tag:blogger.com,1999:blog-4201874739367831894.post7626224750102783306..comments2024-03-28T01:46:02.526-05:00Comments on Healthcare Exchange Standards: Can Direct messages be "delegated/forwarded?"John Moehrkehttp://www.blogger.com/profile/04526719420117446030noreply@blogger.comBlogger7125tag:blogger.com,1999:blog-4201874739367831894.post-30059120175416137052012-07-27T09:04:37.928-05:002012-07-27T09:04:37.928-05:00John thanks for posting this. Glad to also hear DC...John thanks for posting this. Glad to also hear DCK's clarification. I like the idea of making different types of email addresses as you suggest, though that is policy and can't be enforced. Adrian also makes the excellent point that patients need the ability to forward what they receive (the "View/Download/TRANSMIT" objective) if they choose. <br /><br />Just to clarify the context of the "offline" question -- I was the one who sent it, asking whether a Direct Message to a specific doctor could be forwarded to other colleagues (e.g., other physicians in the practice, or office staff). <br /><br />Human behavior can't be totally governed. We expect "common courtesies" from people and usually get them, but not 100%. So even with the vast majority of personal and work-related emails which are unencrypted, I've made the mistake in the past of forwarding something sent to me, only to realize later that it contained some wording that the sender might not want shared (encryption or not!). So, trying to learn from that, I'm trying to develop the habit of asking the sender if it's OK to share the email with others. They generally say "sure" but thank me for asking. But I don't expect everyone to do this each time they forward a Direct message. Hopefully those who forward will fully comply with HIPAA and properly constrained use of the data for treatment, payment, and operations.<br /><br />DavidDavidhttps://www.blogger.com/profile/13251393010554964308noreply@blogger.comtag:blogger.com,1999:blog-4201874739367831894.post-35848222753916643652012-07-25T10:33:17.904-05:002012-07-25T10:33:17.904-05:00David,
It is very possible that I miss understood...David,<br /><br />It is very possible that I miss understood some conversations. I am glad to hear that DirectTrust is sticking only to identity and trust, and not going into governance of the use of Direct.John Moehrkehttps://www.blogger.com/profile/04526719420117446030noreply@blogger.comtag:blogger.com,1999:blog-4201874739367831894.post-21525552545739221912012-07-25T09:22:17.328-05:002012-07-25T09:22:17.328-05:00John: Nice piece. I want to say that I have no r...John: Nice piece. I want to say that I have no recollection of any position taken by DirectTrust, or within the Rules of the Road WG prior to the formation of DirectTrust, on this issue. Specifically, we are not to my knowledge trying to "force" anyone to do this, or anything else for that matter. Let me know if you have any documentation of a recommendation or other policy statement from DirectTrust on this matter.<br />regards, DCKDavid C. Kibbe, MD MBAhttps://www.blogger.com/profile/13787233253906112642noreply@blogger.comtag:blogger.com,1999:blog-4201874739367831894.post-10372031843370902032012-07-25T07:42:13.254-05:002012-07-25T07:42:13.254-05:00Adrian,
I have more faith in real people than I d...Adrian,<br /><br />I have more faith in real people than I do in government mandates. There is far more real e-mail today between doctors and patients than there ever will be using Direct.John Moehrkehttps://www.blogger.com/profile/04526719420117446030noreply@blogger.comtag:blogger.com,1999:blog-4201874739367831894.post-86278298571356673462012-07-24T21:14:49.619-05:002012-07-24T21:14:49.619-05:00There are three reasons to use Direct for sending ...There are three reasons to use Direct for sending links:<br /><br />1) links to streaming medical imaging that would be too large as an email attachment<br /><br />2) the doctor doesn't need to worry about PHI in the message introducing the links<br /><br />3) the EHRs will (let us pray) be mandated to accept Direct messages whereas they can ignore regular email and continue to charge for back end interfaces like HL7 and ExchangeAdrian Gropperhttps://www.blogger.com/profile/14435645301228523460noreply@blogger.comtag:blogger.com,1999:blog-4201874739367831894.post-34079303782390271502012-07-24T21:07:35.539-05:002012-07-24T21:07:35.539-05:00Adrian,
I very much agree with you statements tha...Adrian,<br /><br />I very much agree with you statements that Patients need to be considered a first-class citizen. You and I have been side by side on that point.<br /><br />However the sending of a link to a secured web-service, does not need Direct. This can be sent as a normal email without all the trust fabric that Direct is forced to build. The use of secured web-services is an alternative that I am also very much a proponent of. One definition for these links for document based targets is currently released as a IHE supplement -- Mobile access to Health Documents. I have authored and pushed for this profile because I see REST as a great solution for end-user access. <br /><br />There simply is no need to use the heavy Direct stack for secured web links. We need less friction, not more.John Moehrkehttps://www.blogger.com/profile/04526719420117446030noreply@blogger.comtag:blogger.com,1999:blog-4201874739367831894.post-17675011037320414092012-07-24T20:58:38.009-05:002012-07-24T20:58:38.009-05:00I posed this exact issue to the S&I RHEx group...I posed this exact issue to the S&I RHEx group. RHEx is charged with dealing with links sent in Direct messages. The person who accesses the link may or may not be the recipient of the Direct message. Either way, they will need to be authenticated and the link's host will have to decide if access is appropriate. <br /><br />Let's keep in mind that patients are first-class citizens in Direct and they need the convenience of forwarding and web links.<br /><br />So: Yes, we should allow forwarding of Direct emails and Yes we should encourage the use of links secured with OAuth and OpenID Connect to manage security as required by the patient.Adrian Gropperhttps://www.blogger.com/profile/14435645301228523460noreply@blogger.com