I was honored to address the Texas Interoperability Symposium hosted by the Texas Health Services Authority (THSA). The organization was founded to implement and facilitate the secure electronic exchange of health information throughout the state, which it accomplishes through a state-level health information exchange (HIE).

Kudos go to the organizers who brought together interoperability stakeholders from across the data exchange landscape in Texas. The symposium focused mainly on public health use cases for data exchange, an area where Direct Secure Messaging (DSM) shines.

THSA has brought together local and regional health departments, other providers, and the state HIE to collaborate on how to drive interoperability in the state, specifically to solve clinical challenges.

Public Health Adopting More Modern Technologies

Much like post-acute care providers and facilities, public health entities haven’t been on the forefront of the digital transformation of healthcare that has occurred over the past two decades. Consequently, their network infrastructure may not be as mature as those of hospitals, health systems, and providers that received billions in incentives to adopt modern processes such as use certified EHRs that include Direct Secure Messaging.

The Association of Public Health Laboratories (APHL) serves as a liaison between public health labs, the federal government, and international agencies like the World Health Organization. Although APHL can receive Direct Secure Messages, that’s not how it communicates to member organizations around the country, instead sending .CSV files that analysts must pore over to find what they’re looking for.

With electronic data exchange using Direct, public health agencies can ingest the information they receive into their records systems, then sort and analyze the data in a much more straightforward manner.

Before that can happen within normal workflows, however, agencies must recognize the value of Direct, which is where the THSA workgroup has been instrumental in demonstrating the value of secure data exchange.

Getting on the Direct Bandwagon

THSA organization has devised nine recommendations for a better DSM experience:

  1. Include National Provider ID (NPIs) in Directory entries
  2. List the Direct address on fax cover sheet
  3. Use message routing
  4. Encourage referral partners to adopt Direct
  5. Include your Direct address on all external communication
  6. Verify NPI compliance in your database
  7. Use the Office of National Coordinator’s Project US@ address format
  8. Routinely synchronize your provider directory
  9. Adopt policy and be a good partner

We’ll focus on a subset of those recommendations and how to improve the communications experience.

National Provider ID numbers. Communication can’t happen if people don’t know how to get in touch with each other. That’s why including an up-to-date and accurate Directory listing that includes NPIs is critical. An accurate listing forms the basis of all future communications. Less than 80% of Directory entries include a provider NPI number, or there is a mismatch between the NPI and the National Plan and Provider Enumeration System (NPPES) number. Accurate information increases compliance and improves confidence in the ability to exchange data. Our own Directory Improvement Initiative seeks to enhance the Directory by adding this data to entries.

Direct address on external communications and fax covers. Including your Direct address on external communications — including the fax cover sheet — shows a willingness to exchange data in a secure manner. Just as many people update their email signatures for an upcoming vacation or a change of address, including your Direct address gives other providers a way to directly contact you. Unlike other forms of communication, Direct Secure Messages are encrypted from end to end in a way that faxes aren’t. What’s more, data can be ingested directly into EHRs and practice management systems. Anywhere that a fax number is listed, a Direct address should be listed too.

Facilitate referrals and next care steps. Sent by fax, a referral or an admission/dismissal/transfer (ADT) notification can disappear into the ether, with the sender none the wiser as to whether the referral has been accepted or the patient notification successfully received. Direct is just that — direct. Since it works like secure email, the message gets to where it needs to go. Creating Direct addresses for specific purposes or departments, like referrals or ADT messages, can shift administrative burdens from clinicians onto nurse pools and scheduling. But none of these benefits can begin until referral and provider partners get on the same page with Direct Secure Messaging.

Doing More with Direct

The THSA is creating positive buzz on Direct among its members, which is heartening to see. The power of Direct to facilitate secure peer-to-peer messages that can become part of a patient’s medical record and speed clinician decision-making and overall patient care is a goal that we all can rally around.

This post was contributed by Scott Stuewe, DirectTrust President and CEO.