A Perspective on NHIN Direct Pilots

The following is not an official NHIN Direct stance for all pilots, but was a helpful perspective sent by Kim Long of MedPlus in response a question posed in a discussion thread wanting more specific guidance for what a vendor could tell customers they would be expected to do. Link to Redwood MedNet answers.

I thought I would give you our perspective of what we will be doing with our two pilot sites. I am not sure that there is one answer to all of these questions that could be applied to all pilot sites. It is very dependent on the pilot and what they are trying to accomplish.

What will the pilot do, e.g., use cases? -- (most proposals already have stated this)
I think this answer just depends on who all is participating in the pilot which defines which use cases you can satisfy.

How long is the pilot supposed to last?
We are also thinking about the end date. I imagine that we will be stating so many days after go live with the pilot without any major defects. In other words, we would want them up and running for x days without any issues to deem it successful.

When the pilot ends, does the solution get removed, or will it remain in place indefinitely? (This is the difference between a "prototype" with no ongoing commitment, vs. a "beta" that typically leads to a GA production implementation)
Our pilot agreement that we will have physicians sign does state that we plan to take it GA but that we don’t have to do this and that we can stop the product at any time. However, we are planning to deem it GA when the pilot is over. The only reason we may not is if the entire pilot (not just ours but nationwide) fails which means NHIN Direct fails and will not gain adoption. I hope this does not occur. J

How many users (e.g., physicians) do you need?
I think any more than 5 different offices is acceptable. However, you need as many physicians as you can get to cover all of your use cases. In addition, depending on the number of vendors involved, you need to assure that you have all of the different vendors covered. For our pilots we are focusing on 10-25 different physician offices which will support two different EHR vendors as well as offices with no EHR vendor.

Do you need to send real patient data? If so, how many, and how are you going to get their consent?
I think you do need to send real patient data for it to be considered a valid pilot and to gain support from physicians. Physicians are already super busy and think the use of technology slows them down in some instances. If you forced them to spend time working on fake patients, I think it would be even harder to recruit physicians to participate in the pilot. In addition, I don’t think you can name the patients or how many – it all depends on the care required and the use cases implemented. For instance, if you implement the hospital to provider use case, then any patient in the hospital who is seen by a provider participating in the pilot would have their data sent to the physician upon discharge.
As with our current EHR product, the consent is implied. If the patient has signed the yearly HIPAA form in the provider’s office, which the physician is required to collect yearly, then NHIN Direct is just another means of the physician releasing information for care. The patient has the right, as they do with any release of their information, to state that s/he does not want anything released or to request a copy of everything that was released.

How much work, and what sort of skill sets, do you need from the provider?
This largely depends on what the physician already has and what use cases you are requiring of him/her. For instance, if the physician already has an EHR that is going to be part of the pilot, it may require an upgrade to the vendor’s version containing the NHIN work. If the vendor uses an ASP model, then there is no upgrade required in the physician’s office. In both cases, the physician would then require some training (15-30 minutes) on sending and receiving an NHIN Direct message from their EHR. If the physician has no EHR and has never used email, this would obviously require more setup, training, etc. from the physician’s office. If the physician has no EHR and has email, it should be some configuration and training on sending and receiving NHIN Direct messages.