Direct Messaging in EHRs: The 15-Year-Old Solution We Never Fully Adopted

Fifteen years ago, direct messaging was introduced as a simple, secure way for healthcare providers to exchange patient information. It was supposed to bridge the gap, enabling seamless communication without the complexities of full-fledged health information exchanges (HIEs).

Fast forward to today, and while we’ve seen significant advancements in interoperability, many organizations still struggle with real-time data sharing. Public and priva

te HIEs promise robust connectivity, yet adoption barriers, technical fragmentation, and governance challenges persist. Meanwhile, direct messaging (one of the simplest, most scalable solutions) remains vastly underutilized.

Who Should Be Using It?

For those who could leverage direct messaging, its impact is clear:

✅ Primary care referrals – Securely transmitting patient records and summaries to specialists without faxing or waiting for portals to sync. Direct and to the point.

✅ Post-discharge transitions – Ensuring rehab centers, skilled nursing facilities, and home health agencies receive timely discharge summaries to prevent readmissions.

✅ Behavioral health coordination – Enabling better integration of mental health and primary care by securely sharing critical patient insights.

✅ Pharmacy & lab communication – Accelerating prior authorizations and diagnostic result sharing in a way that doesn’t require complex API integrations.

So Why Aren’t They Using It?

Several factors have contributed to the underutilization of direct messaging in healthcare:

• Technological Limitations: Not all healthcare facilities have the infrastructure to support advanced communication tools. Limited funding and lack of software tailored to specific healthcare needs have hindered adoption of direct messaging in any sort of system (EHR or not).

  
  

• Resistance to Change: Some staff continue to resist adopting new communication methods. This resistance has stemmed from simple things like a lack of training (they don’t know how) to stubbornness (they don’t want to).

  
  

• Interoperability Issues: Fragmented care delivery systems mean repeated patient history sharing, which wastes time and creates inconsistencies. Without an integrated system, direct messaging can become another siloed tool, limiting its effectiveness and desirability.

  
  

QHIN Networks: A Game-Changer for Real-Time Data Transfer?

While direct messaging remains a valuable tool, the rise of QHIN (Qualified Health Information Network) exchanges under TEFCA is shifting the interoperability landscape. Unlike traditional HIEs, which often rely on batched data transfers, QHIN networks have the potential to enable real-time data sharing at scale, effectively addressing one of the core weaknesses of both HIEs and direct messaging.

That said, there’s still room for direct messaging in a QHIN-enabled world. While QHINs may handle large-scale, structured interoperability, direct exchange remains a critical tool for targeted, provider-to-provider communication, especially when speed and simplicity are needed without navigating a broader network.

Instead of viewing these technologies as competitors, we should be asking how direct messaging and QHINs can complement each other to create a truly seamless data-sharing ecosystem.

A Case of Overlooking the “Simple” for the “Complex”

The reality is direct messaging isn’t flashy. It’s not an AI-driven interoperability engine or a next-gen FHIR-powered API ecosystem. It’s a straightforward, email-like exchange mechanism that just works, and somehow, that’s been part of the problem.

Healthcare tends to chase ambitious, large-scale solutions, often at the cost of ignoring practical, incremental wins. Instead of optimizing and scaling direct messaging, we’ve spent years waiting for HIEs, TEFCA, and other grand interoperability frameworks to solve everything when a piece of the answer has been right in front of us.

It’s Time to Rethink Our Approach

Direct messaging won’t replace broader interoperability strategies, but it should absolutely be a bigger part of the conversation. We need to:

🔹 Reevaluate workflows – Where could direct messaging eliminate unnecessary faxes, phone calls, and duplicate data entry?

🔹 Encourage adoption – Ensure providers, specialists, and post-acute care organizations are equipped and incentivized to use direct messaging effectively.

🔹 Optimize interoperability strategies – QHINs, HIEs, and APIs are the future, but ignoring low-hanging fruit like direct messaging is an avoidable mistake.

Simple Solutions Still Matter

As we continue pushing for next-gen interoperability, we can’t afford to overlook proven, scalable tools just because they aren’t “new.” Direct messaging has been here for over a decade, maybe it’s time we actually used it.

How is your organization leveraging direct messaging? Are we missing an opportunity by not scaling its use? Love to hear your thoughts in the comments or a DM.