Exchanging Imaging Documents Outside a Specific Health Information Exchange Domain

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Using the Direct Protocol for Image Exchange

As a member of the Direct Project Workgroup, I would like to highlight work in progress to make the Direct Protocol feasible for image exchange and DICOM study exchange.  The workgroup is testing the concept of message fragmentation (defined in RFC2046 section 5.2.2).  This technique when combined with the Trust, Encryption, and Delivery notification standards of the Direct Protocol create an opportunity to eliminate the SMTP limit of 10 MB for message size and also eliminate the need for expensive persistent connections between parties.  With Direct, any party with a Direct Address can immediately inter-operate with any other party with a Direct Address.  This cost reduction should lead to more widespread Image Exchange.

Bruce Schreiber

CTO MaxMD