From beginning to end, 2013 was arguably the busiest year for the DirectProject, and 2014 shows no signs of things slowing down.

BlueButton+ and Scalable Trust

The year definitely came in like a lion riding on the momentum of aggressive initiatives. In late 2012, ONC kicked off both BlueButton+ (still called ABBI at the time) and the scalable trust forum. Beknownst to some of us in the trenches, these efforts could not been more complementary, and the timing was perfect.

The first BlueButton+ implementation guide was published in February, and Direct was front and center in the blueprints. In parallel, the Trust Bundle Implementation Guide, which is the “tangible manifestation” of scalable trust, was completed and integrated into both the .Net and Java reference implementations. The success of BlueButton+ depended heavily on scalable trust, and the BlueButton trust bundles became the first pilot of the bundle implementation guide, which was subsequently featured in the HIMSS interoperability showcase.

Scalable trust received a boost from ONC in March with a grant to DirectTrust as part of the Exemplar HIE Governance Program. As part of the grant, DirectTrust’s HISP accreditation program went live along with a trust bundle implementation consisting of 15 HISPs by the end of year. Other trust communities such as NATE and the state of California also kicked off scalable trust pilots.

Implementations

With MU2 looming, EHR and HISP implementations of Direct were at an all time high. The community throughout the year hosted several connect-a-thons with many new players popping up not only focused on the MU2 use cases, but offering new innovative solutions built on top of Direct.

As BlueButton and VDT implementations accelerated, so did the interest in the developer community. ONC hosted a pair of developer events on opposite ends of the country, which included an incredible demonstration of Josh Mandel’s Growth-tastic BlueButton+ tutorial.

Reference Implementation

The reference implementation team kept busy not only with the implementation of trust bundles, but took a proactive look at the future of Direct. As the number of Direct implementations continued to grow, so did the need to quickly connect HISPs. Outcomes of the scalable trust pilots showed that one of the main roadblocks for Direct adoption and cross HISP trust was variance in policy across implementations. A goal of scalable trust was to minimize variance, but trust bundles alone could not provide the functionality necessary to assert policy compliance.

In the spring, the reference implementation team published a proposal called Policy Enablement that exploited a little known section of the applicability statement that allowed for expanded evaluation of X509 certificate attributes. A full implementation of the proposal was published in the late summer in major version release of the Java reference implementation. Going forward, the policy enablement features will facilitate the ability of HISPs to customize their implementations as policy guidance and governance is adopted.

In 2014, the reference implementation will continue to meet on the needs of the community and field. Specifically, the RI will focus on those areas needed to quickly move a HISP from a pilot to a full-blown production implementation.

Community

In August, a large gathering of the Direct community met in Washington DC at the ONC hosted Direct Boot Camp 2.0. The two-day event featured the progress made in scalable trust as well as updates on the federal partners' Direct endeavors. Other highlights included updates from DirectTrust, the reference implementation team, testing and MU2 attestation efforts from ONC & CMS, and reports from various provider directory pilots.


2014

Edge protocol harmonization and the ability for EHRs to seamlessly utilize multiple HISP implementations will be an area to watch. The implementation geographies workgroup is preparing to present the Implementation Guide for Direct Edge Protocols in early 2014, and will most likely become part of the reference implementation in the spring.

MU will continue to be the main driving force behind Direct adoption. However, various code-a-thons and hack-a-thons are beginning to explore other use cases building on top of the secure messaging abilities of Direct. We may see some truly innovative ideas throughout 2014.