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  • April 20 2011


    The Direct Project and the Consumer

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    There they were. My new glasses, sitting on the floor, chewed up by a tough-looking pug who didn't care. Worse, I had a schedule full of meetings the next day and didn't have a spare pair of glasses. The next afternoon, I went to a local one-hour glasses shop in my prescription sunglasses and asked them to have my eyeglass prescription faxed from my optometrist so we could get new glasses started. That's when the fun began. 

    After several phone calls and two more faxes, step one of the process was complete. My newly-signed HIPAA form was safely in the hands of my optometrist's receptionist. Step two: finding my prescription. The receptionist had to go on a half-hour hunt for the prescription. Step three: the optometrist had to be consulted before she was satisfied that my request was in order. Step four: call back again because the script was not faxed. (Or I suppose it was, but was sitting in the fax tray of someone else's fax machine other than the eyeglasses shop.) Step five: two hours later, the prescription for my new-new glasses finally arrived. A lot of work for a piece of paper with six numbers on it. It literally took twice as long to get those six numbers from one place to another than to actually grind plastic into corrective lenses and fit them into eyeglasses frames.

    That's a long lead in to say things could be a lot better. It's also what my friends would tongue-in-cheek call a "first world problem." Having to wait three hours for eyeglasses is not a big problem, but it's a personal example of how broken the system is. I have been fortunate enough up to this point in my life to have never experienced a complicated medical condition. I can only imagine what coordinating care between several specialists, a hospital, and a primary care physician is like in the world of phoned-in requests, faxed forms, and missed faxes. I've met Regina Holliday and listened to the heartbreaking story of how her husband, Fred, would likely not have died of kidney cancer at 39 years old if she and he had better access to his medical records. All of the information was in the mish-mash of various paper files that would have informed anyone pulling the information together that kidney cancer was the obvious diagnosis before it was too late. When Regina finally did secure her husband's records, it was a stack of paper several inches thick, for which she had to pay $0.73 PER PAGE.

    Enter the Direct Project. The concept: make secure health communications as simple as email. So the Direct Project team, of which Cerner is a founding member, pulled together and defined a new national standard that is aimed at eliminating phone, fax, and paper with a simple, secure email infrastructure for health information. I'm excited about Direct because it makes it completely easy to send and receive health information securely. Imagine my eyeglasses story when Direct is ubiquitous. Step 1: secure message from local eyeglass shop to my optometrist. Step 2: hunt for the record (we'll cover electronic medical record adoption in another post). Step 3: a secure message is sent back with the prescription attached. Imagine Regina's story in a Direct world. Step 1: Call the specialist and give them her Direct address. Step 2: Ask for Fred's records. Step 3: Receive an attachment securely with an electronic copy of the record.

    The big headline in both of these possible future stories is what's missing. There's no Step 0: Configure the EMR to be able to send information to a specific personal health record. Nor is there a Step 1.5: tell the patient that their EMR system can't send to X system, but can send to Y system. There also isn't a Step 1.5: tell the patient the only way to get this information is to create an account in the hospital's proprietary patient portal. That's because the central principle of the Direct Project, beyond being secure, is that it is a standard protocol. Every Direct-enabled system will be able to talk to every other system. There are no hubs or HIEs to join. Just a simple, easy way to exchange information securely, similar to what everyone is already familiar with - email. Cerner Health, Cerner's personal health record, will offer all users a Direct inbox as part of their account. I intend for this to be available to all users by the end of 2011. This is the revolution we've been waiting for to make health information fluid. I can't wait to see what happens next.

    More about the Direct Project:

    Brian Carter is a Sr. Director at Cerner responsible for Consumer Health strategy. He spends his days working with a world-class team on new ways to get every person excited about being the healthiest they can be.

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