DIRECT Technology is a secure messaging technique that transports Health Information Exchange (HIE) by directed, or point-to-point transactions. This type of technology exchange relies on The DIRECT Project secure messaging protocol. The DIRECT Project, launched in March 2010 as a part of the Nationwide Health Information Network, was created to specify a simple, secure, scalable, standards-based way for participants to send authenticated, encrypted health information directly to known, trusted recipients over the Internet.
DIRECT technology is a transport solution for HIE, therefore it does not focus on the content being exchanged. Anything from simple text narratives to structured documents, such as transitions of care, lab results, or images can be exchanged using DIRECT.
The DIRECT message is secure because the information included is encrypted until opened by the intended recipient. And DIRECT technology is easy to adopt because it looks and operates very much like commonly used electronic email systems.
Implementation of the DIRECT protocol is required for Meaningful Use Stage 2 CEHRT. As required by ONC to meet the CEHRT definition, every EP, eligible hospital, and CAH, must have EHR technology that is capable of electronically transmitting a summary care record for transitions of care and referrals according to the primary DIRECT Project specification (the Applicability Statement for Secure Health Transport). Therefore, EPs, eligible hospitals, or CAHs that electronically transmit summary care records using their CEHRT’s “DIRECT” capability (natively or combined with an intermediary) would be able to count all such electronic transmissions in their numerator.
For Tennessee healthcare providers wanting to use DIRECT technology to exchange healthcare information, there are two options to consider based on whether they operate in the private or public sector.
Tennessee Health eShare DIRECT Project. Any private healthcare provider in the State of Tennessee interested in DIRECT Technology can visit the Tennessee Health eShare DIRECT Project website to find out basic information about DIRECT Technology and a list of vendors that can provide DIRECT technology for secure message exchange. All vendors listed on this website are certified in the Trust Bundle with DirectTrust.org (DTO).
The Health eShare DIRECT Project website is also where Tennessee providers can register their DIRECT address into the Tennessee DIRECT Directory.
Tennessee eHealth Portal – DIRECT for State Agency Users. The Tennessee eHealth Portal has been established to enable Tennessee State agency users to securely send and receive patient data to and from external healthcare providers and hospitals that have a DIRECT email address and to securely send and receive patient data internally, between State agencies and State agency users.
What is Direct Technology?
DIRECT technology is a transport solution for HIE and does not focus on the content being exchanged. Therefore, anything from simple text narratives to structured documents, such as CCDs, lab results, or images can be exchanged using DIRECT. DIRECT exchange describes the push of health information from a sender to a known receiver; similar to a how an email is pushed from one endpoint to another.
Direct uses a HISP (health information service provider) just as other email services use an ISP (internet service provider) to manage the flow of email transmissions.
DIRECT messages are secure by employing a Public Key Infrastructure (PKI) technology that encrypts the messages.
For Stage 2 of Meaningful Use, all certified EHR systems must include DIRECT capability (i.e. upgraded to EHR versions that incorporate Direct into the EHR functionality).
Common Scenarios of using DIRECT messaging to support the transport of clinical information
DIRECT messaging supports common scenarios where one person or organization needs to send clinical information to another person or organization securely.
This simple push of information covers clinical scenarios like:
Many scenarios, each with a point who has the data, sending it to another point that needs the data. The Direct Project doesn't focus on what the data is, only the way it's transported.
Establishing Trust between HISPs
A trade organization called Direct Trust (DTO) launched a national accreditation program for HISPs, certificate authorities, and registration authorities in collaboration with the Electronic Health Network Accreditation Commission (EHNAC). The goal of this program is to create a foundation of trusted data exchange and performance guarantees by operating under the same fundamental transport guidelines and security procedures. This thereby, eliminates the need for each HISP to contract with other HISPs by completing BAs (Business Agreements) or TPAs (Trading partner Agreements) currently required by point-to-point exchange entities that operate data transport with differing guidelines.
Tennessee will be encouraging use of those HISPs listed in Accredited status for the DTAAP-HISP program on the EHNAC website, under the Accreditation Status Link. (http://www.ehnac.org/status). This helps to enable interoperability for providers and other stakeholders using DIRECT for health information exchange.
Is your State Agency Interested in DIRECT Technology?
The Office of eHealth Initiatives has implemented a HISP for State employees that need to exchange healthcare information to physicians or to other State agencies like the Tennessee Department of Health that collect health information for population health management. To learn more, watch this short video.
If your Agency is interested in implementing DIRECT, please contact the Office of eHealth Initiatives at firstname.lastname@example.org. OeHI has a limited number of DIRECT addresses to issue and user training is available.
The State of Tennessee DIRECT Policies include the full range of privacy and security policies necessary to maintain the confidentiality of patient data being exchanged through DIRECT, including but not limited to: authorization, identity verification, access, and breach. The State of Tennessee by and through the Department of Finance and Administration (F&A), Division of Healthcare Finance and Administration (HCFA), Office of eHealth Initiatives (OeHI) has developed these DIRECT Policies.
Each Participating State Agency that has signed an Inter-Agency Agreement and Acknowledgement (Inter-Agency Agreement) between HCFA and the Participating State Agency and wishes to use the State Health Information Service Provider (HISP) services in the State of Tennessee must comply with these DIRECT Policies.
Click here to review the Polices that apply to DIRECT.
First Time User Training
A DIRECT email address will allow you to send and receive Patient Data through the Tennessee eHealth Portal.
To obtain a DIRECT email address:
After these steps are complete, you will receive an email from your DIRECT Administrator that will provide a link to the TN eHealth Portal. Click the link to start the DIRECT System Registration. The following interactive training lessons will prepare you for that step and setting up your DIRECT email address.
General Training Topics
Troubleshooting Problems with the lessons:
If you have a problem viewing these lessons, you should be aware that these interactive lessons require the Flash Player to be installed on the computer. You must have at least version 9 of the player. If you do not have Flash Player on your computer, please contact your IT Administrator. Some devices do not allow the installation of the Flash Player; Apple iPhones and iPads are devices that you will not be able to use to take these lessons.
Quick Reference Sheets
These printable quick reference sheets are yours to use!
Each Participating State Agency has one or more DIRECT Administrators who manage DIRECT accounts for your State Agency. The DIRECT Account Administrator can guide you through the steps required to set up your User ID and password; setting up your DIRECT email address; answer questions relating to breach of the security; daily questions that may arise from normal operation of the system and use of the Provider Directory. The DIRECT Administrator is also responsible for provisioning and de-provisioning users.
Find your DIRECT Administrator:
State of Tennessee DIRECT Administrator
Tennessee Department of Health (Central Office)
TDH East Tennessee Public Health Region
TDH Mid-Cumberland Public Health Region
See a listing (and map location) of known Providers using DIRECT in the State of Tennessee or SEARCH for other DIRECT users by name, organization or City here.
What is the Health eShare Direct Project?
The Health eShare DIRECT Project is Tennessee’s statewide initiative to promote the understanding and adoption of DIRECT Technology. DIRECT technology allows participants in healthcare – physicians, clinical labs, patients, and public health agencies – to send and receive medical information in a secure way.
How does Direct benefit providers?
DIRECT empowers physicians and hospitals to deliver better care with increased efficiency and lower costs.
Using DIRECT, all connected parties can securely transfer medical summaries, hospital discharge information, diagnostic tests and more. With vital information more readily available, providers deliver more efficient and effective care.
DIRECT can lighten the workload of physicians’ offices by:
How does DIRECT benefit the healthcare system as a whole?
DIRECT reduces the burden on healthcare administration potentially taking the fax machine out of the enterprise.
What are some examples of improved communication?
Patients’ hospital discharge information is sent reliably to the next care setting at time of discharge.
Communication between PCPs and specialist referrals is facilitated.
In the future, patients will be engaged through open access to their own healthcare information.
In the future, Tennessee will use DIRECT to collect public and population health information.
How do I find a HISP Vendor to start using DIRECT for secure message exchange?
Visit HealtheShar eTN.com and select the Vendor Information tab. The page will walk you through the steps of vendor selection and shows a listing of those HISPs that are currently part of the Trust Bundle for interoperability exchange with DTO.
How do I register my DIRECT email address to be part of the Tennessee DIRECT Directory?
Visit HealtheShareTN.com , select the Directory tab and clink on the link “Register for the Directory HERE”. Complete the directory registration form and you will be added to both the Directory listing and the map locator.
The HealtheShare Directory page provides a LISTING of Tennessee providers with DIRECT addresses and provides a place to perform a SEARCH for providers with DIRECT, either by Name, City, Specialty or Organization.