Pilot Project Brief - Rhode Island Quality Institute

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Sponsor(s)/Contact(s): Rhode Island Quality Institute / Gary Christensen


  • To demonstrate the feasibility of levering NHIN/Direct as a vehicle for feeding clinical information from practice-based EHRs to the statewide HIE, currentcare
  • To demonstrate NHIN/Direct User Stories:
    • US 1: Primary care provider refers patient to specialist including summary care record
    • US 3: Specialist sends summary care information back to referring provider


  • RIQI will work with an EHR vendor with significant RI market share to integrate NHIN/Direct reference code into the EHR package such that:
    • The EHR will automatically trigger the generation of a CCD as a result of an update to the patient’s record.
    • The EHR will automatically insert the CCD as content into an NHIN/Direct message.
    • The EHR will automatically send the message to the NHIN/Direct address of the statewide HIE.
  • RIQI will work with the vendor for the statewide HIE to integrate NHIN/Direct reference code into the HIE’s Participation Gateway (which prevents records of not-consented patients from reaching the statewide HIE) such that:
    • The PG will detect the receipt of the NHIN/Direct message and will open the contents.
    • If the patient has consented to participate in the HIE, the PG will automatically pass the contents (i.e. the CCD) to the HIE for incorporation into the patient’s longitudinal record, as data.
    • The HIE will automatically prevent historical data contained in the CCD from being duplicated in the patient’s longitudinal record, if that data has previously been sent to the HIE.
    • If the patient has not consented to participate in the HIE, the PG will automatically discard the NHIN/Direct message.
  • RIQI will work with targeted practices that use the EHR participating in the pilot to connect them to the statewide HIE as a Data Sharing Partner for currentcare:
    • The EHR vendor and RIQI will work with the practices to upgrade to the NHIN/Direct-enabled version of the software
    • The practices and RIQI will execute a standard Data Sharing Agreement for currentcare.
    • RIQI will work with the practice to gain consent from the practices’ patients to participate in currentcare.
  • RIQI will work with practices in the RI Beacon Community that have been identified as being coupled in “regular” PCP/Specialist referral patterns such that:
    • From his/her EHR, the PCP will be able to generate a CCD for a patient on demand, for subsequent incorporation into a referral notice.
    • Outside of his/her EHR, the PCP will be able to address and send an NHIN/Direct message to a specialist to whom the patient will be referred, incorporating the patient’s CCD into the message.
    • Outside of his/her EHR, the specialist will be able to detect that an NHIN/Direct message has arrived and will open and review the CCD for the patient.
    • The process subsequently will be reversed, with the specialist sending an updated CCD back to the originating PCP.
    • Workflows will be defined to incorporate this interaction into the practice's regular processes.
  • RIQI will identify whether or not any cross-border referral patterns exist (i.e. with MA or CT) within the RI Beacon Practices, and if so will work to include these interstate referrals into the pilot.


  • Polaris, vendor of EpiChart EHR
  • InterSystems, vendor of Healthshare HIE
  • Inpriva, acting as the HISP
  • RI Beacon practices
  • MA specialist practices (as appropriate)
  • CT specialist practices (as appropriate)

Resources Anticipated Being Available for Pilot

  • Reference code to be incorporated into EHR and HIE logic for sending and receiving NHIN/Direct messages; documentation
  • Stand alone software for manually sending and receiving NHIN/Direct messages (i.e. external to EHR)
  • An operational HISP

Other Notes

  • Beyond this initial scope for the pilot, the ability for a PCP and specialist to send and receive NHIN/Direct messages within his/her EHR will be pursued.
  • Shared Documents