Interoperability Without a Directory is like Blue Cheese Without Celery!


September 18, 2019 — OK, it’s a ridiculous title for a blog. But I think it paints a picture of the central issue of interoperability—because doctors can’t easily and digitally locate their peers, they have no easy means to contact them. In other words, true interoperability isn’t just about being able to find a patient record on another system, it’s about communication and collaboration across the entire care team. When was the last time you heard a hospitalist complete their rounds by saying “I’m outta here—everything you need to know is in the EHR”? 

Screen Shot 2019-09-19 at 4.35.35 PM.png

DirectTrust, a collaborative of organizations supporting secure, interoperable health information exchange, has partially solved the directory problem by allowing its members to share Direct protocol addresses with their subscribers. But (1) they only do this for about half of the Direct addresses, (2) Direct reaches only about half of doctors, and (3) the patient care team extends far beyond the pool of clinicians with Direct addresses. So you can do the math.

HHS is also working to address this by encouraging providers to add secure electronic contact information to NPPES, the NPI database.  But this too has challenges because (1) NPI data doesn’t get updated very often, with an average time between updates of 5 years and 10 months, and (2) based on our database review, the “secure email addresses” entered into NPPES by most practitioners are almost all “non-secure”. While more frequent updates and the request for secure digital contact information is encouraged, it is not yet mandatory.

Then there is the issue that most EHR’s do not give users access to the DirectTrust or NPI information in their default directories.  They do try to make it easier to find another practitioner that uses the same EHR vendor, and that’s a good start. But trying to find a practitioner that uses a different EHR is almost never an option.

This is the problem careMESH is solving, as we:

  • Make it possible for a practitioner to locate any other U.S. clinician directly from their EHR messenger using our FHIR©-based directory.

  • Give them the tools to send a digital message, transition of care, or other information from their EHR at the click of a button.

  • Reduce a hospital’s administrative burden by queuing the message and verifying secure digital recipient contact information if careMESH doesn’t already have it. 

  • Provide a secure messaging service free of charge if the recipient doesn’t have one available.  

  • Produce CEHRT 2015 standard reports for both parties to meet Promoting Interoperability requirements.    

We’d love to hear from you if your organization struggles with digital care team collaboration, wants to fully digitize referrals, discharges and other transitions in care, or simply needs a better embedded directory. 

Please feel free to email me anytime.