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DIRECT Technology

DIRECT Technology is a secure messaging technique that transports Health Information Exchange (HIE) by directed, or point-to-point transactions.  This type of technology exchange relies on The DIRECT Project secure messaging protocol.  The DIRECT Project, launched in March 2010 as a part of the Nationwide Health Information Network, was created to specify a simple, secure, scalable, standards-based way for participants to send authenticated, encrypted health information directly to known, trusted recipients over the Internet.

DIRECT technology is a transport solution for HIE, therefore it does not focus on the content being exchanged.  Anything from simple text narratives to structured documents, such as transitions of care, lab results, or images can be exchanged using DIRECT.

The DIRECT message is secure because the information included is encrypted until opened by the intended recipient.  And DIRECT technology is easy to adopt because it looks and operates very much like commonly used electronic email systems.

Implementation of the DIRECT protocol is required for Meaningful Use Stage 2 CEHRT.  As required by ONC to meet the CEHRT definition, every EP, eligible hospital, and CAH, must have EHR technology that is capable of electronically transmitting a summary care record for transitions of care and referrals according to the primary DIRECT Project specification (the Applicability Statement for Secure Health Transport).  Therefore, EPs, eligible hospitals, or CAHs that electronically transmit summary care records using their CEHRT’s “DIRECT” capability (natively or combined with an intermediary) would be able to count all such electronic transmissions in their numerator.

For Tennessee healthcare providers wanting to use DIRECT technology to exchange healthcare information, there are two options to consider based on whether they operate in the private or public sector.

Tennessee Health eShare DIRECT Project. Any private healthcare provider in the State of Tennessee interested in DIRECT Technology can visit the Tennessee Health eShare DIRECT Project website to find out basic information about DIRECT Technology and a list of vendors that can provide DIRECT technology for secure message exchange.  All vendors listed on this website are certified in the Trust Bundle with (DTO).

The Health eShare DIRECT Project website is also where Tennessee providers can register their DIRECT address into the Tennessee DIRECT Directory.

Tennessee eHealth Portal – DIRECT for State Agency Users. The Tennessee eHealth Portal has been established to enable Tennessee State agency users to securely send and receive patient data to and from external healthcare providers and hospitals that have a DIRECT email address and to securely send and receive patient data internally, between State agencies and State agency users.


DIRECT HIE Technology

What is Direct Technology?

DIRECT technology is a transport solution for HIE and does not focus on the content being exchanged.  Therefore, anything from simple text narratives to structured documents, such as CCDs, lab results, or images can be exchanged using DIRECT.  DIRECT exchange describes the push of health information from a sender to a known receiver; similar to a how an email is pushed from one endpoint to another.

  • DIRECT operates similarly to electronic email so the technology is easy to adopt into a clinical practice workflow.
  • DIRECT messages can include attachments, such as clinical summaries, that providers need to exchange.

Direct uses a HISP (health information service provider) just as other email services use an ISP (internet service provider) to manage the flow of email transmissions.

  • To transmit DIRECT messages, providers must use what are known as health information service providers (HISPs).  These are similar to internet service providers (ISPs), except that HISPs must follow the DIRECT protocol, and requires that holders of DIRECT addresses be registered with a registration authority, and hold digital certificates from a certificate authority.
  • Secure, DIRECT messaging can only occur between participants of DIRECT technology.  In short, a DIRECT message can only be sent by and/or received by those who have adopted DIRECT accounts.  You cannot exchange DIRECT messages with Yahoo or Gmail accounts as any accounts other than DIRECT  would not be ‘recognized’ by the HISP as acceptable recipients.  This protects your PHI information!

DIRECT messages are secure by employing a Public Key Infrastructure (PKI) technology that encrypts the messages.  

  • DIRECT is secure in that each message is encrypted as soon as the sender hits ‘send’ and remains encrypted during transport until the intended recipient opens the message.  This protects your PHI information!
  • DIRECT messages are accessed through a web portal or directly from an electronic health record (EHR) system, providing information transfer via special accounts dedicated solely to DIRECT communications. 
  • DIRECT addresses are issued to those who should be sharing PHI (personal health information) and follow established security policies, including HIPPA.
  • HISPs only issue DIRECT addresses to those whose identity has been verified, a process called authentication.

For Stage 2 of Meaningful Use, all certified EHR systems must include DIRECT capability (i.e. upgraded to EHR versions that incorporate Direct into the EHR functionality). 

  • DIRECT will enable eligible professionals and hospitals to meet the MU requirements when used to send clinical summaries to other providers at transitions of care, including referrals.

Common Scenarios of using DIRECT messaging to support the transport of clinical information
DIRECT messaging supports common scenarios where one person or organization needs to send clinical information to another person or organization securely.
This simple push of information covers clinical scenarios like:

  • A primary care doctor refers her patient to a specialist. She sends the specialist a copy of the patient's clinical snapshot.
    • When the specialist completes his consult, he sends information about his findings back to patient's primary care provider.
  • A primary care doctor refers her patient to the hospital for observation or a scheduled surgery. She sends the hospital a copy of the patient's pertinent clinical information.
    • The patient is discharged from the hospital, which sends the patient’s discharge information back to the referring provider.
  • A provider, clinic, or hospital sends follow-up reminders to the patient.
  • A patient receives an immunization.
    • The physician sends a record of the immunization to the Tennessee Immunization Registry.

Many scenarios, each with a point who has the data, sending it to another point that needs the data. The Direct Project doesn't focus on what the data is, only the way it's transported.

Establishing Trust between HISPs
A trade organization called Direct Trust (DTO) launched a national accreditation program for HISPs, certificate authorities, and registration authorities in collaboration with the Electronic Health Network Accreditation Commission (EHNAC).  The goal of this program is to create a foundation of trusted data exchange and performance guarantees by operating under the same fundamental transport guidelines and security procedures.  This thereby, eliminates the need for each HISP to contract with other HISPs by completing BAs (Business Agreements) or TPAs (Trading partner Agreements) currently required by point-to-point exchange entities that operate data transport with differing guidelines.

Tennessee will be encouraging use of those HISPs listed in Accredited status for the DTAAP-HISP program on the EHNAC website, under the Accreditation Status Link. (  This helps to enable interoperability for providers and other stakeholders using DIRECT for health information exchange.


  • Learn more about Direct and The Direct Project – the original DIRECT project led by the Office of the National Coordinator for Health IT (ONC).
  • Learn more about Direct Trust and the foundation of trust being established for HISPs.

Tennessee eHealth Portal

Is your State Agency Interested in DIRECT Technology?

The Office of eHealth Initiatives has implemented a HISP for State employees that need to exchange healthcare information to physicians or to other State agencies like the Tennessee Department of Health that collect health information for population health management. To learn more, watch this short video.

If your Agency is interested in implementing DIRECT, please contact the Office of eHealth Initiatives at OeHI has a limited number of DIRECT addresses to issue and user training is available.

Tennessee eHealth Portal Website

DIRECT Policies for Tennessee State Agency Users

The State of Tennessee DIRECT Policies include the full range of privacy and security policies necessary to maintain the confidentiality of patient data being exchanged through DIRECT, including but not limited to: authorization, identity verification, access, and breach. The State of Tennessee by and through the Department of Finance and Administration (F&A), Division of Healthcare Finance and Administration (HCFA), Office of eHealth Initiatives (OeHI) has developed these DIRECT Policies.

Each Participating State Agency that has signed an Inter-Agency Agreement and Acknowledgement (Inter-Agency Agreement) between HCFA and the Participating State Agency and wishes to use the State Health Information Service Provider (HISP) services in the State of Tennessee must comply with these DIRECT Policies.

Click here to review the Polices that apply to DIRECT.

DIRECT Training for Tennessee State Agency Users

First Time User Training

A DIRECT email address will allow you to send and receive Patient Data through the Tennessee eHealth Portal.

To obtain a DIRECT email address:

  • Your manager must approve you for an account.
  • You must read and adhere to the State of Tennessee DIRECT Secure Messaging Policies.
  • Your State Agency’s DIRECT Security Manager or DIRECT Administrator will provide two forms for you to complete and sign: the Authorized User Identity Verification Form and the Authorized User Agreement Form.

After these steps are complete, you will receive an email from your DIRECT Administrator that will provide a link to the TN eHealth Portal. Click the link to start the DIRECT System Registration. The following interactive training lessons will prepare you for that step and setting up your DIRECT email address.

General Training Topics

Troubleshooting Problems with the lessons:

If you have a problem viewing these lessons, you should be aware that these interactive lessons require the Flash Player to be installed on the computer. You must have at least version 9 of the player. If you do not have Flash Player on your computer, please contact your IT Administrator.  Some devices do not allow the installation of the Flash Player; Apple iPhones and iPads are devices that you will not be able to use to take these lessons.

Quick Reference Sheets

These printable quick reference sheets are yours to use!

DIRECT USER GUIDES for Tennessee State Agency Users

Contacting your Tennessee Agency’s DIRECT Administrator

Each Participating State Agency has one or more DIRECT Administrators who manage DIRECT accounts for your State Agency. The DIRECT Account Administrator can guide you through the steps required to set up your User ID and password; setting up your DIRECT email address; answer questions relating to breach of the security; daily questions that may arise from normal operation of the system and use of the Provider Directory.  The DIRECT Administrator is also responsible for provisioning and de-provisioning users.

Find your DIRECT Administrator:

Tennessee DIRECT Administrators:

State of Tennessee DIRECT Administrator
Lovel VanArsdale
Phone: 615-507-6404

Tennessee Department of Health (Central Office)
Ricky Tyler
Phone: 615-741-0899

TDH East Tennessee Public Health Region
Luke Rogers
Phone: 865-549-5222

TDH Mid-Cumberland Public Health Region
John Humphrey
Phone: 615-650-7001


Tennessee’s DIRECT Directory

See a listing (and map location) of known Providers using DIRECT in the State of Tennessee or SEARCH for other DIRECT users by name, organization or City here.

Welcome to the Tennessee Health eShare Direct Project

What is the Health eShare Direct Project?
The Health eShare DIRECT Project is Tennessee’s statewide initiative to promote the understanding and adoption of DIRECT Technology. DIRECT technology allows participants in healthcare – physicians, clinical labs, patients, and public health agencies – to send and receive medical information in a secure way.

How does Direct benefit providers?
DIRECT empowers physicians and hospitals to deliver better care with increased efficiency and lower costs.

Using DIRECT, all connected parties can securely transfer medical summaries, hospital discharge information, diagnostic tests and more. With vital information more readily available, providers deliver more efficient and effective care.

DIRECT can lighten the workload of physicians’ offices by:

  • Streamlining the process of treatment authorizations for non-physician providers – home health, long-term care, therapists
  • Improving communication between members of a patient’s care team

How does DIRECT benefit the healthcare system as a whole?
DIRECT reduces the burden on healthcare administration potentially taking the fax machine out of the enterprise.

  • DIRECT creates communication channels for therapeutic consultation
  • DIRECT has the potential to improve quality and efficiency of care and reduce adverse events due to missing health information

What are some examples of improved communication?
Patients’ hospital discharge information is sent reliably to the next care setting at time of discharge.

  • Currently 75% of PCPs don’t have discharge summaries for patients at their first office visit after discharge
  • Too often physicians find themselves asking the patient “What happened in the hospital?”

Communication between PCPs and specialist referrals is facilitated.

  • Patients are often referred to specialists, including nutritionists and therapists, with little or no information sent with them
  • Consultation summaries from specialists often do not reach the PCP before the patient does, if at all, or may be filed in the patient record and never seen by the PCP
  • DIRECT allows important clinical information to be exchanged securely between providers in a timely fashion

In the future, patients will be engaged through open access to their own healthcare information.

  • DIRECT will allow for better flow of information to and from patient
  • Patient information will be sent directly to their DIRECT address or to their personal health record (PHR) portal
  • Can be one means of meeting MU2 requirement to enable patients to view, download and transmit their health information
  • Can be one means of meeting MU2 requirement to provide visit summaries
  • Can be one means of meeting MU2 requirement to provide patient instructions and reminders

In the future, Tennessee will use DIRECT to collect public and population health information.

  • Immunization registries
  • Cancer and other disease registries
  • Syndromic surveillance (for example, Centers for Disease Control monitoring of flu outbreaks)


How do I find a HISP Vendor to start using DIRECT for secure message exchange?
Visit HealtheShar  and select the Vendor Information tab.  The page will walk you through the steps of vendor selection and shows a listing of those HISPs that are currently part of the Trust Bundle for interoperability exchange with DTO.


How do I register my DIRECT email address to be part of the Tennessee DIRECT Directory?
Visit , select the Directory tab and clink on the link “Register for the Directory HERE”.  Complete the directory registration form and you will be added to both the Directory listing and the map locator.

The HealtheShare Directory page provides a LISTING of Tennessee providers with DIRECT addresses and provides a place to perform a SEARCH for providers with DIRECT, either by Name, City, Specialty or Organization.