Direct messaging finding stride, despite hurdles

Direct messaging finding stride, despite hurdles

‘Growth is continuing, and I expect it to continue, but it does feel that it’s been an uphill struggle, at times’

The 2015 Direct Messaging Survey published this week by HIMSS shows growing use and appreciation for the secure, email-like method of data exchange. But there are still challenges to be ironed out – related to technology standards, cost and workflow – before it sees broader acceptance.

The Direct Project, shepherded along by the Office of the National Coordinator for Health IT with collaboration with some 50 or so health IT vendors, went live with pilot projects back in 2011. At the time, then-ONC chief Farzad Mostashari, MD, called it “a new way of doing business.”

Billed as a simple, secure, scalable way to transfer clinicial data between two parties, Direct was touted as “the first technology that could really kill the fax in healthcare,” as Microsoft engineer Sean Nolan put it.

In the years since, the apprach has found favor across healthcare. But perhaps has not spread as far and wide as its creators initially hoped.

“In terms of new technology adoption, it’s been pretty fast,” says David Kibbe, MD, chief executive officer of Direct Trust, non-profit alliance of 150 or so IT and provider organizations who support Direct message protocols. “If you look at the growth of Direct over the past two years – and it’s only been three since it was available as a standard – it’s pretty astorunding. We’re now up to 40,000 healthcare organizations that are contracted for Direct exchange by one of the HISPs in Direct Trust’s network.”

There are currently 36 health information service providers enabling Direct, he adds. “That’s more than doubled in a year, and it had doubled the year before. The exponential growth is continuing, and I expect it to continue. But it does feel that it’s been an uphill struggle, at times. In a fee-for-service world, there isn’t a whole lot of incentive to exhange health information. So it’s taken a while.”

Spearheaded by the HIMSS Interoperability and HIE Committees, the 2015 Direct Messaging Survey polled hospitals, health systems, physician practies, HIEs, HISPs, ACOs, and government officials in 27 states.

The poll found substantial use of Direct in support of care coordination use cases, and broad availability to a provider directory (albeit with “great variability” in the method of access. Participants also reported continued challenges incorporating structured data into the EHR.
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