Many hospitals are using EHRs to implement secure communications services for meeting Meaningful Use 2 (MU2) requirements. These MU2 efforts are focused on transitions of care (TOC) supporting the secure exchange of information related to referrals and the passing of information between providers and hospitals when patients are admitted, transferred or discharged.
Direct Secure Messaging (Direct) is the primary vehicle for this secure exchange. Direct is a national encryption standard for securely exchanging clinical healthcare data via the Internet. It is also known as the Direct Project and Direct Exchange. Direct specifies the secure, scalable and standards-based method, long needed for the interoperable electronic exchange of Protected Health Information (PHI). It was developed under a part of a federal project for standards-based healthcare communications
Collaboration and communication in healthcare are critical to the delivery of quality care. When healthcare organizations, providers, and patients exchange information, they are often sending paper through the mail, exchanging faxes, sending information via insecure email. This paper or “image” based solution lacks truly actionable data. Integration of Direct aims to improve this process, making it faster, less expensive, more efficient, as well as providing actionable data. In fact, many consider fax replacement as an ideal use case for Direct. Such a solution is highly desirable given that many healthcare organizations have a major dependence on fax today, an outdated and inefficient technology by today’s IT standards. The exchange of actionable or discreet data elements which can be integrated into the care record remains one of the most important goals of the HITECH act and Meaningful Use. Direct can deliver on that goal, whereas fax most certainly cannot – in practice or by regulatory edict.
By Andy Nieto, Health IT Strategist, DataMotion
Many hospitals are using EHRs to implement secure communications services for meeting Meaningful Use 2 (MU2) requirements. These MU2 efforts are focused on transitions of care (TOC) supporting the secure exchange of information related to referrals and the passing of information between providers and hospitals when patients are admitted, transferred or discharged.
Direct Secure Messaging (Direct) is the primary vehicle for this secure exchange. Direct is a national encryption standard for securely exchanging clinical healthcare data via the Internet. It is also known as the Direct Project and Direct Exchange. Direct specifies the secure, scalable and standards-based method, long needed for the interoperable electronic exchange of Protected Health Information (PHI). It was developed under a part of a federal project for standards-based healthcare communications
Collaboration and communication in healthcare are critical to the delivery of quality care. When healthcare organizations, providers, and patients exchange information, they are often sending paper through the mail, exchanging faxes, sending information via insecure email. This paper or “image” based solution lacks truly actionable data. Integration of Direct aims to improve this process, making it faster, less expensive, more efficient, as well as providing actionable data. In fact, many consider fax replacement as an ideal use case for Direct. Such a solution is highly desirable given that many healthcare organizations have a major dependence on fax today, an outdated and inefficient technology by today’s IT standards. The exchange of actionable or discreet data elements which can be integrated into the care record remains one of the most important goals of the HITECH act and Meaningful Use. Direct can deliver on that goal, whereas fax most certainly cannot – in practice or by regulatory edict.
Going Beyond MU2
EHRs have met the MU2 certification standard of including Direct secure messaging - a move in the right direction toward the interoperable exchange of PHI. Unfortunately, many EHR integrations and much of the work in this area have naturally focused on only meeting MU checkbox requirements. So much more can be done. Greater integration of Direct into EHR solutions to provide more actionable data would result in an easier exchange of a broader class of information, such as the secure sharing of patient records, lab results, and radiology studies.
Healthcare has long been plagued with proprietary isolated silos of data. Each provider, hospital, clinic and health system has its own EHR system. Before Direct, the exchange of data required vendor specific interfaces. With Direct and its public – vendor agnostic standards – the potential for real universal exchange exists. This is the true value in Direct for healthcare.
It is time for the healthcare community to demand more of their EHRs. To demand interoperability. To expect that communication is not limited by, or controlled by its vendors. To that point, the potential benefits are driving the use of Direct by different groups and organizations. The common thread in the new trials and deployments is that Direct is seen as a secure means to facilitate greater collaboration between parties delivering healthcare. This capability, in turn, is eyed as a way to reduce the time required to exchange information, improve patient care, and increase the efficiency of an individual, group, or organization.
Using Direct
One example of the developing interest in Direct is in dentistry. Dentistry, like other medical fields, has many specialists beyond those who practice general dentistry including orthodontia, endodontics, and periodontics. All may be needed to administer care to a patient. Like other healthcare professionals, dentists are bound by the same regulatory standards of privacy and security of PHI (protected health information). As such, they need to take privacy into account when coordinating evaluations and treatments of a patient. To accomplish this, Direct could be used to provide a universal communication standard for all members of the dental care team.
The American Dental Association has taken notice. At this year’s American Dental Association Annual Meeting, participants were able to see how Direct could be used to securely transfer patient data between dentists, dental specialists, and other healthcare entities.
In a more traditional healthcare environment, there is much activity involving Direct. Last year, two of the largest health information exchanges began exchanging Direct messages across state borders. The Delaware Health Information Network and the Kansas Health Information Network successfully facilitated the secure exchange of patient records between each organization using Direct.
Prior to Delaware-Kansas success, the Nebraska Health Information Initiative (NeHII), Kansas Health Information Network (KHIN), and Missouri Health Connection (MHC) leveraged their respective HISPs, allowing providers to electronically transmit patient care summaries, lab results and diagnostic images, among others, in a HIPAA-secure fashion using Direct. This has been particularly helpful to patients in Kansas City, where many see doctors on both sides of the state line. Having technology like Direct plus Missouri Health Connection and KHIN connected and able to exchange Direct messages helps streamline communication instead of having to send multiple pages via fax.
With Direct, KHIN has been able to improve operations in several areas via the easy exchange of information. For example, KHIN was able to transmit data from the Community Health Center of Southeast Kansas to the Kansas Immunization Registry. The goal of this work is to consolidate immunization information for Kansas residents and assure adequate immunization levels are met. This type of information sharing capability can be used by healthcare organizations to ensure people are sufficiently protected. Exchanging the required information electronically also reduces the administrative time (and cost) of manually entering immunization information. Electronic sharing reduces errors and saves hundreds of hours that would normally be required to enter the data manually. Another KHIN effort dependent on sharing information between different organizations has the goal of treating the whole person by dealing with both a patient’s physical and mental health.
These and other early adopters of Direct clearly demonstrate the potential impact the technology can have on healthcare outcomes. The original intent of Direct was to replace the use of fax and paper when discharging patients from one care setting to another, which is the use case for meeting Meaningful Use objectives for transitions of care. However, there are many other use cases including sending data to public health organizations, transmitting lab reports to physicians, obtaining prior authorizations for services, referrals, and secure patient-provider communications.
Collaboration and communication have always been a cornerstone of healthcare. From the earliest consults to modern data exchange, the need to share, understand, ask questions and make decisions based upon all of the relevant information has been appropriate. Direct is a tool which addresses this in a robust, vendor neutral, secure and private way.
Andy Nieto is the Health IT Strategist for DataMotion, an innovative health information service provider (HISP) with 15 years of experience in secure data delivery. DataMotion was founded in 1999, and today, millions of desktop, tablet and mobile users leverage its mature, cloud-based data delivery platform to securely transmit protected health information.
