Working Hard on NHIN Direct

A lot of my focus this week is on NHIN Direct and trying to work towards consensus.  That means that I haven't been focused on other topics ... and so some would have it that I'm hardly working.  Is NHIN Direct undermining meaningful use?  Only meaningful use of incentive payment kind, not real world meaningful use, so I continue to participate.

Wes Rishel reports on his opinions of where Vendors are in NHIN Direct: Response to Comment on Vendor Positions.  What I find amusing about this is that I know of several cases where "we" are still deciding where "we" are, and if you talk to two different individuals at the same employer, you will get two somewhat different answers on what that "we" thinks.  Some of this is readily apparent if you look at the e-mail threads of the workgroups.  I also find myself clearly in all three groups that Wes identifies, and can put others clearly in at least two, depending on the definition of "big" and "substantial", and other similarly imprecise terms.  Wes, please do me a favor identify companies or don't, but don't take half measures that can be confusing.

It's fair to say that vendors (I won't speak for any specific segment) haven't yet coallesced around a single solution yet for NHIN Direct; that's still a work in progress, though we may get more progress later today.

On Andy's specific comments:
...HIE Vendors should be fairly neutral...
I'm not sure about that.   Whatever gets done, if there's two protocols established, there will be two to support, and given where consensus has been driving us, I expect there will be two protocols.  Yes, whatever the second protocol is, it will be pretty easy to develop (and likely support), but that won't make it "free".  I'd like to have it be supported based what is already in the installed base, because that will reduce implementation costs.

...pushback might be coming from the EMR vendors...Their core competency is clinical EMR development, not interoperability...
Wow!  My autoclassifier marks that last statement with [citation needed], especially given that the source is someone who works for a vendor of "interoperability solutions".  Look at my responses above with respect to "HIE Vendors".  The same principle applies.

...NHIN Direct sets too low a bar...
NHIN Direct sets a very low bar conciously.  As time marched onwards, that bar became MUCH lower than the bar set for meaningful use.  This occured even though the original project description states that it: "... will expand the standards and service descriptions available to the NHIN to address the key Stage 1 requirements for meaningful use, and provide an easy "on-ramp" for a wide set of providers and organizations ...". 

Yes, I'm a little bit concerned that the bar is too low, but that is more of a market opportunity than a problem for me.  It's easy enough to raise that bar to provide better services.  Going from CDA/CCD or CCR to XDM is very simple, and I've written stylesheets in a day or two that support that several times over.

In the interest of full disclosure, I work for GE Healthcare, which is a vendor of Healthcare products that includes EMR and HIE solutions.  Also, and as always, the opinions expressed on this blog are my own and not necessarily those of my employer.