Sponsor(s)/Contact(s):Agency for Health Care Administration

Heidi Fox, Project Director

Carolyn Turner
The Florida Agency for Health Care Administration (Agency) contracted with Harris Corporation in February 2011 to build and implement the Florida HIE, offering two services. These are Direct Secure Messaging and Patient Lookup.
DSM is an implementation of the Nationwide Health Information Network Direct protocols. DSM was implemented in July 2011 and made available to physicians, hospitals, clinical labs, health clinics and county health departments. Outreach activities began in the fall of 2011. The Agency is working with regional extension centers, professionals associations, and targeted groups in outreach to health care providers.
Implementation Details
Deployment / Go-To-Market Model
DSM is a secure email service that allows providers to securely send and receive email messages and attachments (up to 10 MB) containing a patient's clinical data. It also provides a mailbox storage size of 1GB. DSM is accessible via a web browser. The DSM service contains an audit log that tracks the sender, receiver, date and time of email transactions.
Trust Model (Identity Verification / Certificate Distribution)
The Florida HIE’s DSM service is implemented as a full-service Health Information Service Provider (HISP). It has set up an intermediate Certificate Authority (CA) under the domain name “” which serves as its root trust anchor. Using an organization level certificate and the DNS model for public certificate discovery, the DSM service provides HISP to HISP exchanges between its users and other trusted Direct communities.
DSM uses an automated vetting process to register eligible health care providers for use of the DSM service. It uses the National Plan and Provider Enumeration System (NPPES) to establish identity along with a check of the provider’s licensure status against the state’s license database. Organizations must establish a DSM point of contact and the point of contact is responsible for approving the account of individual providers that wish to register.
Technical Architecture / Diagram
The Florida HIE’s DSM system architecture is depicted in the following diagram. The components of the DSM application include a Participant Directory, an E-mail Server, a Web Mail Client application, and an instance of the Direct Reference Implementation. The Direct Reference Implementation component provides an automated means to discover Public Key Infrastructure x.509 certificates and encrypt e-mail messages sent by other Direct implementation users.


Figure 1 – Florida HIE DSM System Architecture.
Project Timeline (Key Milestones)
Version 1.0 and 2.0 were released in 2011. Version 2.0 added a process to require users to sign the Security Best Practices document for mobile devices. Pharmacy registration was added in 2012. Version 3.0 roll out in July 2012 will include state employees and health plans as participants in DSM.

Ancillary Services / Planned Enhancements

The Participant Directory is part of the DSM service that enables lookup of other DSM participating providers based on name, organization, affiliation, or specialty. DSM registration establishes an entry in the Participant Directory. Included in the entry are name, specialty (using the NPPES taxonomy as self-designated by the provider), mailing address, practice address, phone, FAX numbers, and license information.
A special use case is the Florida Department of Health Children’s Medical Services use of Direct to facilitate referral activities. In addition, the Florida County Health Departments provide primary care and are in process of registering for DSM. Pharmacies are piloting use of DSM for medication therapy management.DSM enhancements planned in 2012 include e-mail notification of DSM mail and automatic/mandatory read receipts.

Success Metrics
As of first quarter 2012, there were 151 DSM registrants, with 43 transactions and 20 unique users during the quarter.
Number of Active Participants
Total number of hospitals

Total number of unique users at hospitals (unique addresses associated with hospital domains)

Total number of ambulatory providers (unique users - e.g., Direct addresses)

Total number of individual labs

Other (e.g., long term care providers, home health, etc.)

Number of Completed Transactions
Number of total Direct transactions

Number of transactions between providers/hospitals (unique addresses associated with hospital domains)

Number of transactions from labs (e.g., transactions generated from a lab associated domain or address)

Number of transactions to public health (e.g., transactions sent to a public health domain or address)