Rationale / Objectives
Cerner, Lewis and Clark Information Exchange (LACIE) with Heartland Health wanted to address mounting operational costs and inefficiencies associated with faxing clinical and other documentation. Manual sortation and routing of fax communications was becoming increasingly time-consuming and burdensome on staff, especially those in paper-based environments.
Project/Program Description & Major Achievements
The participating organizations replaced outbound faxing of discharge summaries and other documentation with Direct - a secure, directed, standards-based communication method. Participating physicians’ support staff received a Direct address through which they accessed documentation via a webmail client. The project was successful in establishing an efficient exchange of health information among providers regardless of their level of technology infrastructure. Six healthcare organizations successfully eliminated the need for traditional fax and telephone communication for the routine transmission of health data.
Read receipts helped reduce uncertainty regarding the status of transmitted data during the pilot, and was an improvement over fax communication’s lack of feedback as well. This helped build trust in the system. A communication process that involved a combination of Direct and fax was sometimes necessary, as some endpoints could not be enabled for Direct. If workflows had to be altered too drastically to accommodate Direct, providers with Electronic Health Records (EHR) with embedded fax capabilities found it more convenient to keep using fax. User buy-in was dependent on keeping workflows familiar. DirectTrust.org could help in educating providers about Direct.
Heartland Health, a Cerner client, has operations in 21 counties across the mid-west United States. Lewis and Clark Information Exchange (LACIE) is a multi-state health information exchange (HIE). LACIE uses Direct protocol for secure data exchange between healthcare provider systems. Cerner Corporation is involved in the development of the standards used by Direct. For this pilot (LACIE Direct), implemented in 2011, Cerner served as the Health Information Services Provider (HISP), the Certificate Authority and the Registration Authority. Heartland Health assisted Cerner in recruiting other healthcare providers to participate in the Direct Pilot Project. Cerner’s intention was to “start small and stay local” in order to keep the scope manageable and ensure that participants could be properly supported. They selected pilot participants who were an hour or less away.
To implement Direct in clinical environments without a Direct-enabled EHR, and to allow them to connect to the HISP, Cerner developed application programming interfaces (APIs) and a stand-alone web-based email client (Cerner Direct Inbox) through which they could send and receive messages using a Direct address. Use cases were identified. Clinical documents and reports were originally distributed to clinicians using a module built into the EHR that automatically faxed copies. For the pilot, Cerner repackaged these documents as pdf or rtf documents attached to a Direct message. Cerner held on-site train-the-trainer sessions, and helped build users’ confidence in the Direct system by allowing a parallel message transmission process (both fax and Direct) until users were comfortable with Direct.