By Tracy Asibu, MS, Graduate Scientific Programmer at University of Texas Health Science Center at Houston
Direct Secure Messaging, commonly referred to as Direct, shows great potential to facilitate healthcare data-sharing among organizations that target underserved populations like homeless shelters and care partners.
That’s the takeaway from a recent graduate project I completed at the University of Texas Health Science Center at Houston’s School of Biomedical Informatics. A successful implementation of Direct has the potential to ensure shelters are prepared to provide appropriate support services.
Homelessness has been rising in the United States since the 1980s, worsening during the pandemic years. In Texas, more than 63,000 people experienced homelessness in 2023.
Transitions of care are a critical component of hospital discharge. The process ensures medications have been prescribed, follow-up physician visits are scheduled, and the patient has adequate resources at home. Now, imagine this experience for unhoused individuals who are discharged from clinical settings to shelters with little or no communication. This minimizes the shelter’s ability to provide appropriate support services and negatively impacts the general well-being of unhoused individuals during care transitions.
During a practicum at the Texas Health Services Authority (THSA), I saw first-hand what interoperability channels were available to benefit patients, and where opportunities for improvement existed. Several workshops with the Texas Homeless Network (THN) showed the inefficiencies of healthcare transition processes to community-based support organizations. Another workshop presented information about Direct, and its potential to bridge many of the communications challenges that exist among care partners for unhoused populations.
The Texas Homeless Data Sharing Network consists of 11 regions, nine of which are participating in a data warehouse project designed to tackle inconsistent homelessness management information systems. Phase two of the project would use social determinants of health (SDOH) as a guide to determine when an individual’s health needs are met, and how they can correspond directly to their housing needs.
Direct can be used to send referrals, exchange consult notes, transmit transitions of care directions across care settings, and transmit simple and HIPAA-compliant messages. Integrating Direct has numerous benefits, including its ability to enhance interoperable communication exchange. Benefits also include the improvement of communication and coordinated care, the secure sharing of needed information, reduction of the cost of care, and promotion of patient and provider satisfaction.
A few challenges to widespread adoption remain, many of which can be overcome by knowledge and education. Some healthcare providers and organizations have not yet implemented a certified EHR, all of which have been able to send/receive Direct Secure Messages since 2014. Others have certified EHRs but don’t recognize the power of Direct in care transitions. Missing addresses and directory entries have been an issue in the past, but DirectTrust is tackling this head-on with its Directory Improvement Initiative. Additionally, some organizations lack incentives to use Direct addresses, which homeless healthcare shelters may not have the technology to handle. However, there is an increasing movement for social care organizations to implement Direct, since in many cases, all that’s needed to access a Direct Secure Messaging inbox is a web browser.
Like any successful interoperability deployment, many factors should be considered when it comes to expanding the use of Direct. The first step is confirming the capabilities of healthcare centers and local shelters to support Direct workflows like referrals and transitions of care. Direct addresses must be identified and/or created for specific purposes like referrals, transfer notifications, medications, and other required information among healthcare centers, shelters, or homeless agencies. All members involved in communication exchange must be trained and educated on using Direct for the benefit of their patients and clients.
To ensure success, Direct addresses must be publicized widely in national directories, email signature lines, and anywhere an organization has contact information. To increase efficiency, it is important to communicate to referral partners and agencies that Direct is the preferred communication method.