Direct Secure Messaging Bring Direct Secure Messaging Into the Workflow Your Team Already Uses
Get a Direct address in your Documo account and securely receive referrals, care summaries and results from Direct-enabled hospitals and EHRs. They arrive right next to your fax, so your team works from one place without a separate portal or a new workflow to learn.
What Is Direct Secure Messaging?
Direct Secure Messaging (DSM) is a national standard for sending health information securely between verified healthcare organizations.
Encrypted and Identity-Verified
Only verified senders and recipients.
Used by Hospitals and EHRs
Referrals, care summaries and results.
One Workflow With Documo
Direct and fax land in the same place.
When Records Arrive Two Ways, Work Stalls Twice
Source: Documo, 2026 State of Healthcare Operations
What Is a Direct Address?
A Direct address looks like an email address, but it only works on the DirectTrust network. Click each part to see how it works.
Mailbox Name
The part before the @ can belong to a person, a team or a department, like referrals, intake or a provider’s name. Many practices use one address per department.
Direct Domain
A domain set up specifically for Direct messaging and managed by a Health Information Service Provider (HISP). Regular email can’t send to it, which keeps PHI on the Direct network.
Digital Certificate
Every Direct address is tied to a digital certificate issued after identity verification. It encrypts the message and lets the receiving organization trust who sent it.
Provider Directory
Direct addresses are listed in provider directories, so hospitals, practices and EHRs can find where to send referrals and records.
A Referral Arrives by Direct
See the Difference in One Referral
Lands Elsewhere
The referral sits in a Direct inbox nobody watches as closely as the fax queue.
Someone Logs In to Find It
Staff check another system, download attachments and save them locally.
Retyped by Hand
Patient, provider and reason for referral are typed into the EHR by hand.
The Patient Waits
Scheduling starts only after the paperwork is done.
Two inboxes, manually re-entering data and a patient waiting on paperwork.
Lands Next to Your Faxes
The referral arrives in the same Documo account your team already works in.
Seen Right Away
It shows up in the same queue your team already watches, so it never sits unnoticed.
No Separate Login
No portal to check and no attachments to download and re-save.
The Patient Gets Scheduled Sooner
Your team spends its time on outreach, not hunting for records.
One account. No separate portal. Referrals don’t sit unseen.
What Can You Send With Direct Secure Messaging?
Direct carries structured documents, PDFs and images. Pick a document type to see how it moves through Documo.
Referrals
Referral letters, clinical notes and supporting records sent from one provider to another, often with a C-CDA attached.
Arrives by Direct
Lands in your Documo account
Assigned to your team
Transition of Care Summaries (C-CDA)
Structured summaries of a patient’s problems, medications, allergies and recent results, sent when care moves between settings.
Arrives by Direct
Kept with any attached PDFs
Lands in your Documo account
Discharge Summaries
Sent by hospitals when a patient leaves, so follow-up care can start quickly.
Arrives by Direct
Lands in your Documo account
Assigned for follow-up
Lab and Imaging Results
Results and reports from labs, imaging centers and other providers.
Arrives by Direct
Lands next to your faxes
Assigned to the results team
Consult Notes and Care Plans
Specialist notes and care plans shared back with the referring provider to close the loop.
Arrives by Direct
Lands in your Documo account
Reply over Direct to close the loop
Direct, Fax or Secure Email?
Most practices need both Direct and fax. Secure email can’t reach the Direct network at all.
Direct Secure Messaging
Who you can reach
Organizations with a Direct address
Sender identity
Identity-verified, certificate-backed
What arrives
Structured C-CDAs, PDFs and images
In Documo
Yes, same account
Cloud Fax
Who you can reach
Anyone with a fax number
Sender identity
A phone number
What arrives
Images of pages
In Documo
Yes, same account
HIPAA-Compliant Email
Who you can reach
Anyone with email, but not Direct addresses
Sender identity
Varies by provider
What arrives
Attachments
In Documo
Coming in 2027
Explore Integrations
Connect to the Systems You Already Use
Never Miss a Direct Referral
Give hospitals and health systems a Direct address to reach you, and every referral lands where your team can act on it.
Your own Direct address
Referrals land right next to your faxes
No separate portal to check
One Account for Every Inbound Record
Drop the separate portal. Direct messages and faxes arrive side by side, with the same tagging, assignment and routing.
No extra logins or downloads
Delivery status on every message
One audit trail for compliance
Close the Loop Over Direct
Send consult notes, records and referral responses back to Direct-enabled partners from the same account you use for fax.
Reply, forward or start new Direct messages
Delivery status on every message
One audit trail across fax and Direct
Unlock New Revenue Through Integration
Give your customers Direct Secure Messaging inside your software with the DSM API, alongside fax and document processing.
Basic auth with your Documo API key
Webhooks for sent, failed and received messages
HIPAA-compliant infrastructure
Interested in Direct Messaging Automation?
From Direct Address to One Shared Account
Get Your Direct Address
Documo sets up a Direct address for your organization, so providers on the Direct network can send records straight to you.
One address for your team, or per department
Ready for partners to send to
No separate portal to manage
Send and Receive in One Account
Direct messages arrive in the same inbox as your faxes. Reply, forward or start a new message to any Direct address.
Fax and Direct side by side
Delivery status on every message
Full audit trail for compliance
Keep Every Exchange on Record
Every Direct message is logged with its delivery status and a full audit trail, right next to your faxes.
Delivery confirmation on outbound messages
Failed sends flagged right away
One audit trail across fax and Direct
Use Direct in Documo
Or add it to your product with the DSM API
Accept More Referrals
Give Direct-enabled hospitals and practices a way to reach you, so their referrals land where your team can act on them.
Work One Queue, Not Two
Direct messages sit next to your faxes. Your team assigns, tags and routes them the same way, without a separate portal.
Close the Loop Over Direct
Send consult notes, records and referral responses back to Direct-enabled partners from the same place you handle fax, with delivery status on every message.
A Direct Messaging API for Health IT Teams
Communicate with providers when you send and receive Direct Secure Messages from inside your application with the DSM API. Pair it with the Fax API to give your customers one place to exchange clinical documents.
One API key across fax, Direct and document processing
Webhooks when messages are sent, fail or arrive
Built on Documo’s HIPAA-compliant infrastructure
DSM API
Send and receive Direct Secure Messages from your product, so clinical documents from Direct-enabled providers land in the same pipeline as your fax.
Base URL:
https://api-dsm.documo.com/
Auth:
Basic YOUR_API_KEY
Webhook:
dsm.v1.outbound.succeeded
dsm.v1.outbound.failed
dsm.v1.inbound.succeeded
Common Questions About Direct Secure Messaging
What is Direct Secure Messaging?
Direct Secure Messaging (DSM), often called Direct, is a national standard for sending health information between verified healthcare organizations. Messages are encrypted, and every sender and recipient has a certificate-backed Direct address, so the receiving organization knows who sent it. Hospitals, EHRs, labs and practices use it for referrals, care summaries and results. For a longer explainer, read our guide to Direct Secure Messaging.
What is a Direct address?
A Direct address looks like an email address, such as referrals@direct.northside.org, but it can only exchange messages with other Direct addresses. It has a mailbox name, a Direct domain managed by a HISP, a digital certificate issued after identity verification, and a listing in provider directories so partners can find it. Documo sets up Direct addresses for your organization.
What is a HISP?
A Health Information Service Provider (HISP) runs the service that encrypts, sends and delivers Direct messages, and manages the domains and certificates behind each Direct address. HISPs are accredited through the DirectTrust Accreditation Program. With Documo, your Direct addresses come with your Documo account, so there’s no separate HISP portal for your team to log in to.
How is Direct Secure Messaging different from fax?
Fax sends images of pages to any fax number, and the sender is identified only by a phone number. Direct sends structured documents such as C-CDAs, along with PDFs and images, between identity-verified organizations on the Direct network. Many partners still only fax, so most practices need both. In Documo, Direct messages and faxes arrive in the same account.
Is Direct messaging the same as HIPAA-compliant email?
No. HIPAA-compliant email encrypts regular email, but it can’t send to or receive from Direct addresses, and how senders are verified varies by provider. Direct only works between identity-verified organizations on the Direct network.
What documents can I send with Direct Secure Messaging?
Referrals, transition of care summaries (C-CDA), discharge summaries, lab and imaging results, consult notes and care plans. Direct carries structured C-CDA documents as well as PDFs and images.
Can Direct messages and faxes live in the same place in Documo?
Yes. Direct messages arrive in the same Documo account as your faxes, with the same tagging, assignment and routing. You can reply, forward or start a new Direct message from that account, and every message is logged with its delivery status.
Is there a Direct messaging API?
Yes. The DSM API lets health IT teams send and receive Direct messages from their own application, with webhooks when a message is sent, fails or arrives. It uses the same Documo API key as the Fax API, so your customers can exchange fax and Direct in one place.
Keep Critical Healthcare Work Moving
in one account for your team.