DirectTrust is an organization that provides a secure communication network and protocols to exchange healthcare data with your connections. Learn more about DirectTrust.
They offer Direct Secure Messaging (Direct), a national encryption standard for securely pushing clinical healthcare data without a VPN. Over one million providers across the U.S. have a Direct email address for receiving clinical documents from other providers. Learn more about Direct.
Redox supports Direct via our Health Information Service Provider (HISP) partner Massachusetts Health Information Highway (Mass HIway). We have a contract directly with Mass HIway, and Redox is considered one of their Tier1c Technical Integrators. This means that other "participants" (i.e., Redox customers) can integrate with them through a Technical Integrator like us. Learn more about Mass HIway.
We support exchanging Direct messages as part of base cost of using Redox.
Direct is a communication method you can use to push CDAs to healthcare organizations without a Business Associate Agreement (BAA).
- Providers can communicate about patient treatment without having to set up an organization-specific integrations.
- Since patients receive care anywhere they choose, providers can exchange patient documentation without any existing relationship or affiliation between their organizations.
A caveat to this straightforward type of exchange is that there are real limitations. Setting up a connection with a healthcare organization (i.e., having an explicit BAA and relationship) often serves you the best. Learn more about Redox connections.
However, Direct exchange is the option to explore if:
- You need to dynamically communicate with a patient’s care team at various other organizations, making it impractical or impossible to set up individual connections with each organization.
- All other communication methods don’t work for your unique workflow.
- Works like email: Direct is email with enhanced security, which means it can be used just like standard emails.
- You can set up automated processes for your apps or healthcare organizations to automatically push data to a Direct address or build workflows where the user specifies the recipient.
- Requires HISPs: Direct messages must be sent through a HISP, which handles the actual data exchange and carries out the encryption/decryption and digital signing of each message.
- HISPs are regulated and monitored by DirectTrust, which is empowered by the Department of Health and Human Services (DHHS).
- Of the 19 authorized HISPs in the U.S., Redox has a partnership with Mass Hlway.
- Only requires a Direct address: Although you don’t need a BAA, both sender and receiver must have a Direct address. It should follow this format: @direct.HCOname.HISPname.net (e.g., @direct.partners.masshiway.net). The address can be issued to a person, organization, or machine.
- Healthcare organizations can set up a Direct address specific to an app they expect to receive messages from at their discretion.
- Apps can send directly to a specific provider without requiring intervention or approval from the healthcare organization.
While Direct is convenient and easy to set up, there are some limitations to be aware of:
- You don’t receive an acknowledgement (e.g., 200 response) that the Direct message was received like you would for other types of messages you send via Redox.
- You can’t query or use data on demand workflows. Direct is strictly a push-based workflow.
- Redox supports receiving Message Delivery Notifications (MDNs) or Delivery Status Notifications (DSNs) via Direct, but these aren’t typically reliable methods, nor are they well supported across Direct implementations.
- Direct only supports pushing CDAs and referral data, so it isn’t as flexible as HL7v2, which allows for more granular and more varied data types.
- Direct is a more of a manual type of data exchange, in that the receiver has to manually open the data like an email—unless the receiving system has more support or complexity for handling data within Direct messages.
- The local EHR system renders the pushed document. This means Redox doesn’t control how the document looks in their system.
As a Redox customer, you can push data via Direct like you would to any other connection. This means you can use the same sources or subscriptions you already use for other connections. Learn about Redox connections.
However, you must sign a Participation Agreement (PA) directly with Mass HIway to agree to their terms and conditions. Your Redox Account Manager provides a PA for you to fill out. We send the signed PA to Mass Hlway and note that you will join Mass Hlway under our existing agreement as a Technical Integrator. The turnaround time to confirm your participation takes typically one to two days.
You can choose your own Direct address with this domain: @direct.redox.masshiway.net. You must have your own Direct address to start participating in the DirectTrust network.
If you plan to receive Direct messages, your Direct address must visible in the Mass HIway directory. We let Mass Hlway know and work with them to publish it. However, this step is optional and isn’t required if you only want to send Direct messages.
You can push data to any provider that’s part of Mass HIway or a HISPHealth Information Service Provider (an accredited role that provides certificates and authorization for Direct exchange).
You must have the Direct address of the healthcare organization you want to send data to. This might be for an organization (e.g., partners) or a specific provider (e.g., Dr. Jones).
We regularly receive a spreadsheet from Mass HIway with a list of available National Provider Identifiers (NPIs) and corresponding Direct addresses. You can identify the Direct address using the NPI of the provider you want to send to.
A couple things to note:
- The DirectAddressFrom field is required when sending a Direct message. Redox generates and adds this for you in the Header of either the ClinicalSummary or Media data models.
- If recipients get a CDA from Redox with perceived issues, they must trace the error through the HISP or dig into the metadata and reach out to us directly.