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Direct Messaging in North Carolina: Current Capabilities & Future Directions
November 4, 2015 Research Triangle Foundation
NCHICA Presents the 7th Thought Leader Forum
Presenters Dennis Andrison, IS Project Lead II, New Hanover Regional
Medical Center
Patty Lewis, Implementation Lead, Coastal Connect HIE
David C. Kibbe, MD, President & CEO, DirectTrust
Moderator Mary McCaskill, Health IT Manager, NC AHEC Program
North Carolina Area Health Education Centers
Direct Messaging • Direct messaging is
basically a secure email system
• The vision of a Direct-enabled healthcare system is to provide a secure healthcare network where all participants are verified and can securely communicate with anyone else within this network. This connectivity will empower clinicians, administrators and systems to securely share information. (http://h22168.www2.hp.com/docs/orion/RS971_Demystifying_DSM_WhitePaper.pdf )
North Carolina Area Health Education Centers North Carolina Area Health Education Centers
http://www.njhitec.org/services/direct/
Direct email address from the NCHIE looks like: firstname.lastname@direct.yourdomain.nchie.net
North Carolina Area Health Education Centers
Direct Messaging • Standard Use Cases
– Referrals between organizations – Discharge summaries sent to PCPs and
patients – Transmit Care Summaries – Secure provider to patient communications
North Carolina Area Health Education Centers North Carolina Area Health Education Centers
Direct Messaging
Challenges: • Many implementations for each provider • Each EHR is different in the steps needed to
manage Direct within the EHR and in packaging information for sending via direct
• Not all HISPS talk to each other http://www.directtrust.org/member-list/
• No central provider directory
North Carolina Area Health Education Centers North Carolina Area Health Education Centers
Best Practices Building a Community… 1. Improve communication- What does our internal team look
like? Who are our external partners? 2. Standardize processes- What does a preferred partner look
like? What does the workflow look like? How do we test Direct Messaging capabilities?
3. Establish accountability- What are the roles involved? What tasks are assigned to each role? What do we do when we encounter a problem?
4. Measure performance- How do we know we are on the right track?
5. Encourage strong care coordination- What resource allocations or policy and procedure changes are necessary?
Direct Messaging in North Carolina
Nov. 4, 2015 Dennis Andrison IS Project Lead II
NHRMC
• Based in Wilmington, NC and serving 7-county region in southeastern North Carolina (Pender, New Hanover, Brunswick, Onslow, Duplin, Columbus, Bladen)
• Regional referral center with: – Level II Trauma Center – Heart Center – Stroke Center – Women's & Children's Hospital – Orthopedic Hospital – Rehabilitation Hospital – Cancer Center – Neonatal, Pediatric and Adult Intensive Care – EMS
• Affiliated with NHRMC Physician Group (200+ providers) and Pender Memorial Hospital
• Teaching hospital affiliated with UNC School of Medicine • Third largest county-owned public hospital in the United States • ~ 550 Physician Staff • Licensed for 769 beds
Why Direct
• Comply with Meaningful Use Stage 2 metric for electronic transfer of SOC (summary of care documents)
• To improve care coordination for our patients
Implementation
• Concluded many surrounding Practices not
ready to electronically send SOC/TOC
• Partnered with local CCHIE
• Approximately three and a half month implementation
Lessons Learned
• NHRMC has two direct domains – Direct.nhrmc.org – Soc.nhrmc.org
• Incoming Direct messages had to be uniquely identified
• Many different ways to send a Direct message
• Testing
12
13
Success
Questions
14
Thank you for your time. Dennis.Andrison@nhrmc.org
910-667-7513
Direct Messaging in North Carolina
Patty Lewis Implementation Lead Coastal Connect HIE
Coastal Connect Current Footprint
Total Patients Since Inception: 4,051,703
• HIE to HIE Connection • 40 Counties • 84 Data Contributors – acute, ambulatory and commercial lab,
diagnostic center
Regional Interoperability
17
Solution Use Case
COMMUNITY HEALTH RECORD Access to data outside your own network: Reduction in duplicate testing and more timely diagnosis and completion of care plan .
Access to Acute Care Setting Documents – including ED: Community Practices have a full picture of acute setting care to provide appropriate follow up • Reduction in requests for documents to hospital HIM departments Clinical Inbox – results delivery
NOTIFY Alerting Unaffiliated Providers: Notifications are sent for emergency room and inpatient admissions and discharges for their patient population • Allowing for appropriate/timely follow up and in some cases intervention
during ED encounter
Alerting Hospital Care Team Members (non-provider): ER and other Case Managers are receiving readmission alerts on top utilizers
iNEXX Care Coordination Acute to Ambulatory: Electronic scheduling of ambulatory follow up appointment prior to discharge
NHRMC Community Dashboard
Community Health Record Utilization
.
In September, transition of care was supported for 5,076 unique patients!
0
1000
2000
3000
4000
5000
6000
Logins Unique Patients Accessed
From Sept 15 to Oct 15 – CCHIE Direct Secure 80 practices/ 6444 transition of care or referral documents Direct Trust 34 providers/ 780 messages As practices get their Direct Trust set up – CCHIE numbers will decline
Batish Family Medicine, Leland, NC sanjay-batish@batishfamily.e-mdsdirect.com Dr. Weckel, Burgaw, NC weckelmd@drweckel.amazing-direct.com Wilmington Access for Teens, (WHAT), Wilmington, NC whatswhat@direct.myezyaccess.com Coastal Internal Medicine, Wilmington, NC Coastal.internal.medicine@direct.coastalinternal.nextgenshare.com ayman.gebrail@direct.coastalinternal.nextgenshare.com feras.tanta@direct.coastalinternal.nextgenshare.com Orthowilmington, Wilmington, Leland, Jacksonville, Supply, Southport, Sunset Beach, NC referral.coordinator@orthowilmington.coastalconnectdirect.org
Patient MCOne-One Zzzztest
Date of birth January 1, 1901
Sex Female
Race
Ethnicity
Contact info Primary Home: UNK WILMINGTON, NC 28401, USA Tel: +1-000-000-0000
Patient IDs 12294425 1.2.840.114350.1.13.298.2.7.5.737384.775029
Document Id 1.2.840.114350.1.13.298.2.7.8.688883.255988
Document Created: October 28, 2014, 13:43:14 -0400 Performer (primary care provider)
Author Epic - Version 7.9
Contact info
Encounter Id 207939056 1.2.840.114350.1.13.298.2.7.3.698084.8
Encounter Date at October 28, 2014
Encounter Location id: 14800 1.2.840.114350.1.13.298.2.7.2.688879
Document maintained by
New Hanover Regional Medical Center
Contact info 2131 S. 17th. St. Wilmington, NC 28401 Tel: +1-910-343-2498
Continuity of Care Document Table of Contents •Reason for Referral •Encounter Details •Active Allergies - as of 10/28/2014 •Medications - as of 10/28/2014 •Active Problems - as of 10/28/2014 •Social History - as of 10/28/2014 •Plan of Care •Procedures •Results •Visit Diagnoses
Interoperability Value
www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036
David C. Kibbe, MD, MBA President and CEO, DirectTrust
Senior Advisor, AAFP November 4, 2015
www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036
Mission and Goals: DirectTrust
28
DirectTrust.org, Inc. (DirectTrust) is a voluntary, self-governing, non-profit trade alliance of 150 organizations dedicated to the growth of Direct exchange at national scale, through the establishment of policies, interoperability requirements, and business practice requirements. DirectTrust operated under a two-year Cooperative Agreement with ONC, 2013-15, to support its work of creating a national network of interoperable Direct exchange services providers.
Security & Trust Framework
EHNAC-DirectTrust Accreditation Programs
Trust Anchor Bundle And Network Services
www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036
DirectTrust Network of Networks For Secure, Interoperable Exchange
www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036
DirectTrust Network of Networks For Secure, Interoperable Exchange
www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036
About DirectTrust
• DirectTrust is a non-profit national industry alliance of 155 organizations that is actively supporting Direct exchange through policy setting, accreditation, trust anchor distribution, and outreach activities. DirectTrust is an outgrowth of the Direct Project and supports the “triple aim” set by ONC and HHS: improvement of the health care experience; improvement in the care of populations; and reduction in the cost of care.
• The ONC is establishing governance mechanisms for health information exchange
over the nationwide health information network, Nhwin, in part through a 2 year Cooperative Agreement with DirectTrust.
• The Stage 2 MU objectives require eligible providers engage in health information exchange via standards, used in a manner consistent with these governance mechanisms, including the use of certified EHR technology capable of sending and receiving Direct messages and attachments.
31
See: http://www.healthit.gov/buzz-blog/health-information-exchange-2/onc-partners-health-information-exchange-governance-entities and also http://www.healthit.gov/buzz-blog/electronic-health-and-medical-records/directtrust-builds-transparency-confidence-direct-exchange).
www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036 32
32
DirectTrust’s membership has doubled in the last year and a half.
www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036
DirectTrust’s membership has doubled in less than a year.
www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036
Stage 2 MU focus is on exchange
www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036
Things have been moving very, very fast
April 2010 Direct Project launched Goal: simple, secure, scalable, standards-based way to send health data over the Internet
April 2011 Applicability
Statement published
“Rules of the Road” Workgroup started
HIEs charged w/ Direct
Feb 2013 EHNAC-DirectTrust
accreditation program starts
Stage 2 MU program to require Direct in all EHRs by 2014
Sept 2015 DirectTrust HISPs
provide service to >48,000 HCOs and provision over 1 million
Direct email addresses
Direct = secure, identity validated, vendor/app neutral messaging + content
May 2012 DirectTrust
incorporated as non-profit trade alliance, 501(6)(c)
www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036 36 36
Health Information Service Provider (HISP)
Healthcare Organization (HCO)
Identity vetting at a specific level of Assurance, LoA.
Certificate Authority (CA)
Certificate Validation Service
X.509 Certificate
Issuance Service
Revocation Services
Certificate Signing Services
Registration Authority (RA)
Compile/Validate Identity and Trust Documentation
The CA and RA enforce the
policies specified in the DirectTrust
and FBCA Certificate Policy
(CP).
Credential issued on the basis of RA’s Identity vetting at specific LoA..
HCO Direct
Addressees
Basic services for user: DNS discovery; encryption; certificate signing and validation; send/receive MDNs; provide HISP-side of edge protocol connection compliance with Direct standard,
The HISP enforces the policies specified in the
DirectTrust HISP Policy (HP), and MUST use accredited RA
and CA.
The HCO relies on HISP, CA, and RA as accredited trusted agents, and bears ultimate
responsibility for HIPAA privacy and security.
NOTE: Three separate roles and responsibilities from “trusted agents” combine to enable Direct exchange
1. 2.
3.
www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036
DrBob@direct.familypractice.com (has been identity vetted, has X.509 Digital certificate bound to address.)
DrSusan@direct.cardiology.com (has been identity vetted, has X.509 Digital certificate bound to address.)
Exchange between HISPs requires active use of the Direct protocols for secure Internet email exchange
37
EHR EHR
encryption
identity validation
www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036
Health care organizations served by DirectTrust HISPs
667 1,460 3,336
5,627
28,148
35,657
39,751
46,797
-
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
45,000
50,000
Q2 2013 Q3 2013 Q4 2013 Q1 2014 Q3 2014 Q4 2014 Q1 2015 Q3 2015
Health care organizations served by DirectTrust HISPs
38
www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036
Number of Trusted Direct Addresses
8724 45,300 73,922
182,279
428,105
663,321
752,496
998,313
0
200000
400000
600000
800000
1000000
1200000
Q2 2013 Q3 2013 Q4 2013 Q1 2014 Q3 2014 Q4 2014 Q1 2015 Q3 2015
Number of Trusted Direct Addresses
39
www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036
Direct Exchange Growth
122,842 2,195,433 2,567,110 3,938,346
7,746,375
22,959,139 27,316,438
57,247,435
0
10,000,000
20,000,000
30,000,000
40,000,000
50,000,000
60,000,000
70,000,000
Q2 2013 Q3 2013 Q4 2013 Q1 2014 Q3 2014 Q4 2014 Q1 2015 Q3 2015
Number of Send and Receive Direct Transactions to/from Trusted Endpoints
40
Increase of 30 million transactions from Q1-Q3 2015
www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036
Interoperability Matrix
41
DirectTrust Accredited Bundle Interoperability Benchmarking Results as of 10/2/2015
Health Companion
iShare Medical
MedAllies
CernerData
MotionEMR
DirectICA
MaxMD
McKesson/Relay
MROSure-
scriptsUpdox
NY eHlth Collab
Cozeva MHIN Axesson Inpriva Nitor Glenwood Systems SES Medicity
Athena-health
CareAccord
CernerMobileMD
eClinicalDirect
IODRocheste
r RHIOOrion Health
NextGen (Mirth)
Truven Health Anltcs
Covisint OptumHealthU
nityHIXNY Shifox
Disp Support
(respond)
Interop Score
Interop % Sep. Certs (Send)
Sep. Certs (Reply)
Health Companion Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Sept Jul Sept Jul Sept Jul Jul Jul Jul Jul Sept Jul Jul Jul Jul Aug Sept Aug Jul, 6 33 97%iShare Medical Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Sept Sept Sept Jul Sept Jul Jul Jul Jul Sept Jul Jul Jul Jul Sept Jul Sept Jul Sept 33 97% Sept
MedAllies Jun Jul Jul Jun Jul Jun Jul Jul Jun Jul Jun Jul Jun Jun Jun Jun Jul Jul Jul Jul Jul Jun Jun Jul Jul Jun Jul Jul Jul Jul Aug Sept Jun Jul, 9 33 97%Cerner Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jul Jun Jun Jun Jun Jun Jul Jun Jun Jun Jun Aug Jul Jun Jun Jun Jun Jul Jul Jun Jun Sept 32 94% Aug
Data Motion Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Apr Jun Jun Jul Jun Aug Jul Jun Jun Jun Jun Aug Apr Jul Jun Sept, 16,17 32 94%EMR Direct Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jul Jun Jun Jun Jun Aug Jun Jun Jun Jun Jun Jul Jun Jun Jun Sept 32 94% Aug Aug
ICA Jun Jun Jul Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jul Jun Jul Jun Jun Jul Jul Jul Jul,19 Aug Sept 32 94%MaxMD Jul Jul Jul Jul Jul Jul Jul Aug Jul Jul Jul Sept Jul Sept Jul Aug Jul Apr Aug Jul Jun Jul Sept Sept Jul Jul Jul Jul Jul Jul Apr Sept Sept 32 94% Aug Sept
McKesson/Relay Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Aug Jul Jul Jul Jul Jul Aug Jul Jul Jul Jul Jul Jul Jul Aug Jul Aug,9,17,22,20 32 94%MRO Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Aug Jul Jul Jul Jul Jul Jul Jul Jul Sept 32 94%
Sure-scripts Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Aug Jun Jun Jul Sept Jun Aug Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Aug Jun Sept Aug Sept 32 94%Updox Jun Jun Jun Jun Jun Jun Jun Jun Aug Jun Jun Jun Jun Jun Jun Aug Jun Aug Aug Jun Jun Jun Aug Aug Jun Jun Jun Jun Aug Aug Jun Sept,13 Aug Sept 32 94%
NY eHlth Collab Jun Jul Jul Aug Jul Jul Jul Jul Jul Jul Aug Jun Aug Aug Aug Jul Jul Jun Aug Jun Jun Aug Jul Jul Sept Jul Aug Aug Sept Aug Aug Sept,12,9 31 91%Cozeva Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Sept,13 Jul Jun Jun Jun Jun Sept,13 Jul Jun Jun Jun Jun Jul Jul Jun Sept Oct,13 Aug 30 88%MHIN Aug Aug Aug Aug Sept Aug Aug Aug Aug Aug Aug Aug Aug Aug Aug Aug Aug Aug Aug Aug Aug Aug Sept Aug Aug Sept Aug Aug Sept, 2 Aug Aug Sept, 9 30 88%
Axesson Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Sept Jul Jul Jul Jul Jul Jul Jul Aug 28 82%Inpriva Jul Jun Jun Jun Jun Jul Jun Jun Jun Jul Jun Jun Jun Jun Jun Jul Jun Jul Jun Jul Jun Jun Jun Jun Jun Jun Jun Jun Sept,9,12,23,24 28 82%Nitor Jul Sept Jul Jun Jun Jun Jun Jul Jul Jul Jun Jun Jul Jun Jul Jul Jun Sept, 2 Jun Aug Jul Jun Aug Jul Jul Jul Jul Aug Sept, 2 Jul Sept, 14 28 82%
Glenwood Systems Sept Sept Sept Sept Sept Sept Sept Sept Sept Sept Sept Sept Sept Sept Sept Sept Sept Sept Sept Sept Oct Sept Sept Sept Sept Sept Aug Sept 9,22 27 79%SES Jun Jul Jun Jun Aug,13 Jun Jun Sept Jun Jun Jul Jun Jun Jun Sept Jul Jun Jun Sept Jun Jun Sept Aug 2,13 Jun Jul Sept Sept Sept Jul,13 Aug,13 Sept,13 Sept,13 Aug Sept,16,17,22 27 79%
Medicity Oct, 2 Oct Oct Oct Oct Oct Oct Oct Oct Oct Oct Oct Oct Oct Oct Oct Oct Oct Oct, 2 Oct Oct Oct Oct, 2 Oct, 2 Oct Oct Oct Oct Sept Oct,1,2 Sept Aug, 16 26 76%Athena-health Jul Jul Jul Jul Aug Jul Jul Aug Jul Jul Jul Jul Jul Sept Jul Jul Jul Jun Jul Sept Jul Jul Aug Jul Jul,6,9 24 71%
CareAccord Jul Jul Jul,13 Jul Jul Jul Jul Jul Aug,13 Jul Jul Jul Jul Jul Jul Jul Jul Jul Sept Sept Jul Jul,2 Aug,13 Jul, 13 Jul Jul Jul Jul Jul Jul,1,13 Aug2,13, Jul,13 Sept 24 71%CernerMobileMD Aug Aug Aug Aug Aug Aug Aug Sept Aug Aug Aug Aug Aug Sept Sept Sept,13 Aug Sept Aug Aug Aug Aug Sept Aug Aug Sept, 16,17,24 24 71% Sept
eClinicalDirect Jun Jul Jul Jul Jul Jul, 18 Jul Aug Jul Aug Jun Jul, 2 Jun Jul Jul Jun Aug Jun Jul Jun Jul Jul Jul Jul Jul Sept 17, 20,9,23 24 71%IOD Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul, 9 24 71%
Rochester RHIO Sept Sept Sept Sept Sept Sept Sept Sept Sept Sept Sept Sept Sept Sept Sept Jan Sept,13 Sept Sept,13 Jan Sept Sept Sept Sept,13 Sept Sept Sept Jan Sept Sept,13 Jul, 15 23 68%Orion Health Aug Sept Aug Aug Sept,13 Aug Aug Aug Sept,13 Aug Aug Aug Aug Aug Aug Aug Sept Aug Sept,13 Aug Aug Sept,13 Sept,13 Aug Aug Aug Sept,13 Sept,13 Sept 21 62%
NextGen (Mirth) Aug,2 Aug,2 Aug Aug Aug Aug Aug Aug Aug,13 Aug Aug Aug Aug Aug Jan Aug Aug Aug Sept Aug,13 Aug Aug Aug Aug Aug,2 Sept Aug,2 Aug,13 Jan Aug,13 Sept 20 59%Truven Health Anltcs Aug Aug Aug Aug Aug Aug Aug Aug Aug Aug Sept 22,17 10 29%
Covisint Sept Sept Sept Sept Sept Sept Sept Sept Sept Sept Aug, 12,16 9 26%Optum Aug Aug,9,20 1 3%
HealthUnity Sept, 16,12,25 0 0%HIXNY Sept 17,16,22,23 0 0%Shifox Sept, 14 0 0%
Interop Testing Bundle (Test PKI)
Accredited Bundle Results Summary
Sender
www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036
HIMSS Survey shows Direct exchange now mainstream
Current market view of the usage, value and future of Direct Messaging
Themes from the survey results: • substantial use of Direct in support of care coordination use cases, • broad availability to a provider directory but great variability in the method of
access, • continued challenges incorporating structured data into the EHR, • extensive membership [of provider organizations] in a HISP, • some knowledge of the availability of Direct messaging among the clinician
community, and • that most participating organizations support Direct as the method choice for
exchanging data.
42
www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036
Contact Information
David C. Kibbe MD, President and CEO DirectTrust.org David.Kibbe@DirectTrust.org kibbedavid@mac.com admin@directtrust.org 913.205.7968
www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036
Short lexicon of terms
Health Information Service Provider, HISP An entity or service providing its subscribers Direct accounts, addresses and secure, encrypted exchange of messages between users within the same domain, and also with users in different domains, that is, who are subscribers of different HISPs. It is typically also the responsibility for a HISP to arrange for its subscribers’ identity proofing and verification (the Registration Authority function) and for its subscribers’ digital certificate issuance and management (the Certificate Authority function). HISPs may be organized along several different business models. For example, an EHR technology vendor may operate a HISP internally for its customers. A so-called “full service” HISP may operate a stand alone business, and partner with several EHRs as well as offer its Direct services through a web portal or other set of tools and devices.
www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036
Short lexicon of terms Direct Project A public-private sector initiative sponsored and run by ONC whose aim was to create a simple, secure, and open standard for transport of messages and attachments between health care participants over the Internet, regardless of end-user technology. Direct Standard The outcome of the Direct Project. A set of protocols and specifications, along with a security and trust architecture, for simple, secure, inter-vendor communications over the Internet for use by health care professionals and patients. Direct Message Exchange Use or deployment by individuals or entities of health information exchange utilizing the Direct standard. Also sometimes referred to as Directed “push” exchange, Direct exchange. Direct User or Subscriber An organization or an individual that participates in sending and receiving messages and attachments using technology equipped to do so, e.g. an EHR or a web portal, via the Direct standard, and who has the authority to do so.
www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036
Short lexicon of terms Direct Project A public-private sector initiative sponsored and run by ONC whose aim was to create a simple, secure, and open standard for transport of messages and attachments between health care participants over the Internet, regardless of end-user technology. Direct Standard The outcome of the Direct Project. A set of protocols and specifications, along with a security and trust architecture, for simple, secure, inter-vendor communications over the Internet for use by health care professionals and patients. Direct Message Exchange Use or deployment by individuals or entities of health information exchange utilizing the Direct standard. Also sometimes referred to as Directed “push” exchange, Direct exchange. Direct User or Subscriber An organization or an individual that participates in sending and receiving messages and attachments using technology equipped to do so, e.g. an EHR or a web portal, via the Direct standard, and who has the authority to do so.
Questions?
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