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Are you attesting for Meaningful Use 2 for Transitions of Care? Now you can electronically exchange and manage encrypted, secure patient information to and from other providers using HIPAA-compliant Direct Messaging (Direct) from the IHDE.

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As an IHDE-enrolled participant, Direct is available for your use with or without an EMR system. Direct is an effective, secure email system for use in the point-to-point exchange of sensitive,       protected health information through the trusted Direct network. Direct functions like regular email with  additional security measures and ensures that messages are only  accessible to the intended recipient.

What is Direct Messaging?

Direct enables electronic, secure, encrypted and HIPAA compliant communication between clinicians and ensures only those parties can access the communication exclusively through the Direct Trust network. Developed in 2010, Direct is governed and enabled by the Direct Trust and Direct Project organizations under part of a federal project for standards-based healthcare communications. It specifies the secure, scalable and standards-based method for the exchange of Protected Health Information (PHI).

Why do you need Direct Messaging?

To attest for Meaningful Use Stage 2 – Core Measure 17 criteria issued by the Office of the National Coordinator for Health IT (ONC), healthcare organizations and providers must meet data transfer requirements using Direct. The use of Direct is clinically important to promote transition of care between a patient’s care team involved with patient visits, helping patients manage chronic health issues, and sending/receiving referrals with other providers.

Does your organization have to enroll in the IHDE Direct Messaging service?

Enrollment in the IHDE Direct Messaging service is voluntary. If your organization is already using Direct or if you already have a Health Information Service Provider (HISP), you do not have to enroll in the IHDE Direct service. Included with the IHDE Clinical Portal license, however, is a Direct account for your organization’s use. An IHDE Direct account can be used for other communications that may not be available through your EMR vendor. IHDE also provides easy to access Directory services for other Direct-enabled participants in the Direct Trust network. And, having an EMR system is not a requirement to enroll in Direct.

What can you send using Direct Messaging?

Direct-enrolled users can send simple clinical messages to other users and/or send/receive referrals among providers. Users can also attach clinical documents from their EMR system, SharePoint or from the IHDE Clinical Portal including CCD’s, labs, radiology and       transcriptions reports, etc., as well as single X-rays, CT scans, PET scans, MRIs and Ultrasounds, and send to other Direct-enrolled users.

Who can have a Direct Messaging email account?

IHDE participating organizations including providers and other medical and clerical staff, hospitals, labs, pharmacists, long-term care, rehab and skilled nursing facilities can enroll for a Direct email account. Interested users will fill out an IHDE Direct Messaging New User Form and then IHDE Training & Support personnel will instruct users how to enroll for a Direct email account. Users will access the Direct service via the IHDE website.

Will training be available for Direct Messaging?

Yes. IHDE personnel are available for training either on-site (where applicable) or via live webinars.

Is there a fee for Direct Messaging?

No. Direct will be included in the new Clinical Portal license structure.

If your organization already has Direct Messaging, will it be compatible with the Direct Messaging service available through the IHDE?

Generally, yes. Direct Trust network participants can freely share information between EMR systems, HISPS and the IHDE Direct Messaging system.

Use Case Examples for Direct Messaging: 

For Physicians, Hospitals and Long Term Care Facilities

Direct is being deployed amongst physicians, hospitals and long term care facilities across the  nation. A common use case is presented below showing how Direct supports a patient and her care team, treating her various complications, in her transitions of care through multiple care settings.

Physicians

Scenario: A female patient is admitted to the hospital with syncope. The patient undergoes an EKG and a CT scan while in the hospital, and is diagnosed with an arrhythmia. She is prescribed propranolol and is discharged after two days with instructions to stay on her medication and avoid caffeine. The patient is advised to visit her PCP within one week and obtain a referral to a cardiologist.

Receive Admit / Discharge Notifications

Use Case: Through Direct, the patient’s PCP can be instantly notified when the patient was admitted to the hospital with syncope. The notification can include information such as the patient’s name, DOB and reason for admission. Upon discharge, the PCP can be notified and will receive information including the patient’s diagnosis and follow up instructions.

Benefits: Direct improves the transition of care from the hospital to the PCP as well as allowing the PCP to respond quickly to new information about their patients. Automated admit/discharge notifications are faster and more reliable than fax or mail, and providers can access these notifications from mobile devices, home or office computers, allowing the PCP to quickly respond and to ensure the appropriate follow up care. The data can be automatically consumed by the PCP’s current EHR, so information does not get lost or     delayed.

Receive Lab Results

Use Case:  The patient underwent a CT scan and an EKG during hospitalization as well as routine blood work. Through Direct, the results of these tests can be sent electronically to the PCP and can be integrated into the provider’s EHR.

Benefits:  Direct ensures that lab results are sent immediately to PCPs, so all of the information is in the physician’s hands before the patient’s follow up visit. Direct also eliminates difficulties reading test results (such as EKGs) that come over the fax machine.

Refer Patients to Specialists

Use Case: The patient now needs to be referred to a cardiologist. Her PCP, through Direct, can easily send a referral to the desired cardiologist. The cardiologist can receive the referral instantly, along with the patient’s history, hospitalization details, medications, lab results and current diagnosis. With Direct, it can enable the PCP to download and extract this information from their EHR, and allow the cardiologist’s (different) EHR to download and import the information.

Benefits: Sending referrals and histories electronically is faster and more reliable than sending the information by mail or by fax. The specialist will have all of the necessary information before seeing the patient, and it will be simple and fast for the specialist to respond to the PCP with a summary of care. Direct simplifies the communications between PCPs and specialists, improving transitions of care.

Hospitals

Scenario: A female patient is admitted to the hospital with syncope. She undergoes an EKG and a cardiac ultrasound while in the hospital, and is diagnosed with a life threatening arrhythmia. She is prescribed medication to control the arrhythmia and is referred to a tertiary facility for electro-physiologic evaluation. She is hospitalized at the tertiary facility for two days where she undergoes EP testing and treatment. She is then discharged, instructed to stay on her medication and avoid caffeine. She is also advised to see both her PCP and her cardiologist.

Admit / Discharge Notifications – Improve Transitions of Care: Through Direct, the patient’s PCP can be instantly notified when the patient was admitted to the hospital with syncope. The notification can include information such as the patient’s name, DOB and       reason for admission. Upon discharge, the PCP can be notified and receive information including the patient’s diagnosis and follow-up instructions.

Benefits:  Direct improves the follow-up care patients receive. Automated admit/discharge notifications allow providers to receive instant notifications. Electronic communications are faster and more reliable than fax or mail, and providers can access these                  notifications from home or office computers, allowing the PCP to quickly respond and to ensure the appropriate follow up care. The admit/discharge notifications fit into the hospital’s current workflows, so they improve quality of care without increasing workload.   Information can be automatically consumed by the PCP’s EHR, so information does not get lost or delayed.

Delivery of electronic lab results to PCPs

Use Case: The patient underwent a cardiac ultrasound and an EKG during hospitalization as well as routine blood work. Through Direct, the results of these tests can be sent electronically to the PCP and can be downloaded and integrated into the provider’s EHR  workflow.

Benefits: Direct can that lab results are sent immediately to PCPs, so all of the information is in the provider’s hands before the patient’s follow up visit.  Direct can also eliminate difficulties reading test results (such as EKGs) that come over the fax machine.

Referring a Patient from a  Critical Access Hospital (CAH ) to another Hospital

Use Case: When the patient is diagnosed with a life threatening arrhythmia in a CAH, she is referred to a tertiary facility for electro-physiologic evaluation. The CAH can send the results of the patient’s cardiac ultrasound, EKG and blood work to the tertiary facility through Direct.

Benefits: Direct allows all of the relevant medical information to follow the patient, so that the tertiary hospital has all of the information about the patient at the start of treatment.

Long Term Care Facilities

Secure standards-based communications are key to improving transitions into and out of Long Term Care facilities. Some of the most beneficial uses for Direct for Long Term Care include:

Receiving discharge summaries, patient history and instructions for the transition to Long Term Care. Communicating with primary care providers and payers during patient stay.

Scenario: An 87-year old female patient with a history of high blood pressure and high cholesterol suffers a stroke and is admitted to the hospital. After a five-day hospital stay she is discharged to a short term rehabilitation facility.  Upon discharge from rehabilitation she is unable to function independently and is admitted to a Long Term Care (LTC) facility to receive round the clock nursing. The patient’s medication list includes Hydrochlorothiazide, Enalapril, Metroprolol and Lipitor. Her instructions include daily mild exercise and  maintaining a low salt diet. She must be on falls precaution and requires assistance with all activities of daily living.

Patient is Transferred to a Long Term Care facility

Use Case: Through Direct, the Long Term Care (LTC) facility can easily and instantly receive the patient’s discharge summary, follow up care instructions and medication list from the rehabilitation center, as well as her discharge summary from the hospital and a complete     history from the patient’s PCP. Upon admitting the patient to the facility, they will already have a complete history, be prepared with all necessary medications and will have been able to review follow up care instructions.

Benefits: Direct simplifies the transition from the hospital into the LTC facility. Electronic communications are faster and more reliable than fax or mail, and ensure that all the necessary information arrives at the LTC facility before the patient. This includes discharge information, follow up care instruction, medical history, drug allergies and more. Information can be downloaded and consumed by the facility’s systems, so  information does not get lost or delayed.

Communicating with PCPs throughout a  Patient’s LTC Facility Stay

Use Case: With Direct, the LTC facility can keep in touch with the patient’s PCP or other prior caregivers.

Benefits: Direct allows for the PCP to assist the LTC facility with any additional information that they may need, which gives the  facility an additional resource and gives the patient the comfort of knowing that a caregiver familiar with her complete history is involved in her care.

Ready to enroll in IHDE Direct Messaging service?

Please contact us at: support@idahohde.org