By Alex Young

For the second-straight year, Amazon Web Services (AWS) has awarded DirectTrust a significant grant to support the organization’s ongoing Directory Improvement Initiative, part of Amazon’s Health Equity Initiative.

It’s rare for an organization to receive a second grant for the same project, but the latest award will help expand the DirectTrust Aggregated Directory to include elements of artificial intelligence (AI), machine learning, and generative AI. Last month (February), I participated in a half-day event designed to help nonprofits unlock the full potential of their data using AI. The grant includes an eight-hour proof-of-concept build with AWS, valuable technical support that will help us determine whether the Directory changes are proceeding in the right direction before getting too far into the process.

Our ultimate goal is to create a dynamic directory that supports CMS efforts at its own National Directory of Healthcare Providers & Services, or even provide the framework for a national directory. DirectTrust has issued more than 2.8 million Direct addresses, and more than 272 million messages were sent or received in Q4 2023.

Interoperability can’t happen until providers, care facilities, patients, and social services organizations can communicate and securely transmit information in real time. The DirectTrust Aggregated Directory represents a giant step in that direction.

Moving Toward Industry-Standard Directories

We have made significant strides over the past year to advance the updated Directory. According to an ONC Data Brief, Direct Secure Messaging is actively used in 90% of hospitals, more than twice the participation among providers that are using other exchange mechanisms.

Two-thirds of health information service providers (HISPs) participate in the DirectTrust Aggregated Directory, a figure that is increasing after the DirectTrust Board approved changes to require accredited HISPs to participate. A HISP is an accredited network service operator that facilitates clinical data exchange through Direct Secure Messaging. Additionally, organizations that want to view the DirectTrust Directory are also required to publish at least one valid record to it. Another policy change approved last year will open up portions of the Directory to a public-facing website, increasing visibility and helping patients initiate conversations on their own.

Over the past year, our Directory has grown by 11%, even though the transmittal of directory records using Fast Healthcare Interoperability Resources (FHIR) won’t be available until approximately Q2 2024. This transition will not only facilitate a wider and richer representation of healthcare providers and their varied attributes, it also will align the DirectTrust Directory with emerging national standards, ensuring we remain at the forefront of healthcare information exchange. Even when faced with challenges presented by new standards, our dedication to continuous improvement remains unwavering, underscoring our mission to guarantee equitable and efficient healthcare access for everyone.

As an interim step, many HISPs have transitioned from sending flat files to separate APIs that support CSV files that can greatly improve the updatability and currency of the Directory in downstream applications like EHRs.

We believe the addition of AI or machine learning tools can greatly extend the utility of our Directory. By leveraging Amazon Q with additional add-ons running in our Virtual Private Cloud, our goal is to build an interactive and publicly available mapping capability with a built-in chatbot that can answer most inquiries in real-time. This feature would enable the display of a robust map of healthcare providers based on the user’s basic searches, such as “show me all pediatricians near San Diego that support 360X closed-loop referrals via Direct.”

AWS Shows Commitment to Nonprofits

The AWS Health Equity Initiative is a $40 million, three-year commitment to support organizations that are advancing health equity. The awards include web credits and customized technical expertise to improve health outcomes and health equity in any of the following areas:

  • Underserved communities
  • Social determinants of health
  • More equitable and inclusive systems of care
  • Diagnostics and screening

Our initial experience with AWS has been excellent. Many cloud-services providers seem to place nonprofits on a lower tier, concentrating their resources and expertise on for-profit companies. The Health Equity Initiative is one visible sign that AWS values the role that nonprofits can play in the healthcare ecosystem.

We believe CMS’s desire for a National Directory of Healthcare Providers & Services is a great idea, which we expressed during the public comment period. But we also believe that the DirectTrust Directory could be deployed as an interim solution to discover exchange endpoints and could serve as a blueprint for a CMS national directory.

As DirectTrust moves closer to launching a publicly available version of our Directory, we believe it will become a powerful tool for patients to find convenient providers and for providers to supply additional information about their practices and capabilities.