Katya Samardina

How Accreditation Will Increase Interoperability


Last week, I bought an eBook for my eReader. It was a simple process: I selected the title and made a direct online payment knowing that my credit card information would be protected. These sorts of online transactions are easy to take for granted unless you work in the healthcare industry.

Despite the monumental advances in technology, transferring sensitive patient information from point A to point B and back between providers using different systems requires complex legal agreements to ensure trusted delivery. Until we have a single entity and infrastructure that validates the security of the information’s delivery route, just as companies that provide a secure technical foundation for electronic commerce, health information exchange might take longer to reach its full potential. In an effort to move the needle on trusted exchange, a group of stakeholders ranging from healthcare providers to vendors invested in Direct Exchange are working to create a framework to support secure transactions across healthcare organizations, a movement commonly referred to as “scalable trust.” The goal of this nonprofit trade organization, known as DirectTrust, is to build a Security and Trust Framework to drive interoperability. This post provides an overview of the central challenges that DirectTrust is addressing and the factors of success.

Without scalable trust, health exchange remains complicated

We’ve written before about the potential of Direct messaging, a solution that allows providers to send and receive secure and encrypted messages regarding patient information from point A to point B with the ease of sending an email. Provider access to seamless, fast and secure communications is crucial for ensuring that all pieces of the care delivery puzzle come together and all members of the care team are on the same page.

Through Healthcare Information Service Providers (HISPs) and Certificate Authorities (CAs), including organizations such as Rhapsody, which build technology solutions to support Direct exchange, providers can easily and securely send internal and external communications with any provider also having a Direct email address, increasing organizational efficiency and improving collaboration. However, the second piece of this puzzle—a common framework and standards that enable HISPs to interoperate—presents challenges to most organizations. Without a single accreditation framework, multiple steps must be addressed before HISPs can exchange patient information.

For example, if provider A who uses HISP X needs to send patient information to specialist B who uses HISP Y, the provider organizations need to sign a detailed security agreement before any information can be sent between HISP X and HISP Y. The process becomes overwhelming quickly, requiring providers to complete agreements for every external provider not using an identical HISP. This turns Direct Exchange, which is meant to be simple and seamless, into a resource-draining affair. To enable widespread healthcare and further interoperability, the industry needs to make trust scalable and invest in a universal accreditation framework.

The single accreditation model: The easiest pathway to true interoperability

David Kibbe, M.D., M.B.A, President and CEO of DirectTrust and Senior Advisor for the American Academy of Family Physicians (AAFP), and other healthcare stakeholders committed to the nationwide adoption of health information exchange joined together to build a system where trust will not require dozens of legal agreements and an endless web of connection points. DirectTrust is committed to building an accreditation framework complementary and supportive of the regulations put forth by the Direct Project and the Nationwide Health Information Network (NwHIN). DirectTrust will help organizations move away from multiple one-off provider partnerships that can get tied up in Legal departments.

With a widespread HISP accreditation program, providers will be assured that they are exchanging health information with a trusted HISP, turning the spider web of provider-to-provider legal agreements into a single trusted network of Direct exchange participants. DirectTrust illustrates the difference between the current bi-directional contracts model to a new, interoperable approach: a single accreditation model where all delivery systems are validated by the same governing body.DirectTrust will continue to lead the way to true interoperability using Direct. The ONC recently awarded the organization a cooperative agreement grant to continue its work in developing accreditation standards to enable the seamless exchange of patient data using Direct.


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