How the Direct Project Helps Physicians Exchange Information Securely


The ability to securely communicate ePHI to any provider at any other medical practice or hospital with any EHR may not be as far off as you think.

Just this month, I attended my EHR vendor's user conference and, at the closing session, the CEO showed a demonstration of how Direct e-mail is integrated into their software.

Not sure what Direct e-mail is? Neither was I. In the week since viewing the demonstration, I’ve been searching for information on Direct and, surprisingly, it hasn’t been easy to find. But now that I know about it, it’s like Christmas and my birthday all wrapped into one. It is the electronic protected health information (ePHI) sharing dream! Let me share what I’ve learned.

Direct e-mail enables providers to securely send and receive structured ePHI to and from different EHR systems. Think of it: No printing, no faxing, and no expensive, regulation-heavy intermediaries like my state’s dreaded Massachusetts HIWay. Direct is amazing. It all started in 2011 when the Office of the National Coordinator for Health Information Technology (ONC) announced the Direct Project. To learn more, I highly recommend viewing this 48-minute video from the (ONC) explaining the technology.

As I write, I can already hear those critics out there who “don’t want another standard forced on the industry.” Our small, micropractice (currently we have 727 patients and a grand total of four full-time employees including the solo pediatrician), and other small practices like us, needs enforced standards to survive.

Case in point: the CAQH/CORE Operating Rules for the Health Care EFT and ERA Standard Transactions implemented in January. Because of this rule, in 2014 our electronic funds transfer (EFT) rate has jumped from 65 percent to almost 99 percent. This has significantly lowered our costs and increased our cash flow enabling us to continue to deliver the high-quality care that we believe can only be delivered by a small medical home like ours.

So here’s my pitch to all of you: Get on the Direct e-mail bus! It may help you satisfy the Stage 2 requirement that more than 10 percent of summary care records provided for transitions of care and referrals are electronically transmitted.
According to CMS, an EP may use three different approaches to satisfy the requirement. One of the approaches relates to the Direct Project. Here’s a quote from CMS on the topic:

"As required by ONC to meet the CEHRT definition, every EP, eligible hospital, and CAH, must have EHR technology that is capable of electronically transmitting a summary care record for transitions of care and referrals according to the primary Direct Project specification (the Applicability Statement for Secure Health Transport).  Thus, EPs, eligible hospitals, or CAHs that electronically transmit summary care records using their CEHRT’s 'Direct' capability (natively or combined with an intermediary) would be able to count all such electronic transmissions in their numerator."

Unfortunately, providers not participating in meaningful use don’t have to use Direct e-mail. My hope, though, is that those of us using Direct e-mail will encourage our colleagues to get on board to lower all of our costs and enable us to provide the best possible care for our patients. To be able to securely communicate ePHI to any provider, is for this nerdy practice administrator, a dream come true!

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