Rhode Island Healthcare Providers Reach Direct Messaging Milestone

Integration with CurrentCare leads to one million secure messages sent via national standards-based method for exchanging protected health information

The Rhode Island Quality Institute (RIQI) recently announced that healthcare providers in Rhode Island have exchanged more than one million messages using Direct, a secure cost-effective way to send protected health information (PHI) to known, trusted recipients over the internet.

Direct—started in 2010 by the Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology (ONC)—makes it possible for healthcare providers to securely email information to other trusted providers, such as hospitals, specialists, pharmacies, and laboratories.

RIQI has integrated the use of Direct messaging into CurrentCare, Rhode Island’s statewide health information exchange (HIE). Direct is used by CurrentCare’s Hospital Alerts service to notify providers when one of their patients is admitted, discharged or transferred from any hospital in the state. Direct is also used to transfer continuity of care documents (CCD) from providers’ practice-based electronic health records (EHRs) into CurrentCare. This feed of clinical information, with patient consent, from practice-based EHRs to CurrentCare is improving quality by detecting gaps in care and making sure the full record is available to all care providers.

“Very early on, we recognized the valuable role Direct could play in helping CurrentCare securely collect and exchange patient information among authenticated healthcare providers throughout the state,” said Laura Adams, President and CEO, RIQI. “With more than one million messages sent, Direct has clearly proven to be an important addition to our statewide health information exchange strategy.”

Regular email is not appropriate for sending PHI. Messages could be intercepted and read during transmission, and there is no way of ensuring that the message will be delivered only to the intended recipient.

Direct messaging is both secure and validated, making it appropriate for sending PHI. Message encryption ensures that the message is not compromised during transmission. An electronic credentialing system--using electronic certificates--identifies the sender and recipient to ensure that the mail is routed only to intended and trusted recipients. A Direct message can be delivered only if both the sender and recipient are using Direct accounts and have established a trust relationship.

“Direct messaging has helped facilitate improved communication between primary care providers, specialists, hospitals, and labs," said Al Puerini, MD, President and CEO, RI Primary Care Physicians Corporation (RIPCPC). “Direct has allowed us to exchange EHR data with other providers through CurrentCare and to receive an Alert when our patients receive hospital care. These are two very important functions that allow us to better coordinate treatment and provide follow-up care with our patients.”

RIPCPC and RIQI successfully collaborated in 2010 to develop the technical mapping of Direct messaging through a request from CMS in Washington, D.C. Dr. Puerini sent the first-ever provider-to-provider Direct message in the U.S. in January 2011.

RIQI’s program to facilitate adoption of Direct by providers and practices in Rhode Island launched in September 2011 and is managed by the RI Regional Extension Center (RI REC). The program offers educational materials and webinars and free membership in the Southern New England Trust Community, a community of verified providers who have a legitimate need to use Direct messaging to exchange patients’ protected health information (PHI). In addition, the program provides a selection of three qualified Health Information Service Providers (HISPs) in an online vendor marketplace. RIQI’s HISPs are Inpriva, MaxMD, and Secure Exchange Solutions.

Currently, 162 provider sites throughout Rhode Island, representing more than 600 providers, are using Direct with 135 sites receiving Hospital Alerts and seven major EHR platforms participating in CCD integration.

As a part of qualifying for incentive payments under the Meaningful Use Stage 2 criteria issued by the Office of the National Coordinator for Health IT (ONC), healthcare organizations and providers must meet data transfer requirements using Direct Messaging. These requirements can be demonstrated with EHRs that comply with the ONC’s 2014 Edition EHR Certification Criteria which specifies electronic exchange of transition of care records with Direct Messaging.

About Rhode Island Quality Institute
Rhode Island Quality Institute is a center of collaborative innovation that advances health and healthcare transformation. Our mission is to improve the quality, safety and value of healthcare and share knowledge that advances the field of healthcare improvement. RIQI is a 501c3 non-profit organization founded in 2001 and overseen by a volunteer Board of Directors. Board members are senior health industry leaders from our community, including CEOs of hospitals, health insurers and health-related businesses, along with leaders of consumer groups, academia and government agencies. For more information, visit www.riqi.org.