Direct Project: Revisiting the Innovative Power of Push

Last May Fred Trotter wrote a brilliant blog post entitled The Power of Push. His essay described the latent power of the Direct Project (known then as NHIN-Direct).

At that time, the Direct Project was still being incubated and was not widely known or understood. Since then, it’s gone from being an idea to a project in full-speed implementation.

The simplest conceptualization of the Direct Project has been as a secure email alternative to medically-related transactions that today typically occur by fax, e.g., Dr. A faxes a medical record to Dr. B.

The functionality of the Direct Project has been described as “push-only”. Fred notes that

Push-only means that A can send messages to B, but B cannot automatically get data  from A (that would be pulling). Email and Faxes are push models. Web pages are pull models (i.e. sent to you when your browser asks for them).

“Push-only” misses the innovative potential of how the Direct-Project could be used. Let me try to make a simple conceptual leap that hopefully will open your eyes to The Power of Push.

With a little creativity and jury rigging, push transactions can easily become pull transactions.  For example, what if I were to call you on the phone (or send you an email, a fax, a carrier pigeon, a smoke signal) simply asking you to send (push) me some information.

Voila. Push is turned into push and pull.

Fred describes examples of  higher level functionality enabled when you get creative with push:

  • You can use an email account to prove that you are a human to a website. Have you ever signed up to a website that insisted that you give them an email address and then automatically sent you an email that had something to click on to prove that you owned that email address? I have done this so many times that I have lost count. This is “email for authentication”. Software often uses email messages to provide greater access to websites.
  • You can send messages to just one email address, which will then be sent to many other email addresses. Mailing lists can be pretty amazing software services, but fundamentally all they do is intelligently receive and re-send email messages. This makes email change from a one-to-one messaging system to a one-to-many messaging system. But it is implemented entirely with one-to-one messages.
  • If you push the mailing list even farther you can see that it can become something even more substantial, like craigslist, which pushes the envelope on email broadcasting and blurs the lines between email application and web application.
  • Programs can automatically send email messages when something changes, like Google Alerts tell you when the web has changed (or at least changed as-according-to Google)
  • You can have many email addresses and configure them to aggregate to one email viewing client, enabling separate relationships, and even identities to be managed in parallel. For instance your work email address really means your work identity, and your personal email means your personal identity, but you might forward both to the same email client and then answer and send messages as both identities at the same time.
  • You can use email to create a system for recycling things. Making it easier not to buy new things, and not to throw away working things. This is essentially email-enabled peer-to-peer conservationism.
  • Email clients are more than just programs we use to send and receive messages. We expect them to integrate with calendaring software. We expect them to allow us to extend them with other programs. People use powerful email clients like gmail to run their lives before people started to do that with gmail, they where running their lives with outlook or eudora.

Read Fred’s article…and then spend some time thinking about new ways you might use the Power of Push in exchanging medical information.

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