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Direct Protocol May Favor Large Providers and Vendors

Scott Mace, for HealthLeaders Media, December 10, 2013

A medical group's call for allowing licensed physicians, without vendor interference, to designate any recipients or senders of messages using the Direct protocol puts a spotlight on nagging EHR interoperability issues.

If 2013 has taught us anything, it's that eventually, every area of healthcare IT becomes enmeshed in politics sooner or later.

This week, speculation is bubbling that the low-cost interoperability promised by the Direct protocol is the latest vehicle for the continuation of expensive, business-as-usual interfaces between different healthcare IT vendors' systems.

Evidence of this rising concern surfaced on December 7, when the Massachusetts Medical Society House of Delegates' Committee on Information Technology passed a resolution calling for "a more open, affordable process to meet technology mandates imposed by regulations and mandates."

The resolution goes on to urge that "that all Direct secure e-mail systems, mandated by Meaningful Use Stage 2, including health information exchanges and electronic health record systems, allow a licensed physician to designate any specified Direct recipient or sender without interference from any institution, electronic health record vendor, or intermediary transport agent."

To try to find out what about Direct is rubbing physicians the wrong way in the Bay state, I spoke with Eugenia Marcus, MD, a pediatrician in private practice in Wellesley, MA and chair of the committee that adopted the resolution.

Although the Massachusetts state HIE has promised licensed doctors Direct access to the HIE for $5 per doctor per month, Marcus and her colleagues are troubled by chatter that vendors will continue to be able to charge for interfaces to immunization, disease and allergy registries on top of Direct. If true, that would thwart some early promises by Direct's advocates that the secure messaging protocol would put an end to usurious vendor interoperability fees.

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1 comments on "Direct Protocol May Favor Large Providers and Vendors"


Frank Poggio (12/10/2013 at 2:55 PM)
Scott another excellent piece on an issue that has pretty much gone ignored. But as you say soon it will burst to the surface. The problem is not only with small physician practices but also with small /mid-sized specialty system vendors. As I work with them through ONC Certification most are avoiding it like a plague. You only need to deal with it if you want /need full EHR certification or sell a portal system. It's another example of how government regulation favors large entrenched vendors over small innovative firms. As for the availability of getting government money to help defray development costs many simply do not have the time to chase after a grant while their clients have them up against the Stage 2 timetable.