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The Direct Project,[object Object],Ali Emami,[object Object],Software Engineer,[object Object],aliemami@microsoft.com,[object Object]
Quick History of the Direct Project,[object Object],5/28/2011,[object Object],Launched just after HIMSS 2010,[object Object],Response to community frustration about state of exchange,[object Object],Collaboration across the industry: government, vendors, advocates,[object Object],Today: real production use in multiple programs across the country,[object Object]
Why is there a need for Direct?,[object Object],5/28/2011,[object Object],Current methods of health information exchange are inadequate,[object Object],Communication of health information among providers and patients still mainly relies on mail or fax,[object Object],[object Object]
Health information and history is lost or hard to find in paper chartsCurrent forms of electronic communication may not be secure,[object Object],[object Object],	Physicians need to transport and share clinical content electronically in order to satisfy Stage 1 Meaningful Use requirements.,[object Object],[object Object]
Direct will be one of the communication methods in the Nationwide Health Information Network,[object Object]
Direct ProjectHigh quality open source libraries,[object Object],The history of the Internet shows the power of permissively licensed open source in driving standardization:,[object Object],TCP/IP: Berkeley TCP/IP stack,[object Object],DNS: BIND,[object Object],HTTP: Apache,[object Object],Successful open standards have easily accessible high-quality libraries trivially available to developers, including high quality documentation,[object Object],A key deliverable of Direct Project is a BSD-licensed software stack enabling:,[object Object],Client-side connectivity, for EHRs, EHR Modules, PHRs, etc. and,[object Object],Server-side connectivity for “out of the box” HIOs and Health Information Service Providers (HISPs),[object Object]
Protocols and Technology,[object Object],SMTP Gateway,[object Object],Direct uses SMTP as its transport protocol.,[object Object],S/MIME,[object Object],Messages are signed and encrypted using the S/MIME standard. ,[object Object],A decades old protocol for ensuring authenticity, non-tampering, confidentiality, delivery only to intended recipients. ,[object Object],DNS,[object Object],Used to serve up certificates bound to an e-mail address or organization. ,[object Object],The highest scale distributed directory on the planet. Powers internet addressing. ,[object Object],Configuration Web Service and DB,[object Object],Storage and access to org’s certs, private keys, trust anchors,[object Object]
HISP,[object Object],      Internet,[object Object],Email Server,[object Object],SMTP Gateway,[object Object],Security & Trust Agent,[object Object],MIME,[object Object],+ TLS,[object Object],XD* Agent,[object Object],Firewall,[object Object],SOAP Client,[object Object],HTTP,[object Object],Gateway,[object Object],XD* SOAP Endpoint,[object Object],Configuration,[object Object],Web Service,[object Object],SQL,[object Object],HTML/HTTP,[object Object],Admin,[object Object],DNS,[object Object],Gateway,[object Object],Configuration Web UI,[object Object],DNS Server,[object Object]
Scenario: Doctor to patient messaging,[object Object],Dr. Alex wants to send a visit summary to patient Jill.,[object Object],From: alex@direct.ahospital.org,[object Object],To: jill@direct.aphr.org,[object Object],Subject: Your health visit summary,[object Object],Jill,,[object Object],Here is the summary information from your visit.,[object Object],- Dr. Alex,[object Object],<Summary Attached>,[object Object]
Sending a message,[object Object],Alex creates and sends the message using his favorite e-mail client.,[object Object],Or his hospital’s EHR software. ,[object Object],A Direct gateway is installed at ahospital.org. Secure e-mails at ahospital are relayed through this gateway. ,[object Object],The gateway receives the message and determines it needs Jill’s certificate in order to send the message. It uses DNS to resolve it.,[object Object],The gateway:,[object Object],Signs the message with Alex’s private key. ,[object Object],Encrypts the message with Jill’s public key.,[object Object],Sends the message over SMTP to Jill’s gateway.,[object Object],5/28/2011,[object Object]
Receiving a message,[object Object],Jill is using a PHR system that provides her with a Direct address. ,[object Object],Microsoft HealthVault is one such PHR system.,[object Object],The PHR’s Direct gateway receives the message from ahospital.org. ,[object Object],The gateway looks up Jill’s private key from its local configuration backend. ,[object Object],Jill’s Gateway:,[object Object],Decrypts the message using Jill’s private key. ,[object Object],Verifies the signature on the message is valid. ,[object Object],Verifies that the signer is trusted. ie. Jill trusts Dr. Alex. ,[object Object],Forwards the message to Jill’s inbox. ,[object Object],5/28/2011,[object Object]
More scenarios,[object Object],Provider-to-Provider scenarios have equivalent flow. ,[object Object],Scenario: Referring doctor sends patient information to another doctor. ,[object Object],Patient-to-Provider scenarios are just as easy!,[object Object],Gateways can be configured to allow incoming messages, outgoing messages, or both for a given address or domain. ,[object Object],Example: Doctor wants to send to patients but NOT receive. ,[object Object]
Direct ProjectThe Process,[object Object],	Direct standards and specifications are developed by a group of public-private stakeholders. Weekly teleconferences and periodic face-to-face meetings facilitate active collaboration.,[object Object],Direct Project Output:,[object Object],[object Object]
Implementation Guides
Reference Implementation

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The Direct Project @ Quantified Self

Editor's Notes

  1. All are available via Reference implementation.