The successful integration and implementation of Direct Secure Messaging relies on resilient information exchange. A resilient network can withstand, adapt to, and quickly recover from disruptions – all factors that achieve better user experience and safer, more secure patient care.

Direct Secure Messaging includes built-in features to help ensure just that. With delivery notifications that provide critical message delivery insights, health information continues to flow, even when individual systems or connections fail.

Are you planning a new integration of Direct Secure Messaging, or looking to strengthen an existing one? Familiarity with delivery notifications and how they contribute to a resilient system will be critical to your success.

What Are Delivery Notifications in Direct?

Delivery notifications ensure senders receive clear confirmations about the delivery status of their messages. They are defined in the Implementation Guide (IG) for Delivery Notifications for Direct Secure Messaging, an official component of the Direct Standard®.

When a Direct message is sent, the sender can include a special header parameter requesting Message Disposition Notifications (MDNs). These notifications confirm whether the message was successfully processed and dispatched to its final destination. An MDN is also referred to as a positive delivery notification.

A Delivery Status Notification (DSN), also referred to as a negative delivery notification, may be generated in any of the following instances:

  • A sender’s HISP rejects an address as untrusted,
  • A recipient’s HISP cannot locate the recipient mailbox, or
  • Positive or negative notification is not received from the recipient’s HISP within a reasonable time, prompting the sender’s HISP to determine the delivery was unsuccessful.

Why Are Delivery Notifications Important?

Delivery notifications give senders definitive confirmation of successful message exchange.

This enables systems to remain resilient, responding by resending messages, escalating issues, or alerting administrators when problems occur.

Example scenarios include:

  • An invalid address or missing mailbox can be quickly identified and corrected.
  • A failed delivery can trigger a retry or an alternate communication method.
  • A confirmed delivery reassures users that the message reached its final destination successfully.

By capturing these signals, systems that use Direct can determine the state of each transaction and automatically respond to connectivity issues. This process strengthens both reliability and user trust. Definitive signals confirm when a system is functioning as expected. These signals are important alerts that identify issues and trigger corrective action to be taken.

A resilient Direct Secure Messaging network ensures secure, reliable, and continuous exchange of health information, even when components, organizations, or communication channels experience disruptions. Delivery notifications play a critical role in the resiliency of the DirectTrust network, by establishing the deterministic delivery state of each message.

Best Practices for Processing Delivery Notifications

A robust Direct integration makes message status transparent, actionable, and meaningful for users.

Make message success visible:

  • Capture MDNs and DSNs and store them in audit logs.
  • Surface delivery status in clear, workflow-friendly ways.
  • Automate routine actions (e.g., advance the status of a referral task to “requested” when a referral request message is confirmed delivered).

Plan for success by preparing to address all possibilities:

  • Log and classify DSNs with human-readable explanations.
  • Define retry policies and automate routine actions (e.g., auto-retry sending a referral task when a message is confirmed undelivered).
  • Notify the right people if message delivery fails and retries are not successful — some failures only need logging, while others demand immediate attention.
  • Create escalation processes regarding when to escalate, to whom, and and how.
  • Establish fallback message delivery methods such as fax, portal upload, or phone call when digital delivery fails.

The Winning Implementation Strategy

Plan for delivery success, but design systems that can resiliently detect, handle, and recover from failure.

Winning implementations:

  • Expect both positive and negative outcomes, and use MDNs and DSNs effectively.
  • Document organizational policies for retries, escalation, and fallback methods.
  • Make system behaviors predictable and transparent for users.
  • Focus on end-to-end workflows, not just delivery status — because successful delivery is necessary, but not always sufficient, for successful information exchange.

Truly resilient systems recognize that the “finish line” for information exchange isn’t just the message reaching its destination — it’s the message reaching the right hands, at the right time, in a way that supports the right patient care. Use case-focused implementations that are transparent, proactive, and responsive produce better user experiences, safer patient care, and more resilient systems.