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Improving Direct Secure Messaging through Directory Management.

Kristian Feterik1, Katherine Lusk2, Kathryn Ayers Wickenhauser3

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Standardizing Direct Secure Messaging (DSM) address directory management improves health information exchange. Implementing best practices reduced undeliverable messages and increased new Direct addresses, enhancing interoperability.

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Area of Science:

  • Health Informatics
  • Healthcare Interoperability
  • Digital Health Communication

Background:

  • Direct Secure Messaging (DSM) is crucial for healthcare data exchange but is hindered by incomplete address directories.
  • Lack of standardized directory management workflows impedes timely and universal access to health information.
  • The Texas Health Services Authority (THSA) identified an urgent need for improved DSM address directory practices.

Purpose of the Study:

  • To develop best practices for maintaining DSM address directories.
  • To create recommendations for increasing DSM technology adoption in Texas.
  • To establish a model policy for nationwide DSM optimization.

Main Methods:

  • A workgroup was formed by THSA to focus on increasing DSM adoption.
  • A modified Delphi process was used by workgroup members from August 2021 to March 2022.
  • THSA monitored message volume in 38 hospitals before and after policy implementation.

Main Results:

  • A DSM address directory management best practice policy was published in May 2022.
  • Messages not sent due to unknown addresses decreased from 50% to 42% between September 2021 and December 2022.
  • Participating organizations reported a steady monthly increase in new Direct addresses issued from July 2021 to March 2024.

Conclusions:

  • Healthcare organizations must standardize DSM address data and synchronize with external databases for seamless message flow.
  • Immediate updates to directory entries upon practitioner status changes are essential.
  • The THSA's policy offers a model for optimizing DSM as a key interoperability standard nationwide.