Direct Secure Messaging

Direct Secure Messaging, available in PCC EHR, is a communication technology used to exchange private medical information. Direct Secure Messaging requires special registration and unique addresses that are similar to, but not the same as, e-mail.

If your practice activates Direct Secure Messaging at your practice and you register clinical users, you can:

  • Send a Direct Secure Message containing a Transition of Care document to another medical practice
  • Receive Direct Secure Messages from other medical practices and add the information they contain to a patient’s chart
  • Allow your patient and families to send a visit summary directly from MyKidsChart to another medical practice using a Direct Secure Message

Patient Portal Messages vs. Direct Secure Messaging: The patient portal and PCC EHR support two different messaging technologies. Portal messages are a secure, optional messaging tool built into the patient portal. Patient portal users can exchange messages with their pediatric practice, and the practice can receive and send portal messages with PCC EHR or pocketPCC. Direct Secure Messaging, on the other hand, is a specialized message technology used to share and send medical information. It requires registration with a third-party service and it allows for secure transmission of C-CDA transition of care documents or visit summaries. For more information, refer to Receive and Respond to Portal Messages or Direct Secure Messaging.

Activate Direct Secure Messaging For Your Practice

When you are ready to activate Direct Messaging for your practice, contact PCC Support. We will create your practice’s Direct Secure Messaging connection. PCC partners with Updox to manage the back-end of the service.

Create Direct Secure Messaging Accounts for Users

After Direct Secure Messaging is turned on for your practice, use the User Administration tool to create Direct Secure Messaging accounts.

Open a user account in PCC EHR’s User Administration tool, and then use the “Direct Secure Messaging” tab to create their account.


Who Needs a Direct Secure Messaging Account?: Direct Secure Messaging is optional, and PCC recommends you only create accounts for users who will communicate using Direct Secure Messaging, such as clinicians who transmit and receive electronic transition of care documents. PCC EHR supports Direct Secure Messaging, which is part of making PCC EHR a Meaningful Use certified EHR using the 2014-edition standards. However, your physicians may decide they prefer not to manage an additional communication channel.

After you create the account, you can see the user’s Direct Secure Messaging address as well as options to deactivate their account or set directory preferences.

The user’s Direct Secure Messaging account address also appears in the user’s My Account tool.


You can provide your address to patients or other medical practices, and they can use the address to send you transition of care documents.

Register Your Practice with the DirectTrust Network

Once your practice’s Direct Secure Messaging service is turned on, you can send and receive direct messages to other users within the Updox network. However, in order to communicate with the full range of medical practices, at least one Direct Messaging user at your practice needs to be your practice’s legal representative for Direct Secure Messaging.

Only one Direct Secure Messaging user at your practice needs to complete the registration with the DirectTrust Network. Click on the blue link to get started.



The Updox website will walk the user through the registration process. The user will need to enter identifying information and answer demographic questions to verify their identity.

Once the process is complete, you will see the result in the User Administration tool, or in the My Account tool.

Once one user on your system has registered your practice with the DirectTrust Network, all Direct Secure Message users will have access to the Direct Secure Messaging trust network.

Can a Practice Send and Receive Direct Secure Messages Without Registering?: Your practice can elect not to have a user register with the DirectTrust Network (a process also known as “vetting” your practice’s account). You will still be able to send and receive messages, but you will be limited to contacting other Direct Secure Messaging users who use the Updox service.

What if the Registered User Leaves Your Practice?: When you disable a user from PCC EHR, their Direct Secure Messaging account will be disabled. If the registered Direct Secure Messaging user is disabled, PCC EHR will send a message to Updox, the third-party vendor that manages Direct Messaging accounts. Your practice will no longer be registered. You will see the DirectTrust network information link in the User Administration tool as shown above. A different user can use the link in the User Administration tool or the My Account tool to re-register your practice.

Receive a Direct Secure Message and Add It to a Patient’s Chart

Once your practice has activated Direct Secure Messaging, other medical practices can send Direct Secure Messages to users at your practice. Those messages can include transition of care C-CDA attachments and other documents.

When a Direct Secure Message arrives, it will appear on the Messaging queue. Double-click on a message to review it and associate it with a patient chart.


Similar to the process for importing an electronic lab result, you can review message information, including patient name, birthdate, and sex, and message details, if available. Use the panel on the right to associate the message with a patient’s chart. In most cases, PCC EHR does the work for you and suggests a matching patient. Otherwise, you can search for any patient.

Click “Select” to place the Direct Secure Message into the patient’s chart.


After you click “Select”, PCC EHR will open the Direct Secure Message as it appears in the patient chart. You can see the full message details and any attachments.

Review and Work With a Direct Secure Message

After they are placed in a patient’s chart, Direct Secure Messages appear in the Visit History. You can review them as you would a chart note or phone note.

As you review a message, you can click to open message attachments and create and complete tasks. For example, you can click “View” to view a C-CDA document or other attachment.


You can also create a task for any user so they can follow up on the message.

Remove a Direct Secure Message from the Incorrect Patient’s Chart

If you accidentally attach a Direct Secure Message to the wrong chart, you can un-attach it and send it back to the queue.

From the Visit History, double-click to open a Direct Secure Message.


While viewing the Direct Secure Message protocol, select “Remove Direct Secure Message” from the Edit menu and then click “Remove”.


Reconciled Items: If your practice reviewed the Direct Secure Message and reconciled Problems, Medication Allergies, or Medications, they will not be removed by the above process.

The Direct Secure Message will now appear back in the messaging queue, where you can import it to the correct patient’s chart.

Customize Your Practice’s Direct Secure Message Protocol

Your practice can customize the Direct Secure Message protocol in the Protocol Configuration tool. For example, you may want to add the patient’s Problem List, History, or Upcoming Appointments components to assist your workflow when you read and evaluate a Direct Secure Message.


For information about protocols in PCC EHR, you can read about Protocol Configuration.

Reconcile a C-CDA Document

If a Direct Secure Message includes a transition of care document in C-CDA format, you can import any Problems, Medication Allergies, and Medications from the C-CDA document into the patient’s chart record.

When you see an incoming C-CDA in a Direct Secure Message, you can click “Reconcile” to review and import patient data.


On the “Reconciliation – Import” screen, you will see three sections: Problems, Medication Allergies, and Medications. In each section, you will see both the information in the C-CDA and the information that is already in the patient’s chart. When you want to import information, select it in the “Add to EHR” column.

After you have reviewed each section (Problems, Medication Allergies, and Medications) and selected any items you wish to add to the patient’s chart in PCC EHR, click Next.


On the “Reconciliation – Review and Save” screen, you can review what the final result of the patient’s record will be. You will see what the patient’s new Problem List, PCC eRx Allergies, and Medication History will display after the import is complete.

Optionally, Click Edit: You can click “Edit” and modify the items on these lists before saving. If you have a duplicate entry, for example, you may want to edit and combine notes or delete an item.

Click “Save” to save your changes and import the data. You can also click “Cancel” to close the C-CDA without making any changes to the patient’s chart.

Last Reconciled: PCC EHR tracks when a user clicked the “Reconcile” button, whether or not they decided to import data to the chart. You will see a “Last Reconciled” attribution on the Direct Secure Message as well as in the patient’s Visit History. You can revisit the message and choose to reconcile the C-CDA data with the patient chart again at any time.

Match Medications and Medication Allergies in PCC eRx: After you reconcile and import Medications and Medication Allergies from a C-CDA, they are added to the patient’s chart record as free text. After three minutes, they are synced with PCC eRx, PCC’s ePrescribing system, found in the Prescriptions section of each patient’s chart. After the record has synced, you should open the patient’s Prescriptions screen and use the Find Match feature to associate the new records with actual drugs and drug allergies.

Send a Summary of Care Record with Direct Secure Messaging

You can use Direct Secure Messaging to send a Summary of Care Record to a specialist for a referral or to another clinician as part of a transition of care.

For more information, read the Summary of Care Report help article.

Patients and Families Can Send Direct Secure Messages in MyKidsChart

Patients and families can use MyKidsChart, PCC’s patient portal, to download a C-CDA-formatted visit summary for any encounter. Optionally, they can use your practice’s Direct Secure Messaging connection to send the visit summary directly to another Direct Secure Messaging user, such as another physician or medical practice.

When users want to save or send a visit summary in C-CDA format, they first select the patient and visit from their history.


At the bottom of the visit, they can choose to download or send the visit summary.


On the Direct Secure Email screen, the user can enter the Direct Secure Messaging address provided by the recipient. For example, a specialist might provide a parent with an address for the purpose of sending a visit summary directly to them.

After they enter an address, the user can optionally edit the default subject and message. Next, the user can choose whether to attach a C-CDA or PDF, and click “Send” to send the message and visit summary.

Direct Secure Messaging Required: MyKidsChart users can only send Direct Secure Messages if your practice has activated Direct Secure Messaging. Additionally, until a user at your practice registers with the DirectTrust Network, parents and families can only send messages to physicians and other practices within the Updox network. For more information, read the Direct Secure Messaging sections above.

  • Last modified: May 14, 2018