Direct Messaging

HIway Direct Messaging

The Mass HIway offers Direct Messaging, a way to safely and securely exchange health information between healthcare entities. Providers can send and receive health information via Direct Messaging to obtain the medical history and coordinate the care of their patients. This provides a safer way of sharing patient information than faxing or mailing data to other providers.

What is Direct Messaging?

To implement Direct Messaging to securely exchange health information with other healthcare entities, providers need to connect their EHR to a HISP (Health Information Services Provider). Alternatively, if a provider has no EHR, or the EHR can't be connected to a HISP, the provider can use standalone secure Webmail for Direct Messaging.

Example of Direct Messaging via one HISP

A HISP is an entity that manages the secure electronic exchange of health information across a network of healthcare organizations and professionals using the Direct standard for transport. HISPs provide the technical infrastructure and services needed to send and receive Direct Messages across their network. The Mass HIway is a HISP.

The term HISP refers to the message transport functions needed to support the scaled deployment of the Direct standard across the healthcare market. These functions can be performed by the EHR vendor, by a healthcare organization or hospital, or by standalone entities specialized in HISP services.

To exchange Direct Messages via a HISP network, you need a Direct Address, which is provided by your HISP. As such, if you connect to the Mass HIway, you will receive a Direct Address(es). A Direct Address is like a secure email address that identifies you on the network. You can exchange Direct Messages with providers with a Direct Address and connected to the same HISP network.

Using an analogy, you may have Microsoft Outlook on your computer, but you can only send and receive emails if you have an email address, and your computer is connected to an email network. Likewise, if your EHR can exchange Direct Messages, you can only send and receive messages if you have a Direct Address and are connected to a secure HISP network.

HISPs establish trust networks by defining policies for network participation. Each HISP performs two key activities to regulate and scale the exchange of Direct Messages across their network:

Issue Security Certificates: These are tied to a HISP anchor certificate established to enforce the participation policies.

Issue Direct Addresses: These are tied to the HISP anchor certificate as per conventions defined by the Direct standard.

After you become a member, the HISP will provide the network services that connect your EHR to other EHRs using the Direct standard for communications. The services enable you to exchange Direct Messages to coordinate patient care with other providers.

HISP to HISP connections

HISPs can connect to other HISPs to expand their network. In this case, Direct Messages can not only be exchanged within their network, but also via the other HISP networks. The Direct Messages will transfer from one HISP to another as necessary to complete the information exchange. This expands the network of providers with whom you can exchange health information.

Example of Direct Messaging via two HISPs

The Mass HIway is connected to many other HISPs, which allows HIway users to exchange messages with the members of these HISPs.

Vice versa, if you are a member of another HISP, you can access the HIway network, provided your HISP configures your system to enable access to the HIway. Your HISP will still provide you with your security certificate and Direct address, but you will be able to exchange messages across the HIway. As a member of the HISP you will pay their access fees, but the HIway fees will be waived.

The Mass HIway and other HISPs in Massachusetts

To engage in Direct Messaging, there are many HISPs operating in the Commonwealth to choose from. In practice, however, EHR vendors may dictate the HISPs available to their users, as long as the vendors don’t block transmission of electronic health data.

Whether you can connect to a particular HISP therefore largely depends on which HISPs your EHR vendor supports. Some EHR vendors may require providers to use a specific HISP, which may be their own, or a standalone HISP they integrated with their EHR. Other vendors allow providers to choose any HISP they prefer, and the vendor will integrate the HISP accordingly.

If a vendor allows you to choose a HISP, you can choose to connect to the Mass HIway. If a vendor requires you to use a designated HISP, you can connect to the HIway indirectly via this HISP. This requires that the HISP is connected to the HIway as explained above.

DirectTrust Accreditation

DirecTrust logo

With the release of Mass HIway 2.0, the HIway became a member of the DirectTrust network. DirectTrust is a private non-profit organization that accredits HISPs on a voluntarily basis through its EHNAC DTAAP program. The EHNAC DTAAP accreditation process is unrelated to ONC's EHR certification process used in the Promoting Interoperability programs.

A significant advantage of the widespread DirectTrust network is that it connects many HISPs. By connecting to this network via the Mass HIway, it becomes easier for healthcare providers to find trading partners to exchange health information with. This in turn will help participants in meeting the HIE thresholds and targets of the Medicaid EHR Incentive and PI programs.

Direct Messaging FAQ

To review frequently asked questions and answers pertaining to Direct Messaging, click here.

Direct Messaging Overview Video

Review the animated video below to learn more about the Mass HIway and Direct Messaging.



Review the webinars below to learn more about the Mass HIway and Direct Messaging.

Introduction to participating in the Mass HIway - February 2019 - PDF


Improving Care Coordination by using Direct Messaging - October 2018 - PDF


Enroll in Mass HIway Direct Messaging

Connecting to the Mass HIway to use its Direct Messaging capabilities requires enrollment into this service. To review the enrollment process, click here.