MU2 and Direct Messaging, Part 1.

In today’s and next day’s post, I would like to highlight some of the MU Stage 2 Rules that specifically concern Direct Messaging. To give due credit, the information that follows comes from John Halamka’s blog on August 23, 2012. Dr. Halamka, in turn, is commenting on the MU Stage 2 Final Rule. I’ll be picking out only the Direct Messaging items, so if you want a bigger picture, please use the link provided to go to Halamka’s blog.

SMTP is the required transport standard for all certified EHRs and has been included in the Base EHR definition, meaning that all EHR technology used by EPs, EHs, and CAHs and that meets the CEHRT definition will, at a minimum, be capable of SMTP-based exchange.

The SMTP standard is what mainly interests Health Information Exchanges. It’s not our primary interest today but sets the stage for the emerging importance of “transport”, which we also refer to as exchange or communications. As we have stated in our 5-phase continuum, we move from a stage 1 focus on EHRs to a stage 2 focus on communications.

There are two optional approaches for the transitions of care certification criteria SMTP/XDR and XDR/SOAP. The specific language reads, "The Secretary adopts the following transport standards: (a) Standard. ONC Applicability Statement for Secure Health Transport (incorporated by reference in § 170.299).
(b) Standard. ONC XDR and XDM for Direct Messaging Specification (incorporated by reference in § 170.299). (c) Standard. ONC Transport and Security Specification (incorporated by reference in § 170.299).

Today, I want to focus on (b) ONC XDR and XDM for Direct Messaging Specification. Note in the following that the ONC is providing “flexibility and options” for software vendors to help you meet the “transitions of care” MU objective. We believe this is particularly significant for independent eye care providers who need to be able to communicate both within and without health care systems. HIEs that primarily serve the interests of large health systems will neither favor nor facilitate the independent ECP. Therefore, Direct Messaging will become your friend and alibi.

To permit additional flexibility and options for EHR technology developers to provide their customers with EHR technology that has been certified to support an EP, EH, or CAH’s achievement of the “transitions of care” MU objective and associated measure, we have adopted two optional certification approaches for transport standards.     • The first option would permit EHR technology to be certified as being in compliance with our original proposal: certification to both the Applicability Statement for Secure Health Transport specification and the XDR and XDM for Direct Messaging specification.
     • The second option would permit EHR technology to be certified to: the Simple Object Access Protocol (SOAP)-Based Secure Transport Requirements Traceability Matrix (RTM) version 1.0 standard and the XDR and XDM for Direct Messaging specification."

Join me next day to read more about the applicability of Direct Messaging to two vital areas: care coordination and patient communications.

Alistair Jackson, M.Ed.