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DirectTrust Direct Interoperability Success Story Use Cases

Contact Information

Use Case


Christopher Mack – Sutter Health

Bi-directional Direct referrals

Sutter Health created bi-directional closed loop referral workflows allowing us to send referrals and receive information back from consultants via Direct, resulting in more efficient workflows, quicker referral turnaround times, and improved patient and staff satisfaction.

Theresa Bell - Kno2

Transitioning fax-based workflows to Direct exchange

Bi-directional Direct messaging pilot in which most of the exchange between a health system and a control group of community providers was converted from fax to Direct interoperability.  Roll-out to all community providers is underway.

Alan Swenson - Kno2



Direct interoperability closing the loop on diabetic eye exam referrals

Referrals for diabetic eye exams moved from patient self-scheduling to Direct messaging referrals with scheduling by the ophthalmologist’s office. Results were sent to the patient’s PCP via Direct, resulting in a change from PCP’s receiving results only 35% of the time to receiving results within 48 hours, as well as eliminating faxing, reducing referral scheduling time, and leading toward the automation of health maintenance task completion within the PCPs’ EHR.

Larry Garber, MD - Reliant Medical Group (RMG)

Automated patient summaries to the ED via Direct to optimize patient care in the ED

RMG initially gave ER physicians access (Pull) to their Electronic Health Record (EHR) but found that they rarely looked up patient information. So Reliant created a process to automatically send a patient summary document (push) containing medications, allergies, problems, recent test results, etc. using Direct Interoperability to the ER’s EHR. RMG now automatically receives registration events (ADT) from all of the ERs in Central MA when a patient says their PCP is an RMG physicians. RMG’s EHR receives these ADTs and automatically sends a patient summary document (C-CDA, CCD) via Direct back to the ER along with the ER EHR’s medical record number so that it instantly files into the ER’s EHR. Patients are receiving higher quality, more efficient care because the ER physicians can readily see the latest medical information pushed to their own EHR.

Larry Garber, MD - Reliant Medical Group (RMG)


Automated push event notifications and care plan updates to home health using Direct messages

RMG relays event notifications from their local hospitals by pushing Direct messages to the Home Health Agency whenever a shared patient is seen in the ED or admitted to hospital.  This facilitates avoiding unnecessary home health visits when a patient has been admitted and allowing immediate home health to follow up when a patient returns home after an ED encounter.  RMG has also automated a pushed CCD with visit note to the Home Health Agency whenever a shared patient is seen by the PCP or a specialist, facilitating the home health nurse to always be aware of updates to the patient’s treatment plan.

Arthur Lauretano, MD, MS, FACS – Circle Health


Hospital ADT notifications to patient’s PCP’s EHR via Direct. Upon receipt, PCPs push patient information to the hospital

Circle Health/Lowell General Hospital EHR sends real-time ADT (Admit, Discharge, Transfer) notifications using Direct messaging technology to Primary Care Physicians’ EHRs (Cerner) within our community to help them better coordinate care for their patients.  Upon receipt of the ADT notification the PCP sends the patient’s latest progress note via Direct to the Hospital. This arrives in a hospital pool and is attached to the patient’s chart for the patient’s hospital caregivers to review.

Glen Crandall – Department of Veterans Affairs (VA)

Direct enabled closed loop referral with non-VA community specialists

In OH, the VA uses Direct Messaging with three large Ohio health systems for closed loop referrals.  This has resulted in significant savings of time and staff resources for information exchange. Direct Messaging has improved care coordination for Veterans!  A VA user in Ohio says with VA Direct Messaging, “that we get [health information] immediately from community providers- plus we can converse electronically if there is an issue with the medical records!”

Glen Crandall – Department of Veterans Affairs (VA)

Bi-directional acute-ambulatory Direct patient messages

A North Florida/South Georgia bidirectional Direct interoperability acute – ambulatory pilot between the VA and HCA organizations is now ready to be rolled out nationally.  HCA sends the VA a daily census of VA admitted patients.  In response the VA sends to HCA a C-CDA for these patients. On discharge HCA pushes, via Direct, a discharge C-CDA to the VA EHR to enable care management. The document also assists with VA’s payment process to community care providers, when an open consult is completed using the clinical data received via Direct Messaging.  A VA user in Florida exclaimed, “I have grown to love VA Direct Messaging because as soon as the patient gets discharged, I get documents. It’s wonderful! “