The state of HIEs and direct messaging: 18 key findings from HIMSS

Direct messaging was implemented as a secure, universal standard to facilitate more efficient information exchange within the healthcare industry. A recent survey was conducted by the FY15 HIMSS Interoperability and HIE Committees to obtain a clearer picture of the value of direct messaging and how it is being used to foster interoperability and data sharing.

"Use of direct [messaging] to enable HIE has been a bumpy ride and while variability exists in the market, the message should be that HIE is growing," Mari Greenberger, director of informatics for HIMMS, and Sean Kennedy, HIE director for the Mass eHealth Insitute, wrote in a HIMSS blog post. "The market is maturing and we are all learning how to better collaborate with our community partners. The inter-organizational exchange of information in support of improved patient care is challenging, but from the feedback in this survey, 'the cost is worth the benefit.'"

Here are 18 key findings from the HIMSS survey.

1. There is substantial use of direct messaging in support of care coordination cases.

2. Direct messaging offers providers both broad availability and great variability in the method of access.

3. Users are experiencing continued challenges in integrating structured data from direct messaging into their EHR.

4. There is some knowledge of the availability of direct messaging among the clinician community.

5. Most participating organizations support direct messaging as the method of choice for data exchange.

6. Sixty-seven percent of participants support direct messaging as the method of choice for exchanging data.

7. Fifty-one percent agree that the cost of using direct messaging is worth the benefit of information exchange.

8. Survey respondents said the top three benefits of using direct messaging were improved speed of information access, reduced paper handling and more accurate and complete patient information.

9. The three major challenges to implementing direct messaging, as noted by survey respondents, are: 

• high cost
• changing workflows
• other providers unready/unable to interface.

10. The top five reported uses of direct messaging include: 

• transitions of care
• Admit-Discharge-Transfer notifications
• patient communication
• secure email
• consultation requests between physicians.

11. Sixty percent of respondents report use of hosted webmail accounts.

12. Seventy-six percent of respondents reported access to a provider directory, of those:

• 64 percent report they can access internal providers from that directory form within their EHR.
• 52 percent report they can access external providers within their EHR.

13. Twenty-eight percent report their EHR offers an integrated directory, whereas 28 percent report they pull in the directory via web services and 17 percent perform a manual download.

14. Eighty-three percent of respondents are part of a health information systems program; 85 percent of HISPS are able to route information to another HISP.

15. Eighty-five percent of HIOs are part of a scalable trust network and most respondents report it extremely important that their HISP is part of such a network.

16. There remains no standard provider directory format. 

• 14 percent report using Lightweight Directory Access Protocol
• 14 percent use Integrating the Healthcare Enterprise Healthcare Provider Directory
• 18 percent have no plans to adopt a standard
• 18 percent are considering their options
• Others use another proprietary standard or simply a relational database.

17. Incorporating consolidated clinical data architecture, identifying trading partners and funding implementations are reportedly as modestly challenging; completing the directory is reported as prohibitively challenging.

18. In the absence of meaningful use, respondents reported the following technical preferences for sending electronic health information:

• CONNECT — 27 percent
• SMTP/S-MIME — 23 percent
• Direct + XDR/XDM — 15 percent
• SOAP + XDR/XDM — 6 percent

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