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EHR to EHR Communication — Using the Direct Messaging Protocol

One might argue that physicians are primarily information managers — using key pieces of clinical information to guide and support medical decisions. However, it is equally important to be able to exchange information with other care providers. This information exchange capability is critically dependent on the use of standardized processes and terminologies so that it is accurate and understandable by a variety of different clinical systems. The Office of the National Coordinator has released a new guideline for Direct Messaging specifications.

Why an updated set of guidelines?

In Appendix A of the guideline document, the ONC states:

“ONC has found that many Health Information Service Providers (HISPs) are deploying Direct in a way that proactively enables exchange within a given HISP’s boundaries while not offering mechanisms or supporting policies that enable exchange with other HISPs. Such limitations effectively block providers using different HISPs from exchanging patient information. In effect, HISPs are creating ‘islands of automation using a common standard.’ This will hamper information following patients where they seek care ― including across organizational and vendor boundaries ― to support care coordination and Meaningful Use Stage 2 requirements.”

Due to privacy and security concerns when sharing information between different Health Information Service Providers (HISPs), some of these organizations have executed peer-to-peer legal agreements to allow the information to flow; however, the agreements are expensive to produce and difficult to monitor and enforce.

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