Interoperability Proving Ground (IPG) submissions within the ONC Tech Lab are submitted by healthcare, technology and development organizations that are invested in Health IT and Interoperability and want to share, learn and collaborate with similar stakeholders in the US, and around the world.

To view all submissions, please view the IPG link located within the ONC Techlab.

Closing the loop with Direct messaging to support an ACO

Teams from several organizations collaborated to implement Direct messaging to support a closed loop referral process within a newly formed ACO's Connected Care Network. Connected Care members accessed care through patient centered medical homes, employers' Health for Life Clinics, and specialists and facilities within a medical neighborhood. To support this ACO relationship across multiple organizations with multiple disparate EHRs, a scalable, standards-based method to facilitate efficient referrals management was essential.
Start Date
Projected End Date
Project Tags
  • ACO
  • Care Coordination
  • CCD
  • closed loop referral workflows
  • Closed-Loop
  • closed_loop
  • Direct Interoperability
  • EHR
  • Referrals
  • Referral_Management
Project Point of Contact:
Project Results
The primary exchange partners agreed that it was important to select scalable, standards-based technology to facilitate closed-loop referrals. The organizations had frequent meetings and elected to deploy eHealth Exchange and Direct messaging to facilitate both pull and push modes of exchange. The project team developed workflows and set up pools to manage the messages. Referrals are initiated with a Direct message to the specialist and the closed-loop message is sent after specialty evaluation. We encounter challenges in EHR functionality to support Direct messaging, operationalizing message pools, and limitations in the usability of the CCDs.