Direct Secure Messaging

Secure and trusted health information exchange is fueled by the Direct Standard® and our robust national network

About Direct Secure Messaging

Direct Secure Messaging, commonly referred to as Direct, is a secure communication transport mechanism for sensitive information over the open internet. While appearing like email, Direct Secure Messaging utilizes digital certificates and a Public Key Infrastructure (PKI) to encrypt the contents of a message, meaning only the intended recipient can decrypt the message. Today, Direct Secure Messaging utilizes the foundation of the Direct Standard®, and is a widely deployed and accessible means for communicating sensitive health information to other trusted parties. Considered a “push” interoperability mechanism because of the sender “pushing” a message to the receiver, Direct Secure Messaging is a cornerstone of facilitating interoperability between disparate health technologies and organizations.

Our Interoperability Impact

Direct Addresses
Organizations Served
messages sent & received last quarter
cumulative messages sent & received

Direct Secure Messaging Use Cases


Referrals Use Case Icon

EMS Transfer

Direct Secure Messaging Resources

Direct Secure Messaging Aliases

Direct Secure Messaging is known by many different names across the industry: Direct, DIRECT, The Direct Protocol, The Direct Standard®, The Direct Project, Direct exchange, Direct Messaging, and many more.  We’ve highlighted some of the different names you may know Direct Secure Messaging as by different EHR/Technology vendor below.

EHR/Technology VendorAlternate Terms
athenahealthDirect, Direct Messaging, Secure Messaging, Direct Secure Messaging

Direct Secure Messaging, eReferral

CernerCerner Direct, Secure Messaging, Direct Referrals,  Direct Email, Direct Secure Messaging, Direct
CPSIDirect Message, Direct Messaging, Transition of Care, TOC
eClinicalWorkseClinicalDirect, P2P, Provider to Provider, Direct, Direct Secure Messaging, Direct Plus
EMR DirectphiMail, Interoperability Engine, Direct, Direct Address, Direct Messaging, Direct Exchange, XD HISP service, SMTP HISP service
EpicCare Everywhere, Care Everywhere Outside Messaging, CE Outside Messaging, Direct Messaging, Direct Protocol
Evident (Centriq)Secure Messaging
Glenwood SystemsDirect Messaging
GreenwayDirect messaging
iShare MedicaliShare Medical Messaging
MEDITECHDirect Messaging
NextGenNextGen Share, Direct Messaging
PointClickCareIntegrated Direct Messaging
WellskyWellsky IaaS, Wellsky IO, Wellsky Direct

Direct Secure Messaging FAQ

Why Direct Exchange is Important

The timely and secure exchange of health information is critical to patient care, and Direct Secure Messaging provides for that exchange across organizational boundaries. Utilizing the consensus-based Direct Standard®, Direct exchange is simple, secure, and scalable. Available through certified EHRs, Direct is readily available for providers to share data with other providers, eliminating redundancy of diagnostic testing, reducing the cost of care and easing inconvenience on patients and providers alike. Through utilization of Direct, patients will receive better coordinated care, leading to better outcomes, and ultimately culminating in increased patient and provider satisfaction.

How Direct Exchange is Used

Direct Secure Messaging is used for many purposes, including transitions of care from one provider or setting to another, referrals from one provider to another, provider to patient/consumer communication, public health reporting, transferring a patient from EMS to the ER, and many other purposes.

Who Developed Direct

Direct was born out of The Direct Project, which began in 2010 as a grass-roots public/private partnership focused on creating a simple and low-cost mechanism for healthcare interoperability. In 2011, it was decided an organization would be needed to grow a “trust community” to support the standard utilized for Direct Secure Messaging. DirectTrust was launched as a not-for-profit trade association in 2012 to support trusted health information exchange and was funded in part for a few years by a cooperative agreement with the Office of the National Coordinator of Health Information Technology.

How Direct Exchange Works

Direct Secure Messaging is often compared to sending an email, although Direct exchange is much more secure. A Health Information Service Provider, or HISP, maintains a SMTP server and exchanges. The HISP also carries out the encryption/decryption and digital signing of each message and attachment, as the Security/Trust Agent box within each HISP. Each sender and receiver using Direct must have a unique Direct address. Direct messages can have any type of file attachment, and both message and attachments are encrypted along the entire route from Sender to Receiver, to protect the privacy of the content.