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New Use Cases for Direct Secure Messaging

Overview of Direct Secure Messaging
Direct Secure Messaging (DSM), also known as Direct Exchange or Direct, is a method to securely exchange patient records between healthcare organizations through a Health Internet Service Provider (HISP). DSM uses digital certificates and Public Key Infrastructure (PKI) to encrypt messages, ensuring only intended recipients may access the contents of a message.

Direct Secure Messaging was created in 2010, and its most recent adoption across the medical community has been in part due to legislation such as the Office of National Coordinator’s 21stCentury Cures act and the CMS Interoperability and Patient Access final rule. These rulings have required hospitals and medical centers to provide patients with electronic access to their medical records at no cost as well as improve patient data exchange throughout the care continuum. These regulations benefit both patients and healthcare providers alike, improving access to information and may enable care providers to make more informed decisions, leading to improved patient outcomes.

Compared to more traditional methods of patient information exchange such as fax or phone, DSM is a great improvement on the security and timeliness of data exchanges, turning processes that would normally take several weeks into a matter of hours. It is especially effective for referrals from a Primary Care Physician to a specialist such as a Cardiologist.

Current Use Cases
Historically DSM has had a number of use cases including admissions, discharges, and transfer messaging (also known as event notifications/event reporting); communications of transitions of care; clinical summaries; and e-prescribing. Direct gained several new use cases during the Covid-19 Pandemic, allowing health organizations such as hospitals, primary-care providers, pharmacies, and regional health departments to respond in a timely manner to Covid case reporting and vaccination requirements.

New Use Cases
In the post pandemic world, healthcare providers are continuing to find new uses for DSM. In a recent interorganizational effort between the VA and the National Cancer Institute (NCI), health professionals identified and improved outcomes for patients who indicated a desire to quit smoking. By quickly and securely transmitting patient information between the two organizations, professionals from NCI were able to provide additional support and outreach to patients, improving the rate at which patients successfully stopped smoking.

The VA Medical Center’s Gastro-Intestinal Clinic has made use of DSM for their referral and request processes. This has reduced the time required for clinical data transmission from a PCP to a specialist from over two weeks to less than twenty-four hours. This enables patients to get in to see a specialist faster as their patient records will have arrived two weeks earlier.

DSM Adoption Processes
DSM is gaining traction in interoperability efforts across the healthcare continuum. However, many vendor-designed DSM systems only adhere to the minimum requirements of the Medicare EHR Incentive Program (Meaningful Use), leading to inconsistent capabilities among partnering organizations. Not all DSM systems have the capacity for bi-directional exchange as some organizations are only able to send documents while others are only able to receive. Disparity among document types that can be processed by partner organizations also poses problems for interoperability with some DSM systems unable to send or receive certain file types (PDF, Word, JPG, etc.). Because each healthcare organization has its own method of DSM implementation, unique approaches must be applied on a case-by-case basis, further challenging interoperability.

We interviewed DSM expert Angela Richarte, a J P Systems Senior Healthcare IT DSM Specialist. Angela expressed an optimistic future for Direct’s future role in interoperability, explaining that increased consistency in partner ability and referral workflows would improve Direct’s ability to facilitate data exchange. Ms. Richarte stated, “Effective DSM implementation is about the right people getting the right information at the right time. …We’ve come a long way but have a long way to go. Direct has proven its ability to send and receive messages, it is time to start thinking beyond the traditional use case and start using it in a more meaningful way.”

How J P Systems Can Help
If a provider is not sure if they have DSM or how to use it, J P Systems can conduct an analysis of their EHR system and ascertain if DSM is already available to them. If not, we will propose a cost-efficient enhancement to implement DSM. Our DSM consultants can prescribe how the system can leverage DSM and eliminate faxes which are not secure. We will examine your workflows and identify where improvements can be made.