In response to the CMS Request for Information on the best replacement for fax, DirectTrust members voiced their support for the following statement. 

Direct Secure Messaging provides the most viable alternative or replacement for fax in healthcare today.

Based on the Direct Standard™, Direct is payload-agnostic scalable secure health information exchange, reaching the milestone of one billion Direct Secure Messages exchanged in 2019. Last quarter alone, more than 169 million messages were exchanged.

Furthermore, Direct is prevalent and accessible, as the exchange method is embedded in 2014+ Certified EHR Technology that more than 96% of all hospitals self-report using according to the AHA Annual Survey. Direct is also available for many other non-EHR sectors of the industry through web portal or app. Most recently, we’ve seen large growth in long-term post-acute care and public health reporting.

DirectTrust, a non-profit membership alliance dedicated to instilling trust in secure health information exchange, encourages CMS to recognize Direct Secure Messaging as the best alternative to fax due to its prevalence, security, and usability. Recognizing and endorsing Direct exchange provides a natural bridge to move fax traffic to a more interoperable means of communication that many already have access to, with no additional technology or investments.

The following organizations/individuals voice their support for Direct Secure Messaging as the best alternative/replacement for fax.

Alex Young

Improving interoperable communication across the seemingly endless combinations of devices in the current healthcare landscape should be a top priority for everyone involved. The sooner we move away from antiquated faxing the better. Direct Secure Messaging is the right tool for the job.

Audacious Inquiry

Azuba Corporation

We need to dramatically improve the quality of care and reduce the cost of care in the USA by streamlining the interoperability, availability, and usability of clinical health data across all health providers, payers, and patients. This can easily be accomplished by eliminating the reliance on fax technology that was created in 1843 by a little-known Scotsman named Alexander Bain, and replacing it with the currently available high powered and highly digital interoperability networking provided via Direct Secure Messaging.

Bob Janacek, CEO, DataMotion

Digital-first requirements for remote healthcare, Millennials and Generation Z all point away from legacy methods of collaboration such as fax and paper delivery. Direct Secure Messaging serves as the ubiquitous backbone of secure, digital push delivery for our healthcare providers, and is running at nationwide scale today. It is the natural, secure digital upgrade to fax, and can facilitate a rapid transition to a more cost-effective, modern digital healthcare system.

Julie Maas, CEO, EMR Direct

Recognizing the years of investment already made by the healthcare industry to support and be a steward to the Direct Standard — as evidenced by long-standing testing and accreditation programs, automating the processing of the structured data most likely to be exchanged via Direct (structured data and trusted endpoints being key benefits over fax), building directory, offering transparent practices and open source references that help make the service affordable to adopt, and evolving the standard that it may function robustly and seamlessly fit into additional workflows beyond referrals and transitions of care — this standard has been successfully adopted and its only flaw is that questions like this one arise, demonstrating that awareness is still clearly lacking.

Brett Blackman, HealthSplash

iPSE-U.S., The Association of Independent Workers

LifeWIRE Corp

Livanta LLC

Park Avenue Capital LLC dba MaxMD

Dan Paoletti, The Ohio Health Information Partnership

The Ohio Health Information Partnership supports broad information exchange in Ohio. The success for this work was recently documented in a data brief from ONC describing the state of interoperability among hospitals in 15 major U.S. cities. Northeast Ohio was shown to be one of the most interoperable cities. Those hospitals reported in the study higher rates of interoperability of health data compared to hospitals in the rest of country. Hospital interoperability increased with participation in health information exchanges and health IT developers’ footprint within a city.

Broad adoption of uses of standards like Direct Standard, eHealth Exchange, HL7 and Integrating the Healthcare Enterprise (IHE) standards can assist in maximizing interoperability and helping in “axing the fax” campaigns. Broadening these existing, widely adopted standards to Health plans, Community Service organizations and other involved in the healthcare continuum will have tremendous impact as being documented in Ohio.

Brett Hamilton, Product Director, Orion Health

Orion Health believes that DSM (Direct Secure Messaging) has achieved the adoption levels needed to be the simplest and most cost effective solution to replacing FAX, our clients trust us with their DSM solution to deliver medical data with far higher reliability and value than FAX. We have seen state level adoption of DSM which allows for 99% electronic coverage, FAX does not scale effectively and adds very little clinical value in value based care.

Rochester RHIO

Secure Exchange Solutions, Inc.

Existing fax infrastructure is content neutral and does not require complex technology interfaces between the sending and receiving parties. A digital solution to replace fax must be a generic, secure, already adopted communication standard which integrates to existing EMR systems. Direct Secure Messaging is the only existing data communication and exchange standard that meets these requirements and is the logical preferred method to transition from fax to interoperable secure data exchange.

Secure HIT

Least complicated way to create a secure electronic connection to another end point: The use of fax lines, in addition to being very expensive, allow a too wide margin of error where the protected information that we are so required to be careful of, tools such as the fax cause that by a number that you dial wrong, you are already disclosure with another unauthorized person.

Technology such as Direct Secure Messaging, allows both parties to have the information in a protected, stable and very accessible way, understood at hand. With the benefit that this technology is already integrated from 100% of certified EHRs and further enables the patient to exchange their information from a tool as simple and accessible as their email (Direct).

EHRs confirm that record sharing and referrals can mostly be dealt with today via Direct Secure Messaging instead of fax: The efforts made by the ONC a decade ago, in the implementation of Direct Secure Messaging from the EHR, is the strength that we currently have in our hands, this is a proven, secure and accessible technology (with minor implementation impacts) that allows the use of it in the middle of the emergency situation in which we find ourselves (COVID-19)

Looking at the Provider directory, Direct Secure Messaging is still a tool that offers in a standard way access to a complete and handy directory to find both the healthcare provider and the patient.

Scott A. Finlay

Steven Lane, MD, MPH, Sutter Health