General and Background
1) What is the DIRECT Project?
The DIRECT Project is the set of standards, policies and services that enable simple, secure transport of health information between healthcare participants (e.g., providers, labs) who know each other and already have a relationship of trust. The DIRECT Project enables standards-based exchange of health information in support of core Stage 1 Meaningful Use measures. This can include communication of summary care records, referrals, discharge summaries and other clinical documents in support of continuity of care and medication reconciliation, as well as communication of laboratory results to ordering providers.
2) How does the DIRECT Project help in achieving Meaningful Use?
The DIRECT Project specifies the technical protocols and services necessary to securely push content from a sender to a receiver. DIRECT focuses on the transportation and security mechanism for the content being exchanged, but does not specify the actual content itself. However, DIRECT-enabled products can be used by providers and organizations to transport and share different types of content specified by Meaningful Use – thus the combination of Meaningful Use-specified content and DIRECT-Project-specified transport standards will satisfy certain Stage 2 Meaningful Use requirements that involve health information exchange (e.g., care summary exchange and lab results delivery).
3) When using DIRECT, how can my organization transition to enable other more advanced exchange capabilities?
Although DIRECT and query/retrieve methods of exchange use different protocols and methods, many state HIE programs, for example, plan to implement DIRECT as part of their initial exchange efforts, then leverage the assets they use to support DIRECT — such as provider directory, certificate authority, and other health information service provider (HISP) services — as part of a longer-term strategy to support more advanced forms of exchange.
4) Is the information on DIRECT always there or goes away once opened?
Once the information is pulled down into the local application on your machine, it is stored there. The information will remain there until you decide to delete the information. This will apply to read messages as well.
1) How can DIRECT be deployed?
There are three primary deployment models for DIRECT. In the first model, an entity sends and receives DIRECT messages through a Web portal offered as a service of a Health Information Service Provider, or HISP – the user experience is much like that of a Web-based email account. In the second model, an entity sends and receives DIRECT messages using a standard email client which has been DIRECT-enabled, e.g., through a software plug-in or an upgrade to the email client. In the third model, an entity uses an EHR system software that is DIRECT-compliant, through which it sends and receives DIRECT messages from within the application. The process of generating data from an EHR and sending a DIRECT message, and/or receiving and integrating the contents of a DIRECT message into your EHR, is completely dependent on the capabilities of the application provided by the software vendor.
In all three deployment models, routing of the DIRECT message from one recipient to another is typically facilitated by a HISP. Encryption of the message typically occurs on the HISP (refer to the section on Certificates below).
2) What are the minimum requirements for DIRECT?
From an end-user perspective, there are two minimum requirements to participate in DIRECT:
- Known and trusted “DIRECT addresses” for the sender and the recipient: a DIRECT address is an identifier of the provider and location. This address is essentially an email address (e.g., it may look like “email@example.com”), and not usually one’s general-purpose email address.
- A digital certificate (see Certificates below), which associates (“binds”) the DIRECT address to a public key (often referred to as a “public certificate”) and to a private key.
3) How do I find someone’s DIRECT address?
South Dakota Health Link DIRECT will provide a statewide Individual Level Provider Directory (ILPD) which provides information to enable the routing of messages to participants of the South Dakota Health Link DIRECT community. Individuals joining South Dakota Health Link DIRECT must provide all their members with access to the most up-to-date information. The ILPD will be provided in a an Excel spreadsheet available here.
4) What is a HISP?
A Health Information Service Provider HISP is a role in a DIRECT message exchange that provides edge protocols, message formatting, security and routing according to the Direct project specification. A HISP also provides trust-store management tools and services for members. The HISP member may be providers, payers, EHR vendors, PHR vendors, health information exchanges and third-party entities.
5) What does it cost my organization to use DIRECT?
South Dakota Health Link is dedicated to be a customer focus provider of quality DIRECT services for healthcare providers and organizations. Our objective is to consistently deliver added customer value by providing the timeliest, efficient, and affordable service achievable. DIRECT services also replace the cost of faxes and telephone lines for many types of clinical messages. A DIRECT Webmail service is only $250 per year per DIRECT address which is $21 a month. Please contact the South Dakota Health Link online or by calling (605) 256-5867.
6) How do I sign up for DIRECT?
To begin the process, you will need to go to the following website and register: https://sdhealthlink.medicity.net/ or by contacting South Dakota Health Link at (605) 256-5867.
7) Are there additional costs for hardware or software?
No, there are no additional costs for hardware or software for DIRECT Webmail.
8) How do I get support if I am having problems?
Medicity Support Services are available 24×7 every day of the year to handle your DIRECT issues.
The Medicity Helpdesk may be contacted via the following methods:
For iNexx Issues and Enhancements, please contact Support via email at firstname.lastname@example.org or by phone at (888) 830-1022 and select option 3 and state that the issue involves iNexx Direct.
Please provide the below information:
- Include screenshots of issue if able
- After installation, provide the About information for your platform
- Your name, phone number, location city and email address
- iNexx DIRECT or DIRECT Webmail
- Current impact to your organization
- Description, as detailed as possible, regarding the issue such as is this a brand new issue or have you had this issue before?
- What are the best contact hours for Medicity to reach you?
9) Why do I need to be verified by my HISP?
South Dakota Health Link policy with every participating organization is to physically verify the organization to be a legitimate organization that sends or receives protected health information and has confirmed their commitment to comply with HIPAA and/or other applicable regulations.
10) Who should get a DIRECT address?
Any healthcare organization can apply to receive DIRECT email services. Upon approval, the organization will have to request to assign addresses to their physicians, medical record department, nurses, clinics, etc. The organization should certify that anyone receiving DIRECT address has accepted their policies and any of the organization’s regulation.
1) Do I need to have an Electronic Medical Record system for DIRECT to work?
No. DIRECT uses the internet to send and receive secure messages. You will need a computer with internet access and the ability to install the necessary secure email client or application supplied by your HISP.
1) How do we count a provider that works in multiple locations within the same organization?
The provider needs to be associated with one location within your organization.
2) How do we count a provider that works for multiple organizations?
Each organization will need to count the provider.
3) How do we count a provider that is contracted from another organization?
If they will access the Point of Care Exchange during their time working for you, you will need to count them as one of your providers.
4) How do we count a provider that works in both a hospital and a clinic?
If they are employed by a hospital, they are covered in the hospital fee. If they are employed by a clinic and have privileges at a hospital, they are counted as a provider of the clinic.
5) My organization has multiple clinic locations. Do we pay an annual fee for each?
No. Count all providers for your organization.
6) My organization has multiple hospital locations. Do we pay an annual fee for each location?
Yes. Hospitals are defined by Critical Access Hospital (CAH) and non-CAH based on licensed bed size. Each hospital will need to apply the appropriate fee based on CAH or appropriate bed size for each location.
7) We have Critical Access Hospitals (CAH) and non-CAH facilities. How do we know what one-time connection fee will be charged?
If one connection is required to connect all types of hospitals, the higher fee will be applied.
If multiple connections are required, please contact South Dakota Health Link to determine the appropriate fees.
8) When will I receive a notice of annual fee changes?
South Dakota Health Link has a finance committee that meets at least twice annually to address fees and other financial issues. South Dakota Health Link participants will be given at least 4 months advance notice of any fee changes.
9) Are there any per-transaction fees on top of my annual fee?
No. Your annual fee covers all transactions your organization makes.
10) What if we add more providers and subsequently go over our provider fee cap?
Your annual fee will be adjusted to reflect the appropriate rate for your next annual billing.
Please notify South Dakota Health Link any time you add new providers.
11) What feeds are part of the connection?
For hospitals there will be an ADT, Lab, Radiology, Transcription, Medications, and/or CCD feeds from your EMR. For clinics it is an ADT and CCD feed from your EMR.
12) How can we access the information in the exchange?
A web portal will be provided if your existing EMR does not allow for the integration of the HIE.
13) When is my annual fee payment due?
Your annual fee will be due when your implementation schedule begins and annually October 1st thereafter. You will be given the option to make a one-time or quarterly installment payments of your annual fee.
14) Is the annual fee pro-rated?
Depending on the start date of your implementation your bill may be pro-rated, please discuss this with SDHL if you have questions.
15) Will I receive a bill from South Dakota Health Link or Medicity?
You will receive your invoice for annual service from South Dakota Health Link. Dakota State University (DSU) serves as our fiscal agent so you will receive a W9 from DSU but you may make your payment out to South Dakota Health Link.
16) Do I have to pay the annual fee if I am only using DIRECT?
Yes, a DIRECT Webmail service is only $250 per year per DIRECT address which is $21 a month. Please contact the South Dakota Health Link online or by calling (605) 256-5867.
17) Can I use DIRECT as well as Point of Care Exchange as long as I pay the annual fee?
Yes, many organizations will find use cases for DIRECT and for Point of Care Exchange services that will enhance the quality and efficiency of care they provide to their customers.
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