Direct Messaging: How to Use This Service

Three years ago, you couldn't avoid articles on Direct Messaging.  Practices were reaching out to other practices to obtain the 'Direct Address' of each provider, as most of us lemmings jumped through another hoop to achieve Meaningful Use (MU).  Indeed, using Direct Messaging to exchange a summary of care record with a provider using another EHR was a Meaningful Use Stage 2 requirement. 

Direct Messaging does not get the airplay it did three years ago, yet it remains part of the government's plans under the Merit-based Incentive Plan System (MIPS), the replacement program for Physician Quality Reporting System (PQRS) and MU. This year is a transition year between MU/PQRS and MIPS and the requirements for Direct Messaging and other measures are watered down.  This will not be the case going forward.

Direct Messaging remains the government's preferred mechanism for the secure exchange of health information between healthcare entities.  I believe the requirements for its use will increase given the government's emphasis on improving healthcare via better coordination of care.  I also hope that payers will be required to adopt Direct Messaging, as it holds potential for making 'back office' processes more efficient. 

What is Direct Messaging?

Direct Messaging is a technical standard for securely exchanging health information between physicians, hospitals, labs, and other healthcare providers.  It functions just like e-mail but meets the rigid privacy and security measures of HIPAA.  Messages are encrypted, unlike standard e-mail.  End-user identify confirmation is strict.  It's nothing less than each of us would want if we were sending our personal secrets to someone else across the internet.  And unlike our personal and often work e-mails, your inbox will not be filled with garbage.  Direct Messaging is an option only if both the sender and the receiver are amenable to sharing the information. 

Each provider has a distinct Direct Address (e.g., DrJones@Direct.JonesFamilyPractice.com).  Direct Addresses are obtained from your EHR vendor, a Health Information Exchange (HIE), or another certified entity with Direct Messaging capability.  For my practice, our Direct Addresses were obtained from our EHR vendor, and we reached out to other practices to obtain their Direct Addresses.  Messages containing Summary of Care records, procedure reports, and such are sent via Direct Messaging through our EHR.  You can set up Direct Addresses for both individuals and certain processes (e.g., Referrals@Direct.JonesFamilyPractice.com or LabResults@Direct.JonesFamilyPractice.com). 

Uses for Direct Messaging

Direct Messaging goes beyond an e-mail or fax in the ability for information to be pulled directly into one's EHR.   It permits not just the exchange of health information between different systems - all using the same technical standards of Direct Messaging - it allows for this information to be 'shared.'  The tedious reentering of health information by you and your staff could disappear. 

One of the more difficult facets of patient care, particularly for less healthy patients, is ongoing medication reconciliation.  Updating a patient's active medications, using the discharge summary from the hospital or the summary of care report from another physician, can be as simple as accepting the information into the patient's record.  Similarly, reconciling/updating a patient's active problem list, procedure history, or lab results can be more efficient.

Finally, one frustration I hear from primary-care physicians is that they do not know when their patients have been in the hospital.  They cannot manage patient care in such a void.  Direct Messaging could be used, though, to alert a doctor when one of her patients was discharged from the hospital or seen in the ED.  

Direct Messaging is here to stay.  If you have not adopted it in your practice, I urge you to use this transition year to embrace it.  For those that have it in place, look for ways to use Direct Messaging to make your practice efficient.  It is good for both our practices and our patients.

Lucien W. Roberts, III, MHA, FACMPE, is administrator of Gastrointestinal Specialists, Inc., a 25-provider practice in Central Virginia. For the past twenty years, he has worked in and consulted with physician practices in areas such as compliance, physician compensation, negotiations, strategic planning, and billing/collections. He may be reached at muletick@gmail.com.