Subscribe to RSS
Consensus Statement: Feature and Function Recommendations to Optimize Clinician Usability of Direct Interoperability to Enhance Patient Care
26 September 2017
21 January 2018
21 March 2018 (online)
Background Secure clinical messaging and document exchange utilizing the Direct Protocol (Direct interoperability) has been widely implemented in health information technology (HIT) applications including electronic health records (EHRs) and by health care providers and organizations in the United States. While Direct interoperability has allowed clinicians and institutions to satisfy regulatory requirements and has facilitated communication and electronic data exchange as patients transition across care environments, feature and function enhancements to HIT implementations of the Direct Protocol are required to optimize the use of this technology.
Objective To describe and address this gap, we developed a prioritized list of recommended features and functions desired by clinicians to utilize Direct interoperability for improved quality, safety, and efficiency of patient care. This consensus statement is intended to inform policy makers and HIT vendors to encourage further development and implementation of system capabilities to improve clinical care.
Methods An ad hoc group of interested clinicians came together under the auspices of DirectTrust to address challenges of usability and create a consensus recommendation. This group drafted a list of desired features and functions that was published online. Comments were solicited from interested parties including clinicians, EHR and other HIT vendors, and trade organizations. Resultant comments were collected, reviewed by the authors, and incorporated into the final recommendations.
Results This consensus statement contains a list of 57 clinically desirable features and functions categorized and prioritized for support by policy makers, development by HIT vendors, and implementation and use by clinicians.
Conclusion Fully featured, standardized implementation of Direct interoperability will allow clinicians to utilize Direct messaging more effectively as a component of HIT and EHR interoperability to improve care transitions and coordination.
Keywordsprovider–provider communications - interfaces and usability - care transition - health information interoperability - health information exchange - user–computer interface - continuity of care document
Protection of Human and Animal Subjects
This manuscript does not involve any research on human subjects.
- 1 There are numerous sources of information about the Direct Standard and the Direct Project. The Direct Project maintains a wiki at http://wiki.directproject.org/ . A comprehensive overview of the Direct Project is The Direct Project Overview from February, 2010, available at: http://wiki.directproject.org/file/view/DirectProjectOverview.pdf . Accessed March 01, 2018 . The technical protocols and specifications for Direct are specified in the Applicability Statement for Secure Health Transport of the Direct Project, available at: http://wiki.directproject.org/Applicability+Statement+for+Secure+Health+Transport . Accessed March 01, 2018
- 2 HITECH Act Enforcement Interim Final Rule. Available at: https://www.hhs.gov/hipaa/for-professionals/special-topics/HITECH-act-enforcement-interim-final-rule/index.html . Accessed March 01, 2018
- 3 DirectTrust Reports Steady Growth in Number of Direct Exchange Users. Addresses and Transactions during Third Quarter; October 24, 2017. Available at: http://www.globenewswire.com/news-release/2017/10/24/1152458/0/en/DirectTrust-Reports-Steady-Growth-in-Number-of-Direct-Exchange-Users-Addresses-and-Transactions-during-Third-Quarter.html . Accessed March 01, 2018
- 4 RI healthcare providers reach direct messaging milestone. R I Med J (2013) 2014; 97 (04) 48
- 5 Isetts B. Integrating MTM (MTM) services provided by community pharmacists into a community-based Accountable Care Organization (ACO). Pharmacy 2017; 5 (04) 56
- 6 Reicher JJ, Reicher MA. Implementation of certified EHR, patient portal, and “Direct” messaging technology in a radiology environment enhances communication of radiology results to both referring physicians and patients. J Digit Imaging 2016; 29 (03) 337-340
- 7 Sujansky W, Wilson T. DIRECT secure messaging as a common transport layer for reporting structured and unstructured lab results to outpatient providers. J Biomed Inform 2015; 54: 191-201
- 8 Terry K. How to get started with Direct messaging. Many physicians don't use or are unaware of Direct secure messaging, but it can help improve care coordination--provided you can navigate its challenges. Med Econ 2015; 92 (07) 42-46
- 9 Walker DM. Does participation in health information exchange improve hospital efficiency?. Health Care Manage Sci 2017; DOI: 10.1007/s10729-017-9396-4.
- 10 Lehmann CU, Kressly S, Hart WWC, Johnson KB, Frisse ME. Barriers to pediatric health information exchange. Pediatrics 2017; 139 (05) e20162653
- 11 DirectTrust is a collaborative non-profit association of health IT and health care provider organizations to support secure, interoperable health information exchange via Direct interoperability and other electronic protocols. Available at: https://www.directtrust.org/about-directtrust/ . Accessed March 01, 2018
- 12 DirectTrust Clinicians' Steering Group for Direct Interoperability in Care Transitions and Coordination. White Paper: Feature and Function Recommendations to the HIT Industry to Optimize Clinician Usability of Direct Interoperability to Enhance Patient Care. Available at: https://www.directtrust.org/wp-content/uploads/2017/03/WhitePaper_Final_03.16.2017.pdf . Accessed March 01, 2018
- 13 The Direct Project. Implementation Guide for Expressing Context in Direct Messaging. Available at: http://wiki.directproject.org/file/view/Implementation+Guide+for+Expressing+Context+in+Direct+Messaging+v1.0-DRAFT-2016122901.docx/602899718/Implementation%20Guide%20for%20Expressing%20Context%20in%20Direct%20Messaging%20v1.0-DRAFT-2016122901.docx . Accessed July 27, 2018