Whittier IPA has also contracted with Alere to develop a health information exchange for its service area. The exchange, called Wellport, will issue Direct addresses to IPA physicians and act as a health information service provider, or HISP.
From the patient record on the Wellport HIE, Whittier IPA physicians by the end of 2014 will be able to pull anything off that health information exchange, such as a lab report, progress note from a physician, or a hospital discharge summary, and send it to whoever needs to receive it, Heyman says.
The role of HISPs throughout the meaningful use Stage 2 program is to provide identity verification via a chain of trust. Such a chain requires each HISP to enter into a set of legal agreements with other HISPs via certifying organizations such as DirectTrust or others. In this way, secure messages can eventually find their way to any provider participating in such a chain of trust.
As 2014 progresses, providers say the pricing of Direct messaging services will be determined largely by market forces. Some HISPs are being operated by EHR software vendors, others by HIE technology vendors, and still others operated by state health information exchanges. Some hope to charge by transaction, particularly with hospitals, or by number of Direct addresses provided, particularly with physicians.
Some providers think all Direct services will eventually be free or virtually so. "There will be significant resistance to having to pay for this in the early stages," Schneider says. "While the benefit to many of us is clear, I already have my fax machine and it works quite fine, thank you very much, and while eventually this might be able to replace it, for a while I have to have a fax machine, a phone line, and a person there. If you add costs to my cost structure, again, speaking as a small practice physician here, I'm not terribly happy to do that."
This article appears in the May 2014 issue of HealthLeaders magazine.