing at the time. We wanted the physicians who were in many different networks to be able to look at the entire picture for every patient. So the whole thing is centered on the patient."