Direct Messaging: The Logistics of Exchange

Posted on June 12, 2014 I Written By

Julie Maas is Founder and CEO of EMR Direct, a HISP (Health Information Service Provider) whose mission is to simplify interoperability in healthcare through the use of Direct messaging EHR integration and other applications. EMR Direct works with a large developer community to enable Direct for MU2 and other workflows using a custom, rapid-integration API that's part of the phiMail Direct Messaging platform. Julie is passionate about improving quality of care and software user experience, and manages ongoing interoperability testing within DirectTrust. Find Julie on Twitter @JulieWMaas.

Once you enable digital health data exchange via Direct instead of by fax, you’ll want to share your address with other providers, so you no longer have to deal with all those pesky scanned attachments, subtly linked to electronic patient records.

Direct directories are enabling address lookup to meet this need, and you can also let your most common business partners know your address by including it on document templates you already exchange today, so they can begin to exchange with you via Direct when they’re ready.  You can also contact your referring docs using another method you trust (such as the fax where you usually send them medical records, or their business phone number) to ask for their Direct address.

It’s wise to confirm expectations with exchange partners about the use cases/data payloads for which you intend to exchange via Direct, as Direct isn’t used just like email by everyone.  Some will use Direct solely for Transitions of Care and patient Transmit, others may use it for Secure Messaging with patients, and still other providers will be happy to conduct general professional correspondence with patients and other providers over Direct.  This service information may or may not be reflected in the first provider directories.  And even within the Transitions of Care use case, if standards aren’t implemented for optimal receiving, a sending system may generate a CCDA (Continuity of Care Document) with a subtly different structure than a receiving system is able to completely digest.  So, just a heads up as you receive your first message or two from a system with whom you haven’t exchanged before: you’ll want to carefully monitor what data is incorporated by the receiving system and what is not, and you may need to iterate slightly between sender and receiver to get the data consumption right.  You’ll still be miles ahead of the custom interfaces model.

All in all, Direct is easy to use and is working much better than the naysayers would have you believe.  Direct software follows the specification outlined in the document lovingly known in the industry as the “Applicability Statement”, crafted by consensus through a public/private collaborative effort known as the “Direct Project” and led by the Office of the National Coordinator of Health Information Technology (ONC).   Direct Project volunteers have also written reference implementations following this specification which have been used by many HISPs and EHRs as the basis for their own Direct offerings.  Other private entities have developed their own APIs and implementations of the protocol from scratch.  These different systems and varying configurations regularly test and collaborate with each other, to make Direct work as seamlessly as possible for the end users.  Because the whole system only works as well as our joint efforts, HISPs (Health Information Service Providers who provide Direct services) within the DirectTrust Network take interoperability seriously and work together to iron out any kinks.

A tremendous amount of collaboration is taking place to bring interoperability to fruition for Direct’s well-established standards and policies, and this work is producing a larger and more robust network each day.