State HIE-REC

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Considering that the Direct Project is, at its most basic, "a system for secure e-mail for physicians, their colleagues, and their patients," some of the benefits that State HIEs and RECs can derive from the Direct Project include:

  • Enabling small practices at various stages of EHR implementation to demonstrate exchange. The Direct Project offers specifications to enable simplified interoperability between two known endpoints. The Program Information Notice issued by the ONC for state-level planning allows for Direct Project specifications and services to be used as the simplest means for providing HIE services comply with national standards. Using the Direct Project in state planning will not obviate the need for additional services, but can help in "filling the gaps" in health information exchange coverage. The Direct Project will be especially helpful in connecting to physicians in small and medium size medical practices who want an easy, immediate, and affordable way to send and receive messages in order to attest to the exchange capabilities for phase one Meaningful Use.


  • Can enable exchange to support RECs in efforts to assist providers in meeting Meaningful Use criteria. As the RECs work to help thousands of providers in meeting the phase one Meaningful Use, which includes requirements to attest to the ability to electronically exchange health data with other physicians and to send patients who request one a Clinical Summary in either CCR standard or CDA CCD structured data formats, the Direct Project can help to meet these requirements in a stand-alone manner using familiar e-mail clients, or in conjunction with their purchase of either EHR modules or complete EHRs.


  • Creates a baseline for exchange that the state can build services upon. The Direct Project cannot replace HIOs and is not a substitute for thoughtful state-level planning. States will need to layer additional necessary services over a Direct Project implementation to create a robust statewide health information exchange; such as provider directory, master patient index, on-demand query capabilities, record locator services, etc. The Comprehensive HIE Interoperability Workgroup gives an excellent description of the technical approaches towards seamless interoperability between existing clinical information-sharing capabilities and the capabilities of the Direct Project.


  • Provides an opportunity for states and RECs to work with a diverse group of stakeholders including other states and RECs, vendors, providers and other organizations. Participation in the Direct Project can be invaluable for states and RECs to coordinate efforts with their colleagues in other areas. By participating in reference implementation, implementation geographies and other workgroups there is great potential for collaborative efforts, particularly for simple interstate exchange.