Journal of Digital Imaging

, Volume 29, Issue 3, pp 337–340 | Cite as

Implementation of Certified EHR, Patient Portal, and “Direct” Messaging Technology in a Radiology Environment Enhances Communication of Radiology Results to Both Referring Physicians and Patients



Since 2009, the Federal government distributed over $29 billion to providers who were adopting compliant electronic health record (EHR) technology. With a focus on radiology, we explore how EHR technology impacts interoperability with referring clinicians’ EHRs and patient engagement. We also discuss the high-level details of contributing supporting frameworks, specifically Direct messaging and health information service provider (HISP) technology. We characterized Direct messaging, a secure e-mail-like protocol built to allow exchange of encrypted health information online, and the new supporting HISP infrastructure. Statistics related to both the testing and active use of this framework were obtained from, an organization whose framework supports Direct messaging use by healthcare organizations. To evaluate patient engagement, we obtained usage data from a radiology-centric patient portal between 2014 and 2015, which in some cases included access to radiology reports. Statistics from 2013 to 2015 showed a rise in issued secure Direct addresses from 8724 to 752,496; a rise in the number of participating healthcare organizations from 667 to 39,751; and a rise in the secure messages sent from 122,842 to 27,316,438. Regarding patient engagement, an average of 234,679 patients per month were provided portal access, with 86,400 patients per month given access to radiology reports. Availability of radiology reports online was strongly associated with increased system usage, with a likelihood ratio of 2.63. The use of certified EHR technology and Direct messaging in the practice of radiology allows for the communication of patient information and radiology results with referring clinicians and increases patient use of patient portal technology, supporting bidirectional radiologist-patient communication.


Meaningful use Patient engagement Patient portal 


  1. 1.
    Health Information Technology for Economic and Clinical Health Act (HITECH). Title X2I of the American Recovery and Reinvestment Act of 2009, Pub L No. 111–115, 123 Stat 115, 2009Google Scholar
  2. 2.
    Data and Program Reports. Baltimore: Centers for Medicare & Medicaid Services. Available at Accessed 24 April 2015
  3. 3.
    Morgan TA, Avrin DE, Carr CD, Dreyer KJ, Flanders AE, Khorasani R, Langlotz CP, Arenson RL: Meaningful use for radiology: current status and future directions. Radiology 2:318–321, 2013CrossRefGoogle Scholar
  4. 4.
    2012 Physician Specialty Data Book. Association of American Medical Colleges. Available at Accessed 2 September 2014
  5. 5.
    CMS Medicare and Medicaid EHR Incentive Program, Electronic Health Record Products Used for Attestation. Available at Accessed 24 April 2015
  6. 6.
    Centers for Medicare and Medicaid Services. Meaningful Use. Available at Accessed September 2, 2014
  7. 7.
    Basu PA, Ruiz-Wibbelsman JA, Spielman SB, Van Dalsem VF, Rosenberg JK, Glazer GM: Creating a patient-centered imaging service: determining what patients want. Am J Roentgenol 196:605–610, 2011CrossRefGoogle Scholar

Copyright information

© Society for Imaging Informatics in Medicine 2015

Authors and Affiliations

  1. 1.Stanford Healthcare, Department of RadiologyStanfordUSA
  2. 2.Merge HealthcareSan DiegoUSA

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