We have tried to clarify the aims and goals of NHIN Direct through descriptions of what it is, FAQs, and lots of content in this blog and the wiki. Despite that, we have still managed to engender some confusion, and we have tried to be as responsive as possible to confusion, misunderstanding, and concerns.
For instance, a number of state HIO participants have felt that NHIN Direct is in conflict with the strategic aims of state planning efforts. Sometimes, that has been based on misunderstanding, that, for instance, the output of the NHIN Direct project could be used to bypass HIOs by connecting nationally, or that separating transport and content perpetuates health care content issues, and in those cases, we've tried to clear up misunderstanding by clarifying our intent. When the concern is grounded in the context of what this project is about, we and others have been direct and transparent about what we are doing and why (see, for example, Wes's blog post on the business issues involved in making direct transactions cheaper by standardizing them).
We commit to continuing this work of reducing confusion and would ask that others do as well. If you have concerns, let me know, and we'll work to address them transparently and openly.
I will express a concern to the wider community. I was recently forwarded an email from an organization that raised fears and concerns about what NHIN Direct means for states as a way of introducing fee-based professional services. My view is that the world of health IT is complex and dynamic enough that we don't need anyone to raise additional fear, uncertainty and doubt. We'll do our part to reduce confusion, and I would ask others to do so as well.