9 Must-See Picture Archiving/Communication Systems

The Centers for Disease Control and Prevention (CDC) plans to use the Direct clinical messaging protocol to enable healthcare facilities all over the country to send healthcare-related infection reports automatically to its National Healthcare Safety Network (NHSN). To that end, in late August CDC issued a request for proposals--which were due Sept. 12--for a health information service provider (HISP) that can route Direct messages from healthcare providers to NHSN.

Enrollment in NHSN is open to acute care hospitals, long-term acute-care hospitals, psychiatric hospitals, rehabilitation hospitals, outpatient dialysis centers, ambulatory surgery centers, and long-term care facilities. Nearly 11,000 facilities submit data to the network, said Barry Rhodes, team lead for development in CDC's division of healthcare quality and promotion, in an interview with InformationWeek Healthcare. This data is used by CDC for research purposes, and is also available to state public health agencies and the Centers for Medicare and Medicaid Services (CMS).

Currently, facilities send infection reports to NHSN in one of two ways. They either enter the data into the system through a Web-based interface--the predominant method, which is fairly labor intensive. Alternatively, they can use their electronic health records to generate files that conform to NHSN requirements, but the infection prevention specialist or another staff member has to manually upload those files to NHSN, Rhodes noted. The purpose of using Direct messaging is to simplify the data submission process by allowing staff to send reports automatically.

NHSN has worked with vendors of EHRs and infection control surveillance software to develop standardized reports that conform to the criteria of HL7's Clinical Document Architecture (CDA). These reports are similar to another CDA format, the Continuity of Care Document (CCD), which a growing number of providers use to exchange clinical summaries. But the data elements that NHSN documents contain are different from those in the CCD. Various CDA documents are used for reporting central line-related bloodstream infections, surgical site infections, MRSA infections, and other infection types in a multitude of healthcare settings.

The NHSN selected Direct messaging to facilitate the reporting process because it needed a single standardized way to receive messages, Rhodes said. In addition, he pointed out, the Meaningful Use stage 2 rules approve the use of Direct messaging to exchange CCDs in transitions of care, such as discharges and referrals. "EHR vendors who are implementing Direct [for Meaningful Use] should be able to use a common standard for multiple activities," he said. "So we're piggybacking on that whole process."

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Rhodes also cited one other motivation for using Direct--it is a streamlined version of the Nationwide Health Information Network (NwHIN). "We want to tap into that and be part of it. The more people who participate in and use it, the more important and useful it's going to be."

NHSN will not use a national HISP for routing Direct messages, he explained, even though it will have national reach. For the most part, he said, facilities will use local HISPs for Direct messaging; the local carriers will connect to the NHSN HISP so it can pass on the messages to the CDC network.

Because NHSN is a research network and not a biosurveillance entity, he added, it will not use Direct to send any messages to providers, other than to acknowledge receipt of their information.

As of July, 400 providers had the ability to generate CDA files in NHSN-accepted formats, and 300 more were expected to join in soon. But the NHSN request for proposals said that no more than 100 facilities were expected to send Direct messages in the first year.

Rhodes said that was only an estimate and that it would depend on how many facilities become Direct-enabled in the near future. While leading EHR vendors are adding Direct capabilities, he noted, it could take a while for those to be implemented. "We anticipate that many facilities, because of Meaningful Use, will have Direct capabilities in coming months."

As for infection control software vendors, he said, many of their products are becoming part of larger EHR systems. Many of these vendors, he added, are interested in enabling their customers to send data directly to NHSN without having to do manual uploads.

Direct messaging has been spreading in recent months, with many statewide and regional health information exchanges beginning to deploy the secure messaging protocol.