Health Information Exchange (HIE) uses Direct Messaging to securely exchange patient health information between care providers for transitions of care. When clinicians send information to another provider via HIE, they need to know the Direct Address of the other provider. They can use a Provider Directory or a Trading Partner Directory to find the correct Direct Address.
As part of the HAUS Services, your HIway Account Manager can work with your organization to ensure these directories can be used effectively. In particular, they can assist you in creating or cleaning up your Trading Partner Directory. This is further explained at the end of this page, following an introduction to the purpose of these directories.
Provider Directories versus Trading Partner Directory
A Provider Directory is a listing of healthcare providers that includes their Direct Addresses. The directory also contains identifying information such as a physical address, phone number, and name of the provider’s practice. This information enables providers to search for the correct practitioner to receive protected health information.
HIEs typically offer a Provider Directory of the providers connected to the HIE. For instance, the Mass HIway offers a Provider Directory based on the DirectTrust network. As this includes all providers connected to the HIE, these directories include providers from other organization that one may never work with, which may complicate finding the right practitioner.
If an organization is connected to multiple HIEs, it may end up with multiple Provider Directories. For instance, an organization may have a directory from their EHR vendor, an HIE vendor (HISP), and the Mass HIway. In this case, the combined directories may contain even more providers the organization never deals with, thus further complicating the search.
To resolve this issue, an organization can create a Trading Partner Directory (TP Directory), which is an internal Provider Directory that is limited to only include providers with whom the organization partners to provide care to shared patients. Using a TP Directory can greatly simplify finding the correct Direct Address. Where a Provider Directory is like the yellow pages, a Trading Partner Directory is like a contact list on a phone.
TP Directory Cleanup and Maintenance
Over time, a Trading Partner Directory can become inaccurate as provider data may change. If a TP Directory isn’t kept up to date by the organization, a needed Direct Address may not be available, which can slow patient care. If a Direct Address is incorrect, protected information may end up going to the wrong recipient, resulting in a HIPAA violation.
If Direct Addresses can't be found, this creates missed opportunities to use HIE for transitions of care. In addition to the medical and legal ramifications, a provider may then miss out on financial incentives from the Promoting Interoperability programs, which require transitions of care to be handled via HIE.
To ensure patient information can be sent to the correct providers, organizations need to first clean up and then regularly maintain their TP Directory. Existing Direct Addresses need to be reviewed for accuracy. Addresses of providers who are no longer Trading Partners may need to be removed, and new Trading Partners may need to be added.
The Provider Directories available to the organization can be utilized to correct, delete, or add Direct Addresses to the TP Directory. However, before an organizations considers adding providers, a phone call to a Trading Partner organization may need to be made to understand their current Direct Message capabilities.
The cleanup of existing Direct Addresses involves reviewing the addresses to ensure these meet a specific set of criteria:
- Is the format that of a Direct Address and not a regular email address?
- Does the name or department, listed before the ‘@’ symbol, match the name of the provider, department or the organization?
- Does the domain, listed after the ‘@’ symbol, align with what is expected for the type of organization and technology they use?
Organizations are advised to maintain their TP Directory at least quarterly to ensure all information is accurate and complete. This can be time consuming, but the risk of having an out of date directory can be detrimental and have a negative impact on the organization.
Having multiple people work on the maintenance may be ideal to ensure nothing is missed. Given the detailed nature of the process, allowing plenty of time for completion will reduce the need of tackling the entire directory at once, thus avoiding fatigue and mistakes.
HAUS Support for the Creation or Cleanup of your TP Directory
The team can advise how to recognize Direct Addresses versus regular email addresses, and can provide support for deleting and adding addresses. They have access to several Provider Directories, which they can make available to your organization for this purpose.
Furthermore, the Account Managers are familiar with the capabilities of some of the most popular EHR systems and they can help determine a potential Trading Partner’s capability. This can help to ensure you don't include providers who don't actively use HIE.
If your organization has Provider Directories from your EHR and HIE (HISP) vendors, the Account Managers can also assist with taking those into account as well. This works best if you can provide access to these directories.