When it comes to Patient Data exchange, I want us to be inclusive of “Mediated” exchange, “Directed” exchange, “Controlled” exchange, and “Negotiated” exchange. I have not seen these formally defined, so here is my informal definition. Let me know if you know of another mode of communication.
- Mediated Exchange — where the Patient themselves is an active part of the communication pathway. Such as carrying the data within their possession, using a personal device and application, — Such as using a phone resident App using FHIR to download their data, then upload that data to some recipient.
- Directed Exchange — where the Patient actively requests that the information flow to a selected destination. — Such as a patient using Direct Secure Messaging, or where a patient requests that the data be pushed.
- Controlled Exchange — where the Patient does not get directly involved in the communication, but should be understanding of the communication and possibly have control. over that communication —- Like using Health Exchange between Provider organizations
- Negotiated Exchange — where the Patient themselves connects two parties and authorizes the flow between those two parties. This might use the HEART standard for authorization, and FHIR bulk data access.
Are we there yet? I think we need multiple modes. None of these solve all needs. Each has specific strength.