Use of the Direct Standard for Patient Event Notifications: A Qualitative Study Among Industry Leaders

Abstract

Abstract Background Health care organizations seek to maximize efficiency and effectiveness when sending patient event notifications required by the U.S. Centers for Medicare and Medicaid Services Interoperability and Patient Access Final Rule. Objectives To identify the barriers for senders (i.e., hospitals) and receivers (Department of Veterans Affairs [VA] and non-VA) of patient event notifications using the Direct Standard, the transport method standard that addresses Direct Messaging (DM). Methods Questions were asked to better understand perceived barriers to sending and receiving event notifications as well as involvement with event notifications with VA. Open coding was used to identify themes in the transcribed interviews. Results Analysis of the interviews (n = 17) showed workflow barriers, including identifying a patient's provider, the provider's Direct address, and whether a patient is an enrolled Veteran, were the most common barriers. Next were technical barriers, such as payload and electronic health record ingestion of event notifications. Less common barriers included content, policy/governance, cost, and organizational issues. The interviews also highlighted a promising pilot between VA and an aggregator. Conclusion Overall, interviewees felt that event notifications are a benefit from a coordination of care perspective for patients and clinical care teams. Also, interviewees felt that DirectTrust's Implementation Guide for Event Notifications via the Direct Standard has helped guide (and perhaps the DirectTrust Directory could help guide) the industry in sending and more effectively receiving event notifications.