ONC: Health information exchange happening more via Direct

Hospitals are using network-based methods for health information exchange now more than ever, leading to some, albeit modest, decreases in fax-based data exchange, according to recent data from the Assistant Secretary for Technology Policy/Office of the National Coordinator for Health IT.

In particular, the data brief revealed a marked jump in the number of hospitals using Direct to receive health information from another provider, from 61% in 2018 to 74% in 2023, the most recent year for which ASTP/ONC has data.

On the other side of the health data exchange coin, 49% of hospitals sent health information using Direct in 2018. That number increased to 66% in 2023.

Direct was created in 2010 as a part of the Medicare and Medicaid EHR Incentive Programs and ONC Health IT Certification Program, according to a blog post written to accompany the data brief.

"The Direct Project created Direct Secure Messaging, a simple, secure, scalable and standards-based method to send health information between partners and to provide a straightforward pathway to acquire unique provider and organizational addresses to engage in exchange that resembles secure email," ASTP/ONC's Jordan Everson and Brett Andriesen wrote in the post.

Health information exchange (HIE) is happening by other means in addition to Direct, the data brief continued.

For example, 72% of hospitals are sending and 64% of hospitals are receiving health data via a local HIE. That's up from 59% and 46% who did the same, respectively, in 2018.

Likewise, the number of hospitals sending and receiving health information using national networks is going up. In fact, national networks saw the largest rate of growth during the data brief's five-year study period. In 2018, 34% of hospitals sent and 32% received health data using a national network. By 2023, those numbers had risen to 67% and 62%.

Finally, ASTP/ONC observed increases in the number of hospitals sending and receiving data using vendor networks. The number of hospitals sending health data using a vendor network rose to 55% in 2023 from 33% in 2018. The number of hospitals receiving health data the same way rose to 58% from 41% in that same timeframe.

HIE via systems like Direct are a key step forward for health IT interoperability. They represent a move away from more analog and archaic methods, such as fax.

However, the ASTP/ONC data brief indicated fax is still being used much of the time.

Indeed, the number of hospitals using fax at all only fell from 71% in 2018 to 67% in 2023. The proportion of hospitals using fax "often" dropped from 40% to 30% during that time period.

ASTP/ONC still considers the decrease a win.

"The continued broad use of Direct in 2023 represents an important accomplishment for the industry, as well as a 'win' for patients, providers and information sharing in general," Everson and Adriesen said. "Direct has come 'standard' in certified health IT for years and is widely available and frequently used. We expect Direct and DirectTrust will continue to play a role with respect to interoperability into the future."

Sara Heath has reported news related to patient engagement and health equity since 2015.