Direct Technology Overview

What is Direct Technology?

Direct Technology is a standards-based email service that allows users to securely send and receive messages and attachments. Direct Technology works with or without an electronic health record (EHR) system.

How will Direct Technology benefit me?

Direct Technology is proven to provide healthcare clinicians a simple, affordable, electronic transport solution that improves care collaboration. Using Direct Technology, physicians can easily communicate with each other, allowing clinical information to follow the patient throughout the healthcare system.

Another major benefit is helping you as a provider reach Meaningful Use Stage 2. Hospitals and clinics have used Direct Technology to streamline transitions of care by providing timely discharge summary information, as well as, referral information.

Direct Technology empowers physicians and hospitals to deliver better care with increased efficiency and lower costs. Using Direct Technology, all connected parties can securely transfer medical summaries, hospital discharge information, diagnostic tests and more. With vital information more readily available, providers deliver more efficient and effective care.

These are two examples among several ways Direct can benefit a physician office:

  • Streamlining the process of treatment authorizations for non-physician providers – home health, long-term care, therapists
  • Improving communication between members of a patient’s care team

For additional use cases and testimonials on ways Direct can potentially benefit your organization, go to www.HealtheSharetn.com and review our About page.

Who administers Direct Technology services?

Health information service providers, or HISPs. HISPs hold the security certificates for a group of Direct Technology addresses, providing users authentication, message encryption and message routing. Direct Technology addresses are only issued to those whose identity has been verified. Other organizations, such as government agencies or large healthcare organizations, may act as their own HISP. And in some cases, the provider/hospitals’ EHR itself may act as a HISP.

How is security maintained?

When a message is sent to a recipient, it is encrypted. The message is encrypted until the recipient opens the message. The moment the intended recipient opens the message, it is unencrypted. In typical situations, the message and any attachments are accessible through a web portal or from within the electronic health record (EHR) system itself. Some solutions provide for other types of message access including mobile devices or installed email clients.

How is Direct Technology different than an HIE network?

Direct Technology and Health Information Exchanges are both used to allow for the secure exchange of information. With Direct Technology, the physician can push patient information out to all appropriate parties who have a Direct address.

An HIE provides search functionality to locate patient records throughout its secure network. Participating providers can search for information about the patient they are treating, retrieve it, and incorporate it into the patient’s medical record, if they so choose.

An HIE network requires a data sharing agreement signed by all participants and some require patients to consent or opt out before their information is shared. For an HIE network to share information with another HIE network requires a legal agreement between the two, and if the HIEs are in different states, the agreement has to comply with both states’ laws.

Both Direct Technology and HIE networks enable healthcare providers to exchange data with other providers within the community. The two technologies work to ensure patient data is available at the time of care.

How is a Direct email address different from my encrypted email service that we use?

An encrypted email service from a user’s Outlook or web service is most likely secure, but has several inconveniences:

  • The sender must remember to type “encrypt” in the subject line, or click a checkbox, etc in order for the message to be encrypted;
  • The receiver must follow several links and potentially enter a password to view the message, they might even need to download a specific add-on and/or software depending on the encryption service used;
  • The message might expire depending on the encryption service used.

An encrypted email will not comply with the MU Stage 2 requirement, it must be sent using the Direct protocols. By using a Direct email address, you will have the listing of all Direct email address holders that have registered with Health eShare on our website to ensure you are securely communicating with other practices. Also, Outlook or other email is normally not integrated within your EHR and eventually most Direct Messaging portals will be integrated.

Will Direct Technology become obsolete once newer technology is introduced?

Most certified EHRs will eventually integrate Direct Technology into their EHR product. But providers that don’t participate in the EHR Incentive Program (not eligible or simply elect not to participate) or don’t have an EHR may elect/opt to use a Direct Technology product offering that provides a web-based portal interface. Either way, the functionality and underlying technology are the same.

Providers interested in adopting Direct Technology now, using a non-EHR web-based portal interface, will still find value in utilizing Direct Technology. Direct Technology gives hospitals, IDNs and clinics the ability to communicate across the continuum of care, as well as monitor the exchange of information throughout the communication process. Direct Technology provides a secure way to reply with real-time care recommendations and other clinical content—enabling better transitions of care, referral coordination and more.

Non-EHR, portal-based solutions also have a low cost of entry and deployment is relatively simple. And with incentives available through the State, generally the product costs are offset entirely.

What is the DirectTrust Transition Trust Bundle?

The DirectTrust Transition Trust Bundle intent is to provide a secure distribution mechanism for obtaining those anchors that community members trust for the purpose of Directed exchange. In order for a HISP to be a part of this bundle they must meet the following requirements:

  • The HISP, certificate authorities issuing the trust anchors, and registration authorities MUST be DirectTrust members.
  • The HISP and the DirectTrust CEO MUST have signed the federation agreement.
  • The HISP, the trust anchor’s certificate authority, and registration authorities used to validate identities MUST be listed as a DTAPP candidate on the EHNAC web site.
  • Trust anchors submitted by the HISPs must adhere to the DirectTrust X.509 Certificate Policy, Draft for Trial Use, or more recent versions.
    • An equivalent or more comprehensive Certificate Policy may be acceptable for use, pending approval by the Trust Anchor Approval Committee.
  • Trust anchors MUST be issued by CAs that issue certificates used in Directed exchange and chain down to end-entity certificates of that type only.

For more information on DirectTrust, Trust Bundles, and their Transition Trust Bundle please visit: http://www.directtrust.org/

Direct Technology Implementation

Will Direct Technology work within my EHR?

Yes, there are a number of ways that Direct Technology can be integrated within an EHR. Direct Technology is a nationally recognized, open source standard that could be integrated into any EHR system – although extra costs may be associated as well as extra processes and workflow configurations.

We anticipate that many EHRs will be including Direct Technology in their product roadmaps. EHR vendors have different plans and timelines for integrating Direct Technology into their products and services. Beginning in 2014, eligible hospitals (EHs) and professionals (EPs) must use Certified EHR Technology (CEHRT) that meets the Meaningful Use Stage 2 base EHR definition. CEHRT requires EHRs to possess certain key capabilities, among them, the capability to exchange electronic health information, and integrate such information from other sources in accordance with Direct Technology.

For information about your EHR vendor’s plans for Direct Technology, please contact your vendor directly.

What kind of IS support will I need to implement Direct Technology?

In most instances, you will not need IS support. If Direct Technology is completely integrated into your EHR, service and support would be covered under your standard vendor services agreement. For standalone HISP service providers, or a web-based portal product, the HISP vendor providing the Direct Technology email account typically offers a technical support phone number.

For non-IS support, such as information on how to standardize workflow using Direct Technology, using the system to enhance efficiency or looking for meaningful use cases and providers using Direct Technology in your area, contact us at www.HealtheshareTN.com

Can I maintain more than one Direct Technology account?

Individual users may obtain more than one Direct Technology address. A physician might have one address for their practice office and another in the hospital where they see patients.

Who in my office should have a Direct Technology email account?

The need for an address is completely driven by how your office will use Direct Technology. Typically, anyone responsible for sending and receiving patient health information will likely need a Direct Technology email account. There is no standard protocol for this, as every practice workflow is unique. Your practice should review your current process to see who receives and transmits information electronically now (via FAX), who has a need to review the patient’s clinical information (referrals in particular), and who is responsible for documentation within the patient clinical record. In most offices, this includes nearly all medical, clinical and administrative staff.

Can my office administrator view my account and print or save files on my behalf to patient records?

Most Direct Technology vendors allow you to grant permission for someone other than yourself to access and view your messages on your behalf. This person may be set up as a “proxy” for multiple accounts. An Administrator with proxy rights can view an account and print or save the files. Information forwarded by someone with proxy rights, however, most HISP solutions will identify the proxy user and not the primary address holder as the sender.

Other office and clinical staff may also be granted this permission. For example, a nurse practitioner, on behalf of several physicians in a practice, may review referral information, test results or labs. The nurse practitioner may then notify the physician via Direct Technology and the physician may reply with real-time care recommendations and other clinical content—enabling better transitions of care, and referral coordination.

You will need to check with the vendor to verify the availability of proxy functionality.

Will I be able to communicate with providers outside of the State of Tennessee?

Yes, launched in March 2010 as a part of the Nationwide Health Information Network, the Direct Technology Project was created to specify a simple, secure, scalable, standards-based way for participants to send authenticated, encrypted health information directly to known, trusted recipients over the Internet.

Can I access the email on my smartphone?

Some HISP solutions will provide message access including mobile devices or installed email clients. Please check with the HISP vendor as to their current or future capabilities.

Can pharmacies participate?

Yes, pharmacies may participate and qualify for the incentive program as well. Use cases for pharmacies and Direct Technology messaging have been established to send medication therapy management consult information to the ordering provider.

Direct Technology does not place limits on who can participate in patient information exchange. Anyone requiring access to patient information exchange today can incorporate Direct Technology into their workflow.

How do I sign up for Direct Technology?

Review the vendor information listed under the tab on the www.HealtheShareTN.com website and determine which vendor you feel would be suitable for your organization. Contact information and a link to respective vendor websites are listed. You may also call 615-507-6404 for additional information.

Direct Technology Implementation Costs

How much does Direct Technology cost?

Prices for Direct Technology vary from vendor to vendor. Pricing information for vendors are available at www.HealtheshareTN.com