DirectTrust CEO on why direct messaging should replace the fax machine

An increasing number of providers are engaging in health data exchange and are using data exchange services for a variety of use cases, according to the nonprofit association DirectTrust.

Case in point: Direct message transactions increased by 63% in 2018 with steady growth in the number of healthcare organizations utilizing Direct exchange over the past year. In all, there were nearly 274 million Direct message transactions between DirectTrust addresses in 2018, a significant increase from the 2017 total of 168 million transactions. There were more than 110 million Direct messages transmitted during the fourth quarter of 2018 alone.

In addition, the number of patients involved using Direct increased approximately 35% to nearly 248,000.

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While the nonprofit looked specifically at transactions on its own HIE platform, the growth in Direct message transactions is part of a trend in data exchange that emerged in 2018 and is now becoming more pronounced and growth more broad-based, said Scott Stuewe, DirectTrust president and CEO, in an interview with FierceHealthcare.

There are several private sector-led efforts to advance interoperability in the healthcare industry, including CommonWell Health Alliance and Carequality as well the Direct trusted exchange alliance, which has a total membership up to 115 organizations.

A recent report on interoperability progress drafted by seven leading hospital organizations, including the American Hospital Association and the Federation of American Hospitals, identified security and privacy as two critical areas that needed to be addressed to advance interoperability. Specifically, the report noted that stakeholders must be able to trust that shared data is accurate, secure and used in accordance with best practices and patient expectations.

A movement to “junk the fax,” as one Stanford Medicine report referred to it, has won the backing of federal healthcare officials. Centers for Medicare & Medicaid Services Administrator Seema Verma has called on doctors' offices to eliminate the use of fax machines by 2020.

“We’re seeing growth [in Direct secure messaging] with things like release of information, communication with payers, communicating with registries. As those new use cases grow, it will make a dent in the fax market,” Stuewe said, adding, “I don’t think fax is something we can kill all at once, but Direct has the best potential to put fax on its heels.” 

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According to DirectTrust, the number of healthcare organizations served by DirectTrust accredited health information service providers increased 30% to nearly 139,000, compared with approximately 107,000 at year-end 2017. What’s more, the number of trusted DirectTrust addresses able to share protected health information (PHI) across the DirectTrust network increased by 16% to more than 1.8 million since the end of 2017.

“Those 1.8 million addresses represent trusted exchange partners who are willing to send information back and forth, and that is our big strength—we manage that trust framework and our members are dedicated to the policy and processes necessary to make it work,” Stuewe said.

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Direct health information exchange has tackled this trust issue, Stuewe contended, as the organization’s framework is a technical trust framework, which is about stretching the highest security mechanism across identity-proofed endpoints. This makes Direct exchange of messages suitable for ePHI, he said. “DirectTrust identify-proofs the individuals and machines in our trust framework and everyone trusts that information is safe and secure.”

This issue of trusted exchange will be a critical issue for the Fast Healthcare Interoperability Resources (FHIR) community as well, he noted, and that presents a potential opportunity to extend the organization’s trust framework to FHIR. “As people are trying to optimize the new app economy and patients are getting access to data with the app of their choosing, is there a need for additional security and clarity for hospitals on who is knocking on the door? That’s an opportunity for DirectTrust,” Stuewe said.

From a regulatory standpoint, the health IT industry is awaiting the second draft version of the Trusted Exchange Framework and Common Agreement (TEFCA), a federally constructed interoperability initiative that was announced last January.

“There is a bit of a race to see whether the industry can get things working without a government mandate, in large measure,” Stuewe said.