Next we'll speak with Dr. David Kibbe, president and CEO of Direct Trust,
and a senior adviser to the American Academy of Family Physicians,
the largest primary care physician organization in the United States.
So good morning, David, and thank you very much for
taking the time to be with us today.
>> Good morning, Mark.
It's a pleasure to be here.
>> So at this point, the students are aware of Direct Trust and
the role it plays in establishing trust across HISPs.
But, of course, with health IT, adoption is always an issue.
So, where is Direct Trust in terms of adoption at this point?
>> Yeah, well, we've made a lot of progress, Mark, in the last year.
Your students are I'm sure aware of direct
as a protocol in a set of specifications.
They're probably not aware of the extent to which direct
service providers have been active in this sector of the industry.
DirectTrust membership has grown from about 50 members this time
last year to over 135 members.
We now have 33 health ISPs or
HISPs who are providing services to a range of customers and
clients, including electronic health records.
And of course the electronic health records are provided direct to their
customers, who are provider organizations and
individuals in those organizations.
We also have HIEs, some federal agencies now,
and a growing number of personal health records who are involved.
So, right now that network serves approximately 6,000 to
7,000 healthcare organizations.
There are over 250,000 direct addresses that have been provisioned for
those parties in those organizations and
those numbers have been doubling every three months.
So we think that by the beginning of 2015, there will be
approximately 200 electronic health records, depending on Direct Trust
accredited service providers, and approximately a million
direct addresses being supplied within the provider community nationwide.
>> That's certainly impressive.
In health IT right up there with adoption is use cases.
The purposes to which technology is used to approve care.
You've told me about a very interesting example in hospitals and
transitions of care where patients are leaving the hospital and
going to a long-term care facility.
Could you tell us a bit about that?
>> Yeah. Certainly.
A couple things to keep in mind is that we're clearly seeing the network
effect her.
The hockey stick curve of adoption is growing very, very quickly,
but we're also seeing that there's a long tail here in terms of use cases.
The primary use case that's driving the adoption of Direct exchange right now
is of course stage two meaningful use.
As hospitals and medical practices seek to meet the transitions of care and
patient engagement objectives in stage two meaningful use which require direct
exchange, hospitals are probably the most active now in terms of using direct
exchange to send referral documents, in particular transitions of care clinical
summary, both to provider organizations on discharge of the patients or
just before, but also to skilled nursing facilities.
So we have a growing number of skilled nursing facilities and
rehab centers that are, strictly speaking, not meaningful users, but
they are endpoints for meaningful users and are starting to see the need for
them to have direct exchange capabilities.
I would add to that that claims attachment is a growing use case,
again not really of meaningful use, and
the federal agencies have referral needs to replace fax and
e-fax mail with direct exchange, and that's also growing quickly.
>> Another interesting example, I believe it was in Tennessee and
Kentucky, is the use of direct by health departments to collect very patients
specific data about those patients with sexually transmitted diseases.
Can you tell us a bit about that?
>> Yeah, that's a really exciting grassroots use case, and we're
seeing several like this around the country, in rural areas of the country.
This involves public health clinics in two states, Kentucky and Tennessee,
using direct exchange for patients who they refer to one another or
see in common and those are patients with STDs as you mentioned.
They are also involving an army base, Fort Campbell, that has its own clinic.
And just been contacted by the department of defense,
we have a meeting next week to talk about how they can provide direct
services at their installations within the coming months.
>> Well, so, the use cases we've talked about so far are provider to provider.
The students are familiar with view, download,
and transmit, the VDT requirement meaningful use, too.
That would seem like a role for direct.
What can you tell us about that?
>> The use of direct exchange by providers and
patients to communicate protected health information is an enormous potential.
We have about 15 companies in Direct Trust
who are what I call next generation personal health records.
These are personal health record companies like Healthy Circles that
are contemplating or actually implementing now, direct services for
their customers who are primarily patients and consumers, not providers.
So that could grow very quickly but
it requires first that the provider to provider infrastructure be in place.
I don't expect to see large scale use of Direct exchange in the provider,
excuse me, in the consumer space until 2015.
Because if you want to communicate with your provider using Direct,
which is a wonderful idea.
It's secure messaging with attachments.
Or you want devices to send direct messages to your provider organization.
The provider organization has to be capable of receiving those messages and
attachments first.
And we're very much still in that building phase on the provider side.
>> David, you mentioned something, that I hadn't really thought about before.
Are the device manufacturers, the companies that are hoping to put
devices into patient's homes so that the patients with chronic disease, for
example, can be monitored more continuously,
are they seeing direct as a technology they want to build into these devices?
Yes, without question.
There's one of the things that gives me real confidence that Direct
is a disruptive innovation is this effect you're starting to see where of
course we're talking about S/MIME over SMTP, email messages with attachments.
But there's a lot of innovation occurring around the use of that very
simple technology to replace interfaces of various kinds, including
device to device interactions, or device to server Interactions and connections.
That innovation is sort of quiet at this time,
there's not a lot of noise around it.
But there's significant interest in the part of device manufacturers and
also the payers for example who believe that
Direct can be a last mile from the device or
from the data center to some end point, which could be the provider's inbox.
>> Well, one final question.
Of course there are always challenges, it sounds like exciting times for
Direct and Direct Trust, but what do you see is the most significant challenges
that have to be over come in the next few years for
Direct to really achieve its potential.
>> You know it, it always goes back to some payment or business rationale.
Right now, the incentives for
provider organizations to exchange information with one another easily and
affordably using standards like Direct is not strong.
It's growing with the movement of ACO's, but
I think we still have a hesitancy on the part of providers to move data when
they're getting paid for duplicating care, for example.
I also think that we have to overcome the stigma of patients
asking their providers and the provider organization for that information.
There still is a hesitancy on the part of many institutions to make it easy for
patients to get their information.
Having standard in place, of course, helps.
But it doesn't motivate people.
Standards are not motivators.
Standards are enablers.
>> Well David, I thank you again.
I particularly thank you for your final comments, which just emphasize again
something I tried to get across in this course which is that without the right
incentives, all the technologies in the world won't change healthcare.
>> I would agree with that statement very strongly, Mark.
Thank you for the opportunity to speak with your audience, with your class.
And if there are individuals who want to contact me or
learn more about direct trust, our website is directtrust.org.