In an interview with Healthcare IT News, Kennedy says he sees much to be encouraged about. In particular, he cites the response to one question. When asked to agree or disagree with the statement, "I would still use Direct to exchange health information, even if not required to do so because of meaningful use," 59 percent of respondents assented.

"That tells me that there's an interest in Direct as a standard for exchange," he says. "And given that it's one of the lower-denominator exchanges, it really allows most providers to engage in that activity at a low cost."

Still, Kennedy says there's work left to be done.

"There still remains no standard for provider directories," he says. "We saw disparate implementations using LDAP (Lightweight Directory Access Protocol), using HPD (Healthcare Provider Directory), using other non-standard approaches – and then others saying they had no interest in adopting a standard and were just going to go with a relational database. That was pretty interesting to me. There's no compelling standard that's coming to the forefront, and as a result, people are innovating in that space."

There were some positive surprises in the report's numbers, however, says Kennedy.

"I was surprised that 85 percent of HISPs can actually talk to another HISP. We've always talked aboutthe fact that HISP to HISP is an enormous barrier to exchange, and I still think that's a big deal. But the fact is that most have crossed that barrier with at least one other HISP, and in many cases they're able to talk to a number of HISPs."

As for the respondents citing high cost and workflow disruption as two big reason for pessimism with regard for Direct, Kennedy is understanding.

"Trying to unify that workflow is really paramount to adoption," he says. "And getting an inter-organization exchange of messaging integrated into the EHR is definitely something that's proven challenging. It's gotten better over the past couple years – and I think some of the results say that most respondents to the survey could actually access extrenal providers and provider directories from within their own EHR – which was remarkably encouraging."

But costs can be prohibitive – especially for, say, smaller physician practices.

"Direct was envisioned to be a fairly low-cost standard," he says. "But when you take into account the full solution to implement, the cost definitely became prohibitive" for some.

Nonetheless, all told both Kennedy and Kibbe are greatly encouraged by the responses to the survey, and see a bright future for this (relatively) simple and straightforward piece of the health information exchange equation.

Kibbe says he sees "tipping point" and cites the survey as evidence that standards-based methods such as Direct are now a permanent fixture on the HIE landscape, and will continually gain ground over fax other "one-off" connectivity tools.

"In general, organizations are much better practiced at using HIE, and Direct in many cases," than they were just a couple years ago, says Kennedy. "The market overall is becoming more proficient and has matured. The incentives are certainly there, and we're all sort of learning to collaborate together on this."

HIMSS members can access the full report here.