Western States Consortium Pilot of Direct Demonstrates the Power of Federal/State Coordination

John Rancourt | September 6, 2013

Health care providers in California and Oregon are now querying each others’ provider directories and sending interstate Direct messages as a result of the Western States Consortium project.

The Consortium’s final report, released today, details how the Office of the National Coordinator for Health Information Technology (ONC) collaborated with 13 states to successfully test ways to break down technical and policy barriers to interstate exchange.

This is one example of how the Department of Health & Human Services is encouraging interoperability across states’ electronic information infrastructures, as described in the recently released Principles and Strategy for Accelerating Health Information Exchange.

Pilot Convened 13 States to Tackle Central Use Cases for Direct
The Western States Consortium Project was conceived by states, for states, and was supported by ONC through the State Health Policy Consortium, an activity of ONC’s State Health Information Exchange Program and managed by RTI International.The following states created the Western States Consortium and were actively involved in the project as either core participants or satellite states:

  • Alaska
  • Arizona
  • California
  • Colorado
  • Florida
  • Georgia
  • Hawaii
  • Idaho
  • Nevada
  • New Mexico
  • Oregon
  • Utah
  • Washington

The pilot aspect of this project was executed by California and Oregon. It successfully addressed two critical use cases for provider-to-provider information exchange for treatment using Direct:

  1. When Direct addresses of participants are known to each other, and
  2. When Direct addresses of participants are not known to each other.

As a result of these pilots, providers in Oregon and California are currently exchanging data across state lines. A demo of such exchanges can be viewed here (registration required).

The final report includes detailed analyses of the planning of the pilots and what was involved in their execution. It lays out the critical questions related to trusted exchange that the 13 states and ONC wrestled with during the run-up to the pilots.

Supporting Provider Directory Standards Development
One of the technical solutions required for the pilots was a process for querying multiple interstate provider directories and providing accurate results, which is also known as federation of provider directories. To execute this, the pilot’s solution required implementation of several standards in novel ways.

This included Integration of the Healthcare Enterprise (IHE) Healthcare Provider Directory (HPD) profile and the HPDPlus profile, as developed by the EHR/HIE Interoperability Workgroup (IWG) and based on findings of the S&I Framework Provider Directories initiative.

This experiment serves as a reminder that standards are constantly evolving and can only be improved through use. The specifications from the pilots have already informed ONC’s Modular Specifications – Standards for Provider Directories work. Participants from the Western States Consortium Project have also actively contributed to the work of one of ONC’s Exemplar Governance grantees, the New York eHealth Collaborative, which is supporting additional pilots to refine the HPDPlus standard.

Tackling Blue Button+’s Policy, Technical, and Governance Challenges
The success of this pilot led several of the states involved to form a not-for-profit named the National Association for Trusted Exchange. Commonly known as NATE, the organization continues to support multi-state initiatives and convene member states and others to better collaborate on health information exchange.

“The WSC Pilot was successful on many fronts,” explains Aaron Seib, NATE’s CEO. ”Perhaps the most important being the demonstration that many states could collaborate together to establish solutions that satisfied a diverse set of policy variances.”

“Again, in collaboration with the ONC, NATE will lead a PHR pilot involving multiple states and participation of the Veterans Administration,” Seib said. “All of NATE’s member states will provide support, feedback, and analysis throughout the pilot, working together to resolve problems and align state policies. The anticipated lessons learned will hopefully inform future policy decisions across the nation.”

Through this new work, NATE is again working with ONC via the State Health Policy Consortium. The project is leveraging Blue Button+-enabled personal health records for bidirectional exchange between patients and providers.

The project is exploring use cases and data flows involved in bidirectional sharing of patient data where the provider is a data originator and the PHR is a data receiver and vice versa. Among other things, this work will consider technical specifications and implementation policies of PHRs used in the pilot. Ideally, this work will identify potential gaps and solutions related to policy, governance, and technology for patient-provider exchange.

For more information concerning, the Western States Consortium Project contact John Rancourt (john.rancourt@hhs.gov) or Lee Stevens (lee.stevens@hhs.gov).

For more information concerning ONC’s Exemplar Cooperative Agreement Program, contact Kory Mertz (kory.mertz@hhs.go).