DirectTrust hits milestone of 1B messages exchanged; developing instant messaging standard

Doctor computer keyboard
During the second quarter of 2019, DirectTrust reported that Direct message transactions increased nearly 53% over the prior quarter, 397% over the same period a year ago, and outpaced total 2018 transactions by more than 51%. (Getty/jacoblund)

DirectTrust, a nonprofit association of providers and IT vendors, announced a milestone on Monday: 1 billion messages exchanged.

During the second quarter of 2019, the organization reported that Direct message transactions increased nearly 53% over the prior quarter, 397% over the same period a year ago, and outpaced total 2018 transactions by more than 51%. Direct is a technical standard to exchange patient data. 

There were nearly 251 million messages sent and received through the DirectTrust network during the second quarter of 2019, an increase of almost 87 million messages from the previous quarter. More than 1 billion messages have been exchanged since 2014.

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The lack of interoperability in healthcare, which makes it difficult for providers to share information with each other and with patients across disparate technology platforms, is one of the industry’s biggest challenges. Direct messaging is a cost-effective and uncomplicated way to exchange health information, said Scott Stuewe, president and CEO of DirectTrust.

Organizations are using Direct messaging for transitions of care information and referrals as well as public health reporting, he said.

There are health information exchange approaches, like Direct, that have proven successful, Stuewe said. A new push by the Office of the National Coordinator for Health IT to provide a single "on-ramp" to nationwide data sharing, called the proposed Trusted Exchange Framework, creates a lot of uncertainty for organizations like DirectTrust.

“It’s very prescriptive and, as a consequence, we don’t have a good place to fit,” Stuewe told Fierce Healthcare, noting that DirectTrust supports the goals of the TEFCA framework. “We believe we have an important role to play and we want to fit but, as TEFCA is proposed right now, we don’t necessarily see that as the case.”

RELATED: 4 problems industry groups have with the ONC's Trusted Exchange Framework

ONC released the first draft of the TEFCA back in January 2018 as a framework designed to improve data sharing between health information networks. The framework (PDF), mandated by the 21st Century Cures Act, provides the policies, procedures and technical standards necessary to exchange patient records and health information between providers, state and regional health information exchanges and federal agencies. ONC released the second draft of TEFCA in April.

In a comment letter (PDF) to ONC about the proposed TEFCA, DirectTrust urged ONC to build on what is already working in the marketplace and to adopt a “lightweight, less prescriptive approach to health information exchange.

Stuewe said the Health IT Advisory Committee’s TEFCA task force provided recommendations that, if adopted by ONC, would go a long way toward solving many stakeholders’ issues with the framework.

Instant messaging standard

Healthcare providers often rely on text messaging or tools like Slack for instant messaging with each other and to coordinate patient care.

But unsecured messaging poses the risk that HIPAA and other privacy regulations may be violated, according to Stuewe. There currently is no standard for secure instant messaging in healthcare, especially between disparate systems, he said.

DirectTrust is working to fix this by developing an instant messaging standard to enable physicians to communicate and share protected health information, including file transfers.

The goal of the instant messaging standard is to create a secure way for providers to communicate with each other, as well as with patients and other care team members, Stuewe said. “This is critical to eliminating the risk of violating HIPAA and other privacy regulations, and for the storing and sharing of protected health information,” he said.

RELATED: VA expands data sharing with private providers with DirectTrust

The standard, Trusted Instant Messaging+, or TIM+, will incorporate trust network concepts and use a common standard to allow providers to share information in real-time both within their organizations and across enterprises using disparate technology platforms.

Greg Meyer, director and engineer at Cerner Corporation, a DirectTrust Member, said the instant messaging standard will help overcome security and privacy challenges in digital healthcare.

"Frequently, the continuum of care crosses multiple institutions and organizations, where communication is hobbled by technical, security, privacy, and policy constraints,” Meyer said in a statement.

DirectTrust also issued a call for participation for the TIM+ consensus body, a group of industry stakeholders that will help finalize development of the TIM+ standard and assist with its ongoing maintenance.

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