In 2023, DirectTrust initiated a significant update to its Directory Policy as part of the Directory Improvement Initiative, aimed at refining and enhancing the policy based on community feedback.
Three primary objectives guided the policy updates:
- Increase Participation: Mandating Health Information Service Providers (HISPs) to participate in the Directory.
- Expand Directory Use and Access: Requiring healthcare organizations to publish at least one valid record in order to access the Aggregated Directory.
- Enable New Use Cases: Introducing guidelines to support new interoperability applications.
The process of updating the Directory Policy was marked by a collaborative and consensus-driven approach. Workgroups and subgroups, open to all DirectTrust members, met extensively to outline goals, iterate on proposals, and achieve unanimous approval for the updates. The updated policy, finalized on October 18, 2023, will officially require compliance by October 18, 2024, but early adoption is encouraged.
The updated Directory Policy is set to transform how health information is managed and shared, promoting better interoperability within the healthcare community.
Addressing Gaps in Directory Records
A significant challenge addressed by the new policy is the gap in Directory records, with an estimated one million records missing. This gap arises from the previous policy’s reliance on recommendations rather than requirements. HISP participation was optional, leading to absent Direct addresses from non-participating HISPs. Additionally, many healthcare organizations opted out of the Directory, contributing to the missing records.
The new policy mandates HISP participation and requires healthcare organizations to publish at least one valid record to access the Aggregated Directory. This requirement aims to reduce the number of missing records and encourage comprehensive data sharing. Organizations that previously opted out are expected to meet this minimum requirement and, ideally, publish all relevant records to enhance the Directory’s completeness.
Frequent Uploads to Increase Accuracy
The policy also introduces guidelines to improve data currency, requiring HISPs to upload and download Directory data at least every 72 hours. This change addresses usability issues arising from outdated information. By ensuring frequent updates and data synchronization, users will have access to the most current information, facilitating better data flow and reducing frustration.
The Directory aggregates data from participating HISPs, creating a comprehensive, nightly-updated version. Prior to the policy updates, the frequency of data submission varied significantly among HISPs, leading to inconsistent data currency. The new policy’s 72-hour update requirement ensures that all users work with the most accurate and up-to-date information.
The updated policy broadens access to the Directory, allowing limited use for a wider range of purposes. DirectTrust can now develop a secondary means of looking up addresses, providing a simplified search feature on its website. This feature will help users confirm whether a provider or address is currently published in the Directory.
Additionally, the policy allows for the inclusion of HL7 Fast Healthcare Interoperability
Resources (HL7 FHIR®) endpoints and other communication modalities, expanding the Directory’s use as a crosswalk for multiple communication methods. This strategic move accommodates current needs and anticipates future developments in healthcare interoperability.
New Capabilities and Alignment with National Standards
The updated policy also fosters innovation by enabling new capabilities and collaborations. DirectTrust can now partner with external entities, such as the Centers for Medicare & Medicaid Services (CMS), to exchange data and improve Directory accuracy. These collaborations hold significant promise for further enhancing interoperability and data quality.
CMS developed the National Plan and Provider Enumeration System (NPPES) to assign unique identifiers to healthcare providers on an individual and organizational basis, establishing the National Provider Identifier (NPI) that’s been in effect since 2007. However, the DirectTrust Directory contains provider NPI on less than 79% of practitioners. Unfortunately, disparate directories and multiple efforts at standardization won’t bring the industry closer to the goal of interoperability and better outcomes for patients, which strongly points to the need for a common standard.
The adoption of uniform national provider directory standards is crucial for promoting interoperability. A 2019 data brief from the Office of the National Coordinator for Health Information Technology highlighted the challenges clinicians face in exchanging data, emphasizing the need for better data communication. Communication failures contribute to adverse outcomes, including delays in care and surgical errors.
Goal is Faster, Better Data Sharing
DirectTrust’s commitment to modernization and future-proofing its Directory is evident in its consensus-driven policy updates and strategic enhancements. By requiring HISPs to participate and update their data more frequently, the updated policy aims to close the gap on missing records and ensure the Directory reflects the most current information.
This initiative represents more than just policy changes; it is a reimagining of how secure and efficient health information exchange is facilitated. The introduction of a ‘give to get’ model incentivizes information sharing, enriching the Directory for all users. The policy revisions also open doors to innovative use cases and collaborations, promising to enhance the accuracy and reach of the Directory.
Nine out of 10 hospitals in the U.S. participate in Direct Secure Messaging. In Q1 2024, over 2.7 million providers, departments, and organizations had Direct addresses, and more than 294 million Direct Secure Messages were exchanged, pointing to the ubiquity of Direct Secure Messaging.
As the compliance deadline of October 18, 2024, approaches, the healthcare community can anticipate a transformed Directory that exemplifies trust, collaboration, and innovation in health information exchange. The robust consensus process behind these updates is a testament to DirectTrust’s dedication to supporting interoperable, efficient, and high-quality healthcare.
By participating in the Directory project and adhering to the updated policy, healthcare providers and facilities can significantly contribute to a more connected and efficient healthcare system. This not only benefits individual organizations but also enhances patient care and safety across the healthcare spectrum.