Abstract
Background Secure clinical messaging and document exchange utilizing the Direct Protocol (Direct
interoperability) has been widely implemented in health information technology (HIT)
applications including electronic health records (EHRs) and by health care providers
and organizations in the United States. While Direct interoperability has allowed
clinicians and institutions to satisfy regulatory requirements and has facilitated
communication and electronic data exchange as patients transition across care environments,
feature and function enhancements to HIT implementations of the Direct Protocol are
required to optimize the use of this technology.
Objective To describe and address this gap, we developed a prioritized list of recommended
features and functions desired by clinicians to utilize Direct interoperability for
improved quality, safety, and efficiency of patient care. This consensus statement
is intended to inform policy makers and HIT vendors to encourage further development
and implementation of system capabilities to improve clinical care.
Methods An ad hoc group of interested clinicians came together under the auspices of DirectTrust
to address challenges of usability and create a consensus recommendation. This group
drafted a list of desired features and functions that was published online. Comments
were solicited from interested parties including clinicians, EHR and other HIT vendors,
and trade organizations. Resultant comments were collected, reviewed by the authors,
and incorporated into the final recommendations.
Results This consensus statement contains a list of 57 clinically desirable features and
functions categorized and prioritized for support by policy makers, development by
HIT vendors, and implementation and use by clinicians.
Conclusion Fully featured, standardized implementation of Direct interoperability will allow
clinicians to utilize Direct messaging more effectively as a component of HIT and
EHR interoperability to improve care transitions and coordination.
Keywords
provider–provider communications - interfaces and usability - care transition - health
information interoperability - health information exchange - user–computer interface
- continuity of care document
