August 2017

Building on Direct: Improving interoperability and patient data exchange

From evolving standards and regulations, to the need for higher quality and more patient-centric care, many factors are fueling the adoption of technology that drives interoperability. Direct Messaging is just one example that shows how interoperability and patient data exchange are not only possible, but are happening more today than ever before. Though there have been great strides made in nationwide connectivity and data exchange, significant barriers still exist when it comes to easily sharing information across disparate platforms and sources.

What is Direct?

The Direct standard was developed in 2010 by a public-private collaboration led by the Office of the National Coordinator for Health IT (ONC). Direct is part of a long term national strategy to transition from paper-based to electronic health records that can be easily shared to reduce costs and improve care quality. At its core, Direct gives providers a trusted, secure way to exchange patient information across all points of care.

As a founding member of DirectTrust, a collaborative non-profit organization that supports secure, interoperable health information exchange via the Direct message protocols, Surescripts helped establish a trust framework that makes it easy for care providers, technology vendors, and patients to communicate easily and securely. Today, DirectTrust is focused on further improving the integration of Direct into provider workflows to ensure more consistency and usability of EHRs and recently published a whitepaper outlining more than 50 feature and function recommendations.

How is Direct helping overcome these interoperability challenges?

Using Direct Messaging, providers send and receive patient data – or, actionable intelligence – they need to make the smartest care decisions possible. And because Direct capabilities are integrated into existing EHR systems and provider workflows, caregivers can seamlessly send and receive information where and when they need it most, without taking time or attention away from their patients. DirectTrust has had an enormous impact on interoperability and will play a significant role going forward. DirectTrust will enhance its services and lead the industry as ONC develops and supports an interoperability framework and common agreement. 

What is Surescripts doing to make holistic patient data sharing a reality through tools like Direct Messaging?

There has been a recent surge in Direct Messaging use due in part to its ability to help providers easily meet current and future regulatory standards, including Meaningful Use and the Quality Payment Program’s Merit-based Incentive Payment System (MIPS). In 2017, 25 percent of an eligible clinician's MIPS performance comes from the advancing care information category.

Direct’s connectivity and overall ease of implementation is a key factor driving its record adoption to date. There were 98 million Direct message transactions sent industry-wide in 2016 alone. Surescripts facilitated nearly 30 million of those clinical messages. In addition:

  • 96% of hospital physicians have a Direct-enabled EHR as of the end of 2016 (source: ONC).
  • 78% of office physicians have a Direct-enabled EHR as of the end of 2016 (source: ONC).
  • The volume of clinical messages in the first quarter of 2017 increased 76% over the same time period in 2016 (source: Surescripts).

To truly reap Direct’s benefits, accurate and timely data must be at the foundation, and this includes an updated provider directory. With Surescripts accounting for 35 percent of the health information service provider (HISP) market, our unmatched footprint means we have the expertise to create the highest-quality provider directory by proactively scrubbing for errors and eliminating poor quality data.

What role does security play in Direct?

Security is the foundation of both DirectTrust and Direct, and has been core to Surescripts since its founding in 2001. Because Surescripts plays a critical role connecting federal entities such as the U.S. Department of Veterans Affairs, we take this responsibility seriously and have made significant investments in network security. In fact, Surescripts is just one of only 105 companies in the United States certified for the highest level of information security. Other security certifications and accreditations include the Electronic Healthcare Network Accreditation Commission (EHNAC) and WebTrust.

What’s next for Direct?

In June of this year, ONC released a new health IT interoperability benchmarking tool, the “One Click Scorecard,” to help improve the accuracy and portability of patient information commonly shared via Direct. As described by ONC’s director of the Office of Standards and Government, Steven Posnack, the Scorecard “is the health IT equivalent of an internet speed test and is specially designed with health care providers in mind – to give them visibility into the quality of the Consolidated Clinical Document Architecture (C-CDA) their health IT generates.”

But meeting Meaningful Use or MIPS criteria and interoperability scorecards are only small use cases and a sliver of how Direct protocols and Direct Messaging can be used to improve care and drive interoperability. Once enabled, the foundation that the Direct standard provides, paired with the quality of information and size of the Surescripts network, opens the door to many other ways that the technology can be used to arm caregivers with the data that they need. For instance:

  • Many patient information sharing challenges exist when patients move from one care location to another. These transitions of care represent one area that can use Direct to improve coordination and lower costs for more efficient, safer patient care.
  • Direct is also improving connectivity and communication between physicians and pharmacists in order to eliminate inefficient and burdensome phone calls and faxes, so they can stay focused on their patients.

Ultimately, information must be accessible across care settings for providers to make the best care decisions possible. Direct Messaging is one way that the power of Surescripts’ network is being scaled to achieve interoperability and meet some of the most-pressing challenges today -- arming caregivers with the actionable intelligence required to make optimal decisions in a value-based, quality-centric world.

To learn more about our efforts to advance standards and technology that support interoperability, please join us at Beyond Boundaries: ONC’s 2017 Technical Interoperability Forum. Surescripts is participating in a panel discussion on Interoperability Networks and Nationwide Infrastructure on August 15 from 1:30-3:00 p.m. ET.

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