Current Market View of the Usage, Value and Future of Direct Messaging


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Recently the FY15 HIMSS Interoperability and HIE Committees conducted a nationwide survey on Direct messaging to learn how the marketplace is using Direct to facilitate health information exchange (HIE). Direct messaging was intended to increase interoperability, and this survey was intended to provide visibility on the use and value of Direct.

While Health Information Organization (HIO) participation in the survey is not statistically significant compared to the entire HIO population, we believe the responses serve a broad and diverse representation of the HIO market.  With 75 responses representing 27 states, the 2015 Direct Messaging Survey has provided essential information for the HIMSS Interoperability & HIE Committee to assess current trends and refocus their efforts to deliver better value to our interoperability and health information exchange stakeholders.

We have identified the following themes from the survey results which indicate:

  • substantial use of Direct in support of care coordination use cases,
  • broad availability to a provider directory but great variability in the method of access,
  • continued challenges incorporating structured data into the EHR,
  • extensive membership in a HISP,
  • some knowledge of the availability of Direct messaging among the clinician community, and
  • that most participating organizations support Direct as the method choice for exchanging data.

From our perspective, we see significant progress and optimism in several areas, signaling that HIE is maturing in the marketplace and beginning to deliver the intended value to their providers and communities. The survey reports on feedback gathered across five categories of questions: (i) hosted and integrated Direct mechanics, (ii) training and education, (iii) workflow, (iv) interoperability and standards, and (v) HISP.

To access the entire 2015 Direct Messaging Survey results, but here are a few key takeaways to consider:

  • The top five reported uses of Direct include: (i) transitions of care, (ii) ADT notifications, (iii) patient communication, (iv) secure email for other purposes and (v) consult requests between physicians
  • The top three reported benefits of using Direct include (i) improved speed of info access, (ii) reduce paper handing, more accurate and (iii) complete patient information
  • Major challenges impacting Direct implementations include: (i) high cost, (ii) changing workflows and (iii) other providers not ready to interface
  • 60% of respondents report use of hosted webmail accounts (available via a browser)
  • 76% of respondents reported access to a provider directory, further 64% report they can access internal providers from that directory from within their EHR, whereas 52% report they can access external providers within their EHR
  • 28% report their EHR offers an integrated directory, whereas 28% report they pull in the directory via web services and 17% perform a manual download
  • 83% of respondents are part of a HISP; 85% of HISPs can route information to another HISP
  • 85% of HIOs are part of a scalable trust network (e.g., DirectTrust, NATE, HealtheWay) and most respondents report it extremely important their HISP is part of such a network
  • 51% agree that the cost of using Direct is worth the benefit of information exchange
  • There remains no standard provider directory format – 14% report using LDAP, 14% use IHE HPD, 18% have no plans to adopt a standard, 18% are considering their options, while others use another proprietary standard or simply a relational database.
  • Incorporating C-CDA data, identifying trading partners and funding implementations are reported as modestly challenging; completing the directory is reported as prohibitively challenging,
  • In the absence of MU, respondents reported the following technical preferences for sending electronic health information: CONNECT (27%), SMTP/S-MIME (23%), Direct + XDR/XDM (15%), SOAP+XDR/XDM (6%)

To access the 2015 HIMSS HIE and Direct Messaging infographic.

Use of Direct to enable HIE has been a bumpy ride and while variability exists in the market, the message should be that HIE is growing, the market is maturing and we are all learning how to better collaborate with our community partners. The inter-organizational exchange of information in support of improved patient care is challenging, but from the feedback in this survey “the cost is worth the benefit.”

To access the full 2015 Direct Messaging Survey results and to download the infographic please visit our website.

For further resources about health information exchange and interoperability please check out the HIMSS HIE and I&S Toolkits.