Communications, Connected Care and DIRECT?

It's time to re-visit the topic of the Direct Project, or simply DIRECT. We opened this discussion back in February under our series, "Acronyms of Change". (See Archives, February 2012, Part 4A and 4B dated Feb. 20th and 22nd.) At EMRlogic, we're now fully engaged with DIRECT. The rubber is meeting the road among eye care providers.

What is DIRECT? 

DIRECT is a national communications standard created by the Office of the National Coordinator for Health Information Technology. The standard describes secure transmission protocols for exchanging patient health information. DIRECT also verifies the identity of both the sender and the recipient. It is the standard approved and required for all state Health Information Exchanges as a common method that providers can use to communicate securely between health care facilities whether within the state or across state boundaries.

What software is required?

The secure transmission protocols contained in DIRECT are used by software vendors to create end-user solutions which, in turn, can be incorporated into functional applications.  These software applications are distributed by certified companies and organizations in several formats:

• a web portal (e.g. webmail) 
• an email client (e.g. Outlook)  
• a software integration (e.g. an API for certified EHRs)  

A certified organization is referred to as a Health Information Service Provider (HISP). Typically, HISPs sell the application as an annual per-provider license fee. When information is exchanged between providers using different HISPs, the transfer is referred to as a HISP-HISP exchange.

How do I connect to DIRECT?

Some HISPs distribute their Direct-enabled applications in a particular region or state while others do so throughout the country. Your state HIE office can provide information on the HISPs approved in your state but be sure also to check with your EHR vendor. As noted above, EHRs integrations are available and can only be implemented through a direct partnership between the HISP and the EHRs vendor. Integrations represent the highest level of communication between two EHRs and are required on both ends in order for the patient health information to be consumed into the receiving EHR.

The National Eye Care Communications Project is working in partnership with Secure Exchange Solutions (SES) and can help arrange a software installation at your office. 

How clinically complicated is the process?

You will likely find that communicating with other health care practices through DIRECT is easier than your current methods. DIRECT is simple and intuitive and, in addition, will maintain a log of your communications and provide completely secure exchange capabilities.  

DIRECT is content agnostic. This means the focus is on secure transmission regardless of the contents. DIRECT does not know what is being transmitted and has no interaction whatsoever with what is sent. Your EHR will create a communication of some type, e.g. a CCD, Summary of Care or consult. Depending on the type, the system may automatically associate the file with a folder read by the DIRECT software, or you may manually attach the file created by your EHR. Next, you will use the directory built into DIRECT to find the office to which you want to send the information, select and send. 

The DIRECT software does the encryption, applies the required certificate, and password protects the communications package. DIRECT sends your “package” through a secure internet connection and, at the receiving end, verifies that the receiving office is who they are supposed to be. Once verified, DIRECT decrypts and unlocks the communications package so it can be either humanly read, or consumed into the receiving EHR system.  


Alistair Jackson, M.Ed.