This page will be used to assemble content for the Pilot Projects Vignettes for upcoming announcements.

CareSpark (not reviewed by Carespark)

This project seeks to demonstrate Direct Project-based exchange between a federal agency and providers in a private-sector HIE. The main focus will be on facilitating an improved process for exchanging referrals and consultation reports between VA providers and private-sector providers in east Tennessee and southwest Virginia. It will demonstrate two user stories: Primary care referral to specialist and Specialist sends summary care information back to referring provider. Text-based mammography interpretation reports will be exchanged utilizing source code made available from the Direct Project workgroups. The project scope will also demonstrate the routing of mammography referrals from the VA to the private sector provider. It is also the intent of the participants that this project once fully vetted could be expanded to additional VA sites. The pilot will exchange information between two different Health Information Service Providers (HISPs) - the VA and CareSpark, a non-profit regional health information exchange, and is supported by the Tennessee State HIE.
Project Status: Weekly calls being held to finalize technical requirements. Demonstration project will begin Q1 2011 with production planned later 2011.


MedAllies (Reviewed and Approved by MedAllies)


MedAllies, a Health Information Service Provider (HISP), is launching a Direct pilot project to demonstrate the delivery of critical clinical information across transition of care settings in a “push” fashion that supports existing clinical workflow in the Hudson Valley (NY). MedAllies will implement the full Direct infrastructure, including both the required SMTP backbone, and the XDR elective protocol. MedAllies is working with many stakeholders including EHR vendors, and clinicians in both ambulatory and hospital settings.
The three initial use cases include:
· Primary care provider refers patient to specialist including summary care record
· Specialist sends summary care information back to referring provider
· Hospital sends discharge information to primary care provider

Technical integration with leading EHR and Hospital system vendors is underway with pilot exchange alpha sites beginning to go live in Q1 2011.


Redwood MedNet (Reviewed and Approved by Redwood MedNet)

Redwood MedNet provides health information exchange services in rural Northern California. The Redwood MedNet Direct Project pilot has one goal: to deploy directed secure messaging for production data delivery in support of meaningful use measures. Three meaningful use messaging patterns are in development.
  1. Receipt of Structured Lab Results
  2. Immunization Reporting
  3. Sharing Patient Care Summaries Across Unaffiliated Organizations (including both referral to a specialist and discharge summary to a patient centered medical home)
The project will establish a standards-based way for participants to send authenticated, encrypted health information directly to known, trusted recipients. As an HIE in a rural area, participants in the Redwood MedNet directed messaging project include small practices, community clinics and small hospitals, as well as the State immunization registry. The discharge summary may also incorporate use of a patient controlled health record (PCHR). The project will begin pilot testing in January 2011. (See full pilot project brief here: http://wiki.directproject.org/Pilot+Project+Brief+-+Redwood+MedNet)


Rhode Island Quality Institute (Reviewed and updated by RIQI)


The Rhode Island Quality Institute (RIQI), the state-designated entity for Rhode Island, has initiated a Direct Project pilot project with two primary goals:
  1. To demonstrate the feasibility of direct provider-to-provider data exchange between PCPs and specialists as a key component of Stage 1 Meaningful Use
  2. To demonstrate the feasibility of levering the Direct Project as a vehicle for feeding clinical information from practice-based EHRs to the statewide HIE, current//care// . Clinical information will be shared via a standard CCD, maintaining compliance with Rhode Island's unique data sharing consent laws.

RIQI is working with a variety of stakeholders to ensure the project's success, including a local EHR vendor (Polaris Medical Management) with significant market share in RI, the statewide HIE infrastructure partner (InterSystems), and an independent HISP (Inpriva).

The project plans to support both e-mail interfaces and a direct EHR system interface to the state HIE, current//care//. As of November 2010 RIQI is currently wrapping up development and unit testing and expects the pilot to begin end-to-end trial implementation in the beginning of 2011. Initial rollout will be to the RI Beacon Community participants in Q1 2011, followed by a broader statewide rollout in Q2. The RI Regional Extension Center (REC) will be the vehicle for Direct Project education and rollout, via a series of new services.


VisionShare and Public Health [Reviewed and approved by VisionShare]


VisionShare, a Health Information Service Provider (HISP) is managing a Direct Project pilot project to demonstrate the feasibility of using the Direct Project communication protocols, security model, and addressing mechanism to securely submit immunization data from providers into a state immunization information system. Working initially with Immunization Information Systems in Minnesota and Oklahoma, the project will allow providers to submit immunization information using HL7 v2 messages to their appropriate state using a secure edge protocol. As HISP, VisionShare will secure and transport the messages, as well as provide translation from the Direct protocol to the PHIN Messaging System (PHINMS) protocol used by many state health departments.

The project is in final testing and expects to initiate its first data submission in early 2011.


Medical Professional Services (reviewed and approved by MPS)

Medical Professional Services (MPS) is a clinically-integrated, multi-specialty IPA in Connecticut with approximately 400 physician members. Along with several partners, MPS is working to demonstrate successful exchange of laboratory results back to the ordering provider and exchange of referral information and summary care information between providers, a local hospital (Middlesex) and a multi-site FQHC (Community Health Center, Inc.). Electronic exchange of data is a challenge in this setting because of the diversity of MPS physician practices, EHRs and HIT tools in place.

The goal of this pilot is to enable MPS physicians to receive lab results back from Middlesex Hospital and Quest Diagnostics, to exchange referrals with Middlesex Hospital, and to exchange referrals and summary care information among MPS primary care and specialty physicians. Results and referral information will be exposed through Care360 EHR, eClinicalWorks, DocSite/Covisint (pilot partners) or through an e-mail client. In addition, physicians will have the ability to securely send lab results and care summaries to their patients via Microsoft HealthVault.

Final pilot details are in process, with anticipated launch in January 2011. 


South Texas Direct Project (Requires additional review by South Texas)

A broad set of stakeholders in South Texas are planning to use Direct to improve the health status of persons in South Texas with diabetes, including gestational diabetes. Participants come from the medical community (CHRISTUS Health, the Health Information Network of South Texas, the Driscoll Children’s Health Plan, Corpus Christi Medical Center, Public Health Department, Nueces County Medical Society), community-based social service organizations, colleges, and employers (the Coastal Bend Diabetes Community Collaborative, The Salvation Army, the United Way, etc.). The main goal is to connect the OB-GYNs, pediatricians, hospitals, and the State of Texas’ Newborn registry so they can share information (referrals, lab results, discharge summaries) in real time with their care teams to improve health outcomes. Additionally, the projects hopes to provide patients themselves with better information so they can better manage their chronic diseases. This will be accomplished using Direct by enabling the following use cases:
  1. Physician to physician referral
  2. Physician to hospital referral
  3. Hospital to physician lab results reporting
  4. Hospital or physician to state newborn registry


Morris-Somerset IPA (Requires additional review by MSIPA)

The Morris-Somerset IPA is a New Jersey based group of 600 physicians. They will be recording ePHI with the eCast Corporation ACO-Care system. Records will be transported to an HIE via Direct Project push-technology standards, over the mdEmail health information network. MaxMD is a HISP, and provides the operational mdEmail network infrastructure. The push technology is interoperable with all HISPs who comply with Direct Project policies.

Applications include:
  • A specialist getting a referral from a primary care doctor, and needs a clinical snapshot.
  • The specialist sends his findings to the primary care physician
  • A hospital needs a patient's clinical information from a primary care physician.
  • A primary care physician needs discharge information from a hospital.
  • A lab sends results to a care provider.
  • A patient receives a clinical snapshot, information about a visit, or follow-up reminders, from a healthcare provider.
  • A patient must send release authorization for the specialist to access his / her record.



MEDfx and Verizon partner to provide Direct Project capabilities to support Patient Centered Medical Home Initiative

As part of a Patient Centered Medical Home initiative, CenVaNet is providing care management services to Dominion Medical Associates patients with chronic healthcare needs. The workflow process to identify and refer the appropriate patients to CenVaNet and the communication back to the practice with Patient Assessments is currently manual and is achieved either through a physical hand-off at the practice, or via fax. CenVaNet and Dominion’s use of the Direct Project standards and transactions is an ideal methodology to be used to facilitate this process:
  • Dominion practice staff will scan the paper referral form and it will be stored in a standard location.
  • Using the MEDfx Direct portal, this file will be an attachment to an email ‘push’ from the practice to the appropriate clinical care manager at CenVaNet.
  • CenVaNet care managers use a Medical Home Information System (MHIS) provided to them by MedVirginia and powered by MEDfx to maintain their Patient Assessments.
  • The patient is enrolled within the MHIS system and an electronic Initial Assessment form is created.
  • The care manager uses the MEDfx Direct Portal to ‘push’ a copy of this form back to Dominion Medical Associates where it is attached to the front of the patients paper medical record identifying that patient as one of the patients participating in the care management program.

The transport of clinical information is channeled through an infrastructure provided by Verizon Business through their Cloud Services and secured by certificates issued and signed by Verizon's NIST Level 3 Certificate Authority which is certified to create PKI usable on the Federal Bridge. Although Direct is a ‘push’ model standard only, this process clearly shows the use of Direct as a means to achieve a two-way communicate path demonstrated by the securely transfer the completed Initial Assessment from CenVaNet back to the practice.