- It is necessary for vendors to standardize and enhance their users' experience in handling inbound and outbound Direct secure messaging, DirectTrust explained in a recent white paper.
A DirectTrust workgroup made more than 50 recommendations for EHR vendors and HIT product vendors in how they can work toward overcoming usability issues with their secure, interoperable clinical messaging products.
Public comments on the recommendations will be accepted until March 30, 2017.
Sutter Health Clinical Informatics Director and Clinicians Steering Workgroup Co-Chair Steven Lane, MD, explained that it’s critical for clinicians and their teams to be able to share patient information “across commonly-encountered boundaries of health IT systems.”
"Right now, in the typical medical community there is great diversity in the brands of EHRs and other health IT systems used by clinicians for Direct messaging,” Lane said in a statement. “We're calling for all these vendors to make available more consistent and standardized software features to manage Direct clinical messages and their attachments. The existing variability in usability among different vendors' products is unacceptably high and poses a barrier to Direct interoperability, and thus to the adoption of secure messaging by clinicians to support common care coordination workflows.”
MedAllies Chief Medical Officer and Workgroup Co-Chair Holly Miller, MD added that Direct interoperability can be beneficial in communities with high risk patients who receive care from multiple physicians, using different EHR systems.
“This has been found to prevent patient adverse events and to be potentially lifesaving. Direct interoperability has provided basic connectivity,” she said in a statement. “Now the HIT community needs to enhance usability, and address deficiencies and inconsistencies of messaging content and functionality."
The recommendations are divided into the following categories:
- Highly desired/Future priority
- Advanced/Future development
The top recommendation within transitions of care suggested that all Direct interoperability messages be sent in "real time" and to not be "batched" for timed sends.
“This allows the receiver to organize appropriate patient outreach and follow up quickly and for patient care and transitional care management to be delivered more efficiently,” the workgroup explained in the paper. “Anecdotally, there are many reports of this resulting in the prevention of hospital readmissions and other adverse events.”
One of the required recommendations for clinical messaging is for clinical users to have full individual Direct messaging capability, regardless of whether they have an NPI. This will ensure that secure messaging can be used by an entire team as they care for patients.
Additionally, organizations should have the capability to create departmental and location based Direct accounts to send and receive messages in addition to individual clinician accounts. The workgroup explained that this will ensure that secure messaging use “promotes patient care by other than clinicians.”
A recommendation for future development discussed preventing information forwarding, which is specifically protected under HIPAA regulations.
“The receiving system is able to prevent the forwarding or resending of behavioral health, substance abuse treatment or other information as required by state and federal law, unless appropriate patient consents are documented,” the workgroup recommended. “[This] prevents the inappropriate distribution of patient information that would be in violation of existing law.”
Even with DirectTrust voicing concerns over potential secure messaging barriers, numbers that the organization released earlier this year show a continued growth in Direct messaging.
There were more than 98 million Direct message transactions between Direct addresses in 2016, the company said in a January release. Direct added that more than 33.5 million Direct messages were transmitted in Q4 2016.
"As EHRs become virtually ubiquitous in hospitals and medical practices, Direct messaging adds value by virtue of being 'plugged in' and able to replace fax and mail for all sorts of transactions, without the end user having to leave his or her EHR system,” DirectTrust President and CEO David. C. Kibbe, MD MBA, said in a statement. “It's important that Direct be convenient and work flow friendly.”
Overall, the number of trusted Direct addresses utilizing PHI sharing on the DirectTrust network increased 24 percent, totaling more than 1.36 million since 2015 ended.