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Frequently Asked Questions


What is Direct?
Direct is a protocol for sending and receiving patient data. It is secure, HIPAA-compliant, spam-free, messaging for healthcare industry professionals.


Once I submit by registration form, how long will it take before I can start using direct?
In most cases, Direct accounts can be ready for use within 2 business days. We require the hard copy of the notary form and Service Agreement in order to activate the account(S).

What information and types of attachments can I send from my Direct account?
Any items that are PHI related. Common documents include; CCDs, referrals, lab results, consultation notes, and other PHI can be sent between care team members via Direct. California Direct’s functionality is similar to your normal everyday email account. You can attach many different types of files such as .doc(x), .xml,  .txt, .eml, PDF, and more. The max size for attachments is (max 10MB).

What is a HCO representative? Why does the HCO representative have to get notarized?
The HCO is a legitimate healthcare organization. Axesson requires identity proofing from the HCO (through notary) and the HCO identity proofs the accounts for their organization. A representative of the HCO is the person in charge of requesting new accounts, changes to accounts, and revoking access to accounts. The identity of each individual using a Direct account must be vetted by the HCO representative.

Who should register as the HCO?
In a single provider practice the medical provider or office manager may take on this role. If you are a large entity this role is typically handled by the accounting or human resources department. This person is responsible for authenticating the members of your organization and authorizing Axesson to implement or revoke their Direct accounts and any associated billing.

Can I register for Direct if I am an Ancillary Organization without an NPI #?
Any person or organization needing to send patient health information securely can sign up for California Direct. This includes medical billers, insurance companies, and claims adjustors. If you have questions regarding your needs for California Direct contact a representative today.

Integrating California Direct into your Workflow

What information can I send and receive from my California Direct account?
California Direct is tool to send and receive protected patient health information electronically and securely. You are encouraged to send and receive referrals, CCDs, CDAs, ADT summaries, reports, results, follow-up questions, medication reconciliations, and more to other care team members. You can also use California Direct to send your patients reminders, billing documents, medication information, care instructions, health education materials, etc. Axesson team members are standing by to answer your individual use case questions.

Which Meaningful Use Stage 2 requirements does California Direct Support?
Measure 7 (Mandatory): Provide patients the ability to view (online), download or transmit (VDT) their health information.
Measure 8 (Mandatory): Provide clinical summaries for patients for each office visit.
Measure 15 (Mandatory): Provide summary of care record for each transition of care or referral
Measure 17 (Mandatory): Use secure electronic messaging to communicate with patients on relevant health information

I am already connected to an HIE. Do I have a use case for Direct?
California Direct allows you to communicate with providers outside of your HIE. It is a great connectivity tool for rural or dispersed providers. Additionally, you can use Direct Secure Messaging to communicate with patients who have a personal health record such as HealthVault or NoMoreClipboard.

Using the California Direct Application

What devices can I use with Direct? Can I use both Windows and Apple products?
Any device that has an internet connection and a browser should be able to connect to California Direct. If you experience any difficulties contact an Axesson team member for support.

Are there any suggested browser for running Direct?
The Mirth Mail Webmail client is accessible by any modern web browser. We officially support Internet Explorer 8+, Mozilla Firefox 3+, Safari 4+, and Google Chrome 9+.

Can I send a message to a non-direct user from my direct account?
No. Remember when fax machines were new to the market? You could only send a fax to another person that had a fax. Direct is the same. The other party must have a Direct address. Direct messages will only send to other Direct accounts. This means that you cannot send a Direct message to a yahoo, gmail, aol, etc. user

How do I know if a person I want to exchange with has direct?
If you cannot find a contact in the Directory, who you would like to communicate with, tell Axesson who you wish to exchange messages with (at the organization level) and we will advise if they are available to send direct messages.


Is there a difference between Direct and California Direct?
No, California Direct is a product name. California Direct is based on the Direct ONC standards. You may exchange messages with any other person with a Direct address – even if it is not a California Direct address.

Why do certificates have to be exchanged – it seems like a hassle?
Yes, it can feel like a hassle but Direct is about TRUST. Trust has to be built through trading certificates, trust anchors, etc. Once the trust is established, however, exchanging becomes fast and easy.

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