Blog Post

Direct Secure Messaging: The Missing Link in Strengthening Care Coordination

Faxed communications, paper or digital, create administrative burdens on staff and holes in data security. Find out why DSM can change that.

Heidi Jannenga
5 min read
August 2, 2023
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Since the pandemic, there has been a significant rise in the adoption of digital solutions within the rehab therapy arena. According to WebPT’s 2023 State of Rehab Therapy report, 68.3% of the nearly 6,000 respondents currently use telehealth, and—with just two years under its belt—15.8% of respondents have implemented remote therapeutic monitoring in their clinics. These data points demonstrate the growing acceptance of digital solutions to improve the overall patient experience and reduce the administrative burden that often impedes quality patient care.  

Yet, despite this progress, it may surprise you to learn that many private rehab therapy practices (and healthcare practices at large) still rely on an archaic technology for communication: fax. In fact, 75% of patient information in the US is still communicated via fax, and only 56% of faxed referrals end up with scheduled appointments. Moreover, traditional fax remains highly vulnerable to hacking, with the highest fine for a HIPAA violation—amounting to $2.5M—being issued for a fax sent to the wrong number. In an era where so many secure solutions exist to solve mundane—yet integral—tasks such as referral management and inter-professional communication, one might wonder why rehab therapy clinics are still so reliant on fax?

HIPAA compliance and the low cost of a fax machine were the drivers, but today, there are companies like Kno2, who are spearheading an industry-wide evolution toward direct secure messaging (DSM). DSM aims to empower users to safely manage all inbound and outbound communications, effectively meeting the demands of an increasingly digital industry. So, without further ado, let’s delve into the reasons why DSM is the long-awaited digital transformation that private practices of all sizes cannot afford to overlook.

What is direct secure messaging? 

While the most basic definition of DSM can be inferred from its name, its true meaning lies in its role as a secure and efficient method of exchanging sensitive patient information among healthcare providers and organizations electronically. 

At its core, DSM utilizes a technical standard called the Direct Standard™, which sets guidelines for exchanging health information among different healthcare entities. These entities can include primary care physicians, specialists, hospitals, clinical labs, and other healthcare providers involved in a patient’s care. Most DSM platforms and entities rely on the DirectTrust network to support this secure exchange of information. In a nutshell, DirectTrust is a non-profit trade alliance that grants trusted access to secure and encrypted services, promoting interoperability and communication among different healthcare professionals.

DSM vs. Digital Faxing

Before we move on, it’s important to note that DSM and digital faxing are not one and the same. “The only comparison between DSM and digital faxing is that they are both paperless,” stated Therasa Bell, President and CTO at Kno2. “However, DSM transmits key patient information, including the full name, gender, and often the address and phone number, directly from the sender to the receiver. Whereas digital faxes still require a human, or imperfect technologies like optical character recognition, to manually read and identify patient data.”

Bell went on to provide other key differences between DSM and digital faxing, which I’ve summarized in a side-by-side comparison chart:

What are the benefits of direct secure messaging? 

I know DSM may seem like a drop in the bucket amidst all the other priorities our profession is currently contending with, but it lays the groundwork for a larger movement aimed at enhancing interoperability, communication, and collaboration among providers. So, with that, let’s take a closer look at how these advantages can lead to significantly improved practice and patient experiences. 

Improved Care Coordination 

As we know, delivering the right information at the right time to the right person is critical to optimal care delivery and coordination. But as it currently stands, communication channels across healthcare organizations are incredibly fragmented. According to TigerConnect’s 2020 State of Healthcare Communications study, groups across the US health system are still using a variety of tools to facilitate inter-organizational communication. And while physicians and nurses identified secure messaging as their preferred method of communication, allied health professionals (including PTs, OTs, and SLPs) and staff outside of hospitals rely predominantly on landlines. Given this lack of consistency, it should come as no surprise that “39% of healthcare professionals surveyed say it is difficult or very difficult to communicate with one or more groups of care team members.”

Furthermore, this study revealed that lapses of care are more prevalent when secure messaging is not implemented across the organization, underscoring DSM’s most vital benefit: improved care coordination. Real-time digital communication enables rehab therapists to easily connect with referring providers and other healthcare professionals on a patient’s treatment plan—as well as receive up-to-the-minute updates to that plan—facilitating greater clarity and collaboration in the process. DSM also enables rehab therapists to obtain nearly instantaneous digital signatures for plans of care (POCs) or additional physician orders—which has never been more necessary amidst the rising number of administrative hurdles that are placed between rehab therapy providers, patients, and payment for services.

DSM and HIEs

On a broader scale, regulatory boards on the state and national levels are seeking to address healthcare fragmentation through health information exchanges (HIEs). Participation in an HIE, enabled by a DSM-certified EMR, ensures standardized communication between different facilities and providers, promoting seamless data transmission and ultimately enhancing patient care coordination—which is a perfect segue to my next point.

Enhanced Patient Satisfaction

In my days as a clinic director, I can vividly recall the frustration of having to triage disgruntled patients due to lost faxes or spending time hunting down fax numbers in the Rolodex—neither of which are activities conducive to patient care. However, DSM presents a relatively simple solution to removing these distractions and helping providers refocus their attention on where it matters most: the patient. (Queue the patient-centered care trumpets!)

As Bell aptly stated, “Patients take comfort in knowing that their records and critical information are flowing smoothly from one provider to the next and that they’re not responsible for brokering the engagement. Moreover, this enables prompt engagement for scheduling through phone, email, or text, as the patient's contact details are often included in the received information.”

Regarding Bell’s last point, I found a highly interesting (and encouraging) study in which 89% of specialists who utilized eReferrals—as opposed to paper-based referrals—saw a considerable decrease in wait times for new patient visits. And as we all know, shorter wait times directly contribute to higher levels of patient satisfaction.

Stronger Referral Relationships

As DSM weaves its way into rehab therapy workflows, it serves as a natural catalyst for strengthening relationships with referral sources. As I mentioned, DSM is a tremendous tool for streamlining interdisciplinary communications—making it a heck of a lot easier for all care team providers to work cohesively toward their common goal. And, being a DSM-enabled entity puts your name front and center on DirectTrust’s national directory, which greatly increases your clinic’s visibility to referral sources that are looking to work with other professionals who are prioritizing interoperability. And trust me when I say that this pool of referrers is growing.

As of 2021, a notable 78% of office-based physicians and 96% of acute care hospitals are already using an EMR that is DSM-capable. What’s more, physicians who participate in Medicare’s Merit-Based Incentive Payment System (MIPS) are increasingly inclined to work with DSM-enabled clinicians due to its positive impact on their Promoting Interoperability scores.


Although rehab therapists who participate in MIPS aren’t currently required to report Promoting Interoperability scores, it is a mandatory MIPS reporting category for referring physicians. Part of the requirements for this category involves supporting electronic referral loops by:

  1. sending health information electronically via DSM, and 
  2. receiving and reconciling DSMs. 

In fact, some referral sources will flat-out refuse to refer patients through avenues outside of DSM (e.g., paper fax) to avoid a subpar Promoting Interoperability score—which is a completely understandable preference at this point.

Furthermore, CMS’s 2024 proposed rule discusses potentially adding a musculoskeletal (MSK) MIPS Value Pathway (MVP) to the program next year, which will require some participating rehab therapists to include interoperability scores as part of their reporting. It’s a bit of a convoluted subject—one that we can (and have) dedicated entire blog posts to. So, if you think this change might impact you, I encourage you to read up on this subject further, starting with CMS’s “Proposed and Modified MVPs Guide,” which can be found in the Quality Payment Program’s Resource Library.

Increased Efficiency 

Last but certainly not least, I’d like to touch on the efficiency boost DSM provides—namely in the form of reducing the time and effort spent on administrative tasks (remember those lost faxes I was talking about earlier?) To that end, Bell emphasized that:

“DSM has a significant impact on the referral and intake process of new and existing patients in that it helps care teams:

  • Avoid lost records due to secure delivery tracking functionality between DSM-enabled systems;
  • Eliminate time-consuming phone tag to obtain additional clinical information;
  • Automate patient record data entry into the EMR; and
  • Streamline scheduling workflows, including appointment scheduling, patient reminders, and test result sharing.”

This increased efficiency also translates into significant cost savings for front-office operations. DSM eliminates the need for expensive fax machines and dedicated phone lines. Moreover, imagine the time and money saved when staff no longer need to make an average of 19 copies for each document or spend $20 in labor just to file one fax. 

During the early stages of my career as a technology entrepreneur, I advocated hard for EMRs as the future of rehab therapy documentation. Now, I find myself in a similar role, championing DSM as an integral component of healthcare interconnectivity. By embracing DSM, we are embracing an efficient, straightforward solution that will transform how therapeutic care is delivered and experienced. 

However, it’s one thing to talk about it and another thing entirely to put it into action. That’s why WebPT has teamed up with Kno2 to integrate their DSM solution into our platform, which we’ve named WebPT Message Manager. This partnership is a crucial step in improving our Member clinics’ efficiency, bolstering their referral relationships, and saving them valuable money and resources.

Overall, I’m thrilled to see the role DSM will play in shaping a brighter, more collaborative future for our profession—and I’m excited to be a part of this transformation.


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