Signed, sealed, delivered and secure

By Erin McCann
11:49 AM

In an epoch of HIPAA breaches and privacy lawsuits that leave healthcare providers keeled over with clinical, financial and legal headaches  -  oftentimes meltdowns  -  more state medical organizations are adding Direct Messaging to their to-do lists. 

The nationwide Direct movement is a progeny of the 2010-launched Direct Project  -  a supplement, so to speak  -  of the Nationwide Health Information Network. The project establishes a set of standards for transmitting secure, encrypted health information over the Internet. 

Today, there are 38 states live with Direct and using these standards, with seven additional states participating in pilot programs. 

Most recently, secure messaging has connected providers in Indiana, North Carolina and Arkansas. 


Rural hospitals often lag behind with implementing health IT  -  such as Direct  -  when compared with the larger, more financially robust institutions. However, some rural hospitals are making strides to set themselves apart. 

Decatur, Ind.-based Adams Memorial Hospital, a 35-bed critical access hospital has put itself on the map after becoming the first rural hospital in the state to adopt the messaging technology. 

This newly added security blanket, so to speak, began its journey back in July, and it has made it possible for users to securely and electronically communicate with other users. Via an encrypted channel, lab reports, radiology images and other personal health information can all be exchanged and accessed. 

"With Direct mail, our providers are receiving information on their patients immediately as the results are made available. From there, their action items are more convenient and effective, with little to no training on the product itself," said Tom Nordwick, president and CEO of Adams Memorial Hospital. "It's just going to make our physicians' lives easier, and that's how technology should work."

Presently, 15 physicians at Adams Memorial Hospital are utilizing Direct, and hospital officials expect this number will increase over the next few months. 

North Carolina

North Carolina's Health Information Exchange (NC HIE) also recently added Direct capabilities, officials announced back in July. Today upwards of 250 healthcare professionals are utilizing the encrypted messaging, representing more than 100 organizations and more than one million transactions. 

Officials at NC HIE anticipate an upward trend in Direct accounts over the next few months in response to a launch of a statewide initiative that provides five free Direct accounts to all North Carolina Health Departments. Considering a Direct messaging mailbox typically runs some $100 per user per year  -  a price tag not feasible to many organizations  -  officials hope to offset some of these costs. 

"The implementation of NC DIRECT through Orion Health Direct Secure Messaging is another step forward in NC HIE's mission to give physicians across North Carolina access to patients' health information when and where it's needed," said Jeff Miller, CEO of the North Carolina Health Information Exchange.

Whitney Baker, marketing and communications manager for NC HIE, said that HITECH funds have enabled the state's HIE to "create the foundational infrastructure needed to be sustainable."  In conjunction with government funding, Baker said other organizations and stakeholders are involved in the sustainability of the HIE. "We are very fortunate to operate in a state where government, payers, nonprofits, providers and many others are willing to come together to ensure the sustainability of the HIE," she said. "Like other HIEs, we will continue to evolve to meet the needs of the state." 


Arkansas, too, is saying 'sayonara' to fax and unencrypted email accounts by tapping into Direct. The endeavor, spearheaded by State Health Alliance for Records Exchange (SHARE), the state's health information exchange, began enrolling providers in early March, and has already added more than 1,761 individual users  -  with an additional 3,000 folks who have signed user agreements to begin the process.

This is the first year SHARE  -  headed by the Arkansas Office of Health Information Technology (OHIT)  -  has provided Direct to providers, and already, they have seen growing demand and positive feedback pouring in.

 "Our goal, in this first year, is to sign up 26 hospitals and 200 plus practices for the full HIE solution," said Ray Scott, Arkansas' HIT coordinator. 

The transition to Direct is necessary, Scott said, as today's healthcare industry is an entirely different beast. "The healthcare marketplace that we're dealing with is not your mom and dad's market place. Hospitals are no longer hospitals; they are now integrated delivery networks." 

  Scott pointed out that provider organizations see Direct as helping with two big problems: the costs fax lines tacked onto the bill, and patient privacy concerns that come with fax technology.

He cited a state community health center that spent $25,000 annually just on fax-related services within its own network  -  and that's not including labor. "When they found out about secure messaging, they immediately signed up."

Scott added, "It's not just the monetary costs, it's the time and effort spent on running down faxes that either got sent to the wrong fax number, or it's a 35-page document and five of those pages got left on the machine," added Scott. "We hear those kinds of stories frequently."

  Scott anticipates a growing number of providers using Direct, but worries some smaller, more rural hospitals simply don't have the funds. SHARE still has a large amount of HITECH funds that it will be using to offset the cost of Direct for providers. "We hope to be able to reduce the initial costs of connecting to and using SHARE for the early adopters by offsetting those one-time connection fees, and technology costs with the one-time federal funding."