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David C. Kibbe MD MBA

Arien: thanks for this post. It will serve as an important technical reference for CIOs and others in hospitals, HIEs, etc. who already have private networks established. It should allay their fears that they're going to have to "rip and replace" their current network protocols and specs. The basic issue here is for these folks to have a Direct gateway available for cross-institutional and cross-network exchanges, and for communications with physicians who choose not to, or cannot, become members of those private networks for whatever reason.

I think there is another problem we have to address, and that is how to explain the value of Direct compliance to non-technologists in institutions that have spent a lot of money and energy to create relatively expensive closed (secure) networks, or whose business model derives in part from access to that network by some providers and exclusion of others.

There is the perception among some health care organizational leaders that Direct is competing with their investments in health data exchange. Once this idea has grabbed hold in a particular area, or within a particular institution, I'm finding it can be quite difficult to be persuasive about the value of Direct. And the technological arguments and facts aren't persuasive to this group.

Perhaps the idea of "gateway," and "bridge" as the fundamental ideas of Direct compliance will win over these good folks. Clearly, we need illustrative examples from the field, the pilots in particular, to show how Direct compliance can be of value for required cross-network communications, even in those places where the investment in private network technology has been very high.

Kind regards, DCK


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