Software Solutions/EHR

Direct Messaging: Communicate Securely with Other Healthcare Providers

By Michael J. Lyons, OD, FAAO


Establishing protocols for direct messaging to other healthcare providers meets Meaningful Use 2 requirements and facilitates team-based patient treatment.


USE DIRECT MESSAGING TO MEET MU 2. Sharing patient information with other healthcare providers via a secure electronic system is an MU 2 requirement.
CALCULATE COST. Eligible physicianswill spend an estimated $48,000-$58,000 over the next five years to meet MU requirements; about 5 percent of that cost should be devoted to communications like direct messaging.
APPLY DIRECT MESSAGING TO PATIENT CARE. Your patient’s cataract surgeon will be electronically updated with pre-op exam findings and you will electronically receive reports about the surgery.

I have a goal for the next year: to establish secure messaging with other healthcare providers through a free, government-provided software called Direct Secure Messaging. Known simply as “Direct,” this software, which is also available via an online download, is already a part of most EHR systems. All independent ODsshould have the same goal as it is a required part of Meaningful Use 2, and doing so will provide better patient care.

This communication will replace our conventional way of sending reports to other offices, which is currently done via a secured fax line or mail. Direct is a federal initiative messaging system designed for healthcare communications. It utilizes an encrypted, e-mail-like platform to provide standard, secure messages. When a message is sent through Direct, the content is protected via the encryption.

An important project taking effect in seven major markets nationwide, including the Greater Cincinnati Region, where my practice is located, is known as the Comprehensive Primary Care Initiative. This project launched in 2012 and involves only primary care physicians that applied and met the necessary requirements for enrollment. The project is evaluating the delivery model of primary health care, including the electronic communication between physicians in different health care systems.

Learn More About Direct Secure Messaging

Click HERE to learn more about Direct, a free software from the federal government. All healthcare providers using this messaging software will be able to share information about patients with greater ease, seamlessly importing patient data into one another’s EHR systems.

Use Direct Secure Messaging to Meet Meaningful Use Requirements

Direct Secure Messaging is part of Stage 2 of Meaningful Use. MU is defined as using certified electronic health record (EHR) technology to:

• Improve quality, safety and efficiency, and reduce health disparities

  • Engage patients and family

    Improve care coordination and public health

  • Maintain privacy and security of patient information

In order for a health care system to safely and efficiently manage a person’s health, information must be exchanged quickly in a secured manner. For the independent, this is where Direct fits in.

Direct Secure Messaging Part of Overall MU Cost

Setting up Direct can be considered part of the overall cost of meeting MU requirements. The Centers for Medicare and Medicaid Services (CMS) estimated that the five-year cost to adopt MU ranges from $48,000-58,000 per physician. This cost includes hardware, EHR software, implementation assistance, training and ongoing network fees and maintenance. Approximately 5 percent of the total cost required to meet MU standards goes toward meeting related communication needs, such as setting up Direct and ongoing yearly maintenance fees. Some EHR vendors have Direct built into the software, whereas others will depend on a third-party solution.

Learn More About Consolidated Clinical Document Architecture (C-CDA)

Click HERE to download a PDF from the federal government on Consolidated Document Architecture (C-CDA), an IT standard that specifies the computer encoding and structure of clinical documents. Working with your EHR provider to ensure your EHR’s documents are created using this standard computer system will help you more easily share information with other healthcare providers through Direct Secure Messaging.

Apply Direct Secure Messaging to Patient Care

Here are two hypothetical examples of how a Direct Link can help an OD:

Cataract referral. Dr. Foreyes has a patient who she needs to refer for cataract surgery. The current procedure is to generate a note, either utilizing EHR or by standard dictation, and sending that note via mail or secured fax. With Direct, the information will be sent electronically, instantly updating the cataract surgeon of the referral. More importantly, when using a standardized format, such as a Consolidated Clinical Document Architecture (C-CDA), that surgeon’s office will have the capability of instantaneously creating a chart while automatically populating all of the demographics and diagnosis list.

Post-op care. Likewise, when the patient in example number one has completed the surgery and post-op care by the surgeon, an update will be sent back to the OD via Direct. This update, also in C-CDA format, will be used to instantaneously update the chart with the diagnosis, operative dates and outcome.

Meet Direct Link Challenges

The largest challenge that I’ve encountered is the standardization of the data that is sent from EHR System A to EHR System B. For Direct Link to work, the data must be sent and “absorbed” into the EHR. Meaning, if I had sent health information in form of a CCD (Continuity of Care Document) to an outside office in 2012, this information was viewable, but not necessarily upload-able.
I had the opportunity to do tests with ODs in 2012 and 2013 who had the same EHR system as myself. By transporting a CCD via Direct Link, not only could we pass along viewable health information on the patient, but the EHR was automatically uploaded and updated with the new information. Going back to the surgery example: If I referred a patient out, the receiving surgeon’s EHR would automatically create a new patient file (if the patient was new to the practice) and update all the demographics, medications and allergies from my CCD. And if the patient had surgery on September 1, 2013, and I received a CCD from the doctor with that information on the report, my EHR would automatically have added the event in my records. This is efficient health care! But this automated process is hindered when healthcare providers have different EHR systems.

In Stage 2 of MU, we are now required to use C-CDA format (Consolidated-Clinical Document Architecture) for our CCD exchange. This is very exciting since the C-CDA standardizes the format of the CCD, and any additional data needed, making it readable and absorbable regardless of the brand of EHR. This is the driving force of Meaningful Use and a necessity for independent eyecare practitioners.

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Michael J. Lyon, OD, FAAO, is the owner of Focal Pointe Eye Care in West Chester, Ohio. To contact:

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