Direct Messaging

Disclaimer: Praxis does not purport to represent or be an agent of HHS. Please access the CMS Quality Payment Program ( to review any official or changing information.

December 12, 2017

Dear Praxis Clients,

It is with great pleasure that we announce the partnership with "EMR Direct" to handle all your interoperability, but you need to act quickly.

As you know, if you intend to attest for MIPS this year, one of the requirements is that by December 31:

"For at least one transition of care or referral, the MIPS eligible clinician that transitions or refers their patient to another setting of care or health care provider-(1) creates a summary of care record using certified EHR technology; and (2) electronically exchanges the summary of care record."

This should not represent a great burden, but it requires that you do two things immediately:

  1. Obtain a Direct Messaging Certificate that allows you to receive and send Direct Electronic Messages to and from Praxis right away.
  2. With your Certificate in hand, using Praxis EMR to exchange at least one electronic Summary of Care, via Direct Secure Email, to another provider located in a different medical setting, i.e. clinic or hospital by December 31. Obviously, number 2 is dependent on number 1 above.

That's it!

The exciting part is that thanks to this method, sending referrals and consultation reports will be extraordinary simple in the future. In the next few days, you will receive a short video training course showing you exactly how to send and receive these messages. Again, you need to be successful in sending one such referral before December 31st. Right now, all you need is to get your certificate and it will take a maximum of seven days to do so from the moment you complete and send your application. So this is the crucial urgent step.

What is "DIRECT"?

In simple terms, Direct is a secure email generated by Praxis. It is one that may not be read or changed during its transit to the final destination (another setting of care, such as a hospital, Health Exchange System, or provider) and will report back that the intended recipient has, in, fact, received the patient information. The secure email includes the Discrete Patient Summary, which is generated and sent automatically.

Praxis Secure Messaging Mini-Manual

By the time you receive your certificate, you should have access to this training video.

What is "EMR Direct"


Think of EMR Direct as the telephone company. Praxis gives you the telephone, but to connect Praxis to the other EMRs from other healthcare facilities and exchanges in the US, you need a switchboard that transfers these messages safely and securely. EMR Direct was founded by Julie Maas PhD, MBA, MEng, who holds Electrical Engineering and Computer Science degrees from MIT, as well as an MBA from UC Berkeley and her husband, Luis Maas, MD, PhD, who holds bachelor and master's degrees in Electrical Engineering and Computer Science from MIT, an MD from Harvard Medical School, and a PhD in Medical Engineering from the Harvard-MIT division of Health Sciences and Technology. Luis is co-chair of the DirectTrust Security and Trust Compliance workgroup. We tested their interface and passed the technical certification for Meaningful Use without a hitch back in September. Then we negotiated the best possible deal on your behalf.

**Important and Urgent** - Signing On to "EMR Direct" now.


To accomplish this step is straightforward but needs your careful attention:

There is a modest cost per clinic. This cost is calculated as follows:

  1. Initial setup fee: $200.
  2. Annual Fee $75 per billing provider per year.
  3. If you need more certified email addresses for your non-providers (not required) then the charge is an additional $75 per additional email address per year (Your medical assistants may use the provider's email address to send and receive medical records with your permission). (There is a 5% handling fee)

Example: Your clinic has three providers: The initial cost is $200 and 3x75+200 = $425 + 21.25
(The yearly renewal fee for this example would be $225 per year plus the 5% handling fee payable after the first year)

Note that EMR Direct makes no distinction as to whether a provider uses the interface or not to calculate the clinic cost. A provider in Praxis is considered a provider for EMR Direct as well, whether this interface is used or not.

Also please keep in mind that we make this interface with EMR Direct available as direct benefit to all our clients (The average cost in the industry is between $120 to $180 dollars per provider per year). However, we make no warranties about reliability or continuity of this service. In the worst of cases, we reserve the right to change vendors, which would imply additional fees to your clinic. Hopefully that will never be necessary.

The four steps you need to
carry out immediately


STEP 1: Select an authorized representative for your clinic.

If you have a choice, please select someone in your clinic who has a PayPal Account, as the process will be faster and easier using Paypal.

STEP 2: Fill out the "Organizational Application for a Direct Messaging Certificate"

Carefully have your Authorized Representative fill out the "Organizational Application for a Direct Messaging Certificate":

DOWNLOAD Organizational Application for a Direct Messaging Certificate

Caveats for filling out this document:

  • a. Please use the LEGAL Name and address of your clinic (such as it appears in your taxes and other official documents). It must match exactly with your other official records.
  • b. Use the GROUP NPI number of the Clinic (not of individual providers)

When completed, please EMAIL directly to EMR DIRECT at or FAX it to them at 760-882-4317.

STEP 3: Use either a Notary Public or PayPal to certify the identity of the Authorized Representative for your clinic.

If your Authorized Representative does not have a PAYPAL account, then download this phiCert Identity Verification Form:

DOWNLOAD phiCert Identity Verification Form

Please have your Authorized Representative notarize it, and then overmail mail to:

EMR Direct Registrar
PO Box 676011
Rancho Santa Fe, CA 92067

If you prefer to Fedex or UPS, please use this address:

EMR Direct
16870 West Bernardo Drive Suite 400
San Diego, CA 92127

Please do not fax or email this form to either Praxis or EMR Direct. It must be physically mailed.

If your Authorized Representative does have a PAYPAL Account then it is easy: Simply indicate this fact within the Praxis Payment Form below that will forward to us, also indicating the Authorized Representative email address (not the proposed secure email selected but the current email address). We will immediately forward your message to EMR DIRECT, who will promptly email your Authorized Representative the directions to use PayPal for purposes of identification authentication only. You will not be charged via Paypal. Doing it this way is obviously faster and simpler than contacting a notary public and physically mailing the form to EMR DIRECT.

STEP 4: Selection of your Email Addresses and PAYMENT

DOWNLOAD Praxis Payment Authorization Form.

Please indicate the selected Email addresses for each provider who will participate (Remember that payment is not based on participation, so please include all providers) and indicate how many providers are currently working in your clinic.

Your selected email addresses should include a combination of your clinic name or abbreviation, your provider name or abbreviation, our name and EMR Direct's HISP name. In brown is everything you may change. The text in blue must stay the same.



...or any other combination of your choosing. Like in any email address, you may use periods, hyphens and underscores for your part of the email. Email addresses are never case sensitive.

If you have someone in your practice who is NOT a provider but for some reason wishes to have his or her unique secure email as well, please include them in this form. There is an $75 charge per year for those additional non provider email addresses. Keep in mind that your staff may use the providers' secure emails to send and receive clinical information as long as the non providers are authorized.

As soon as we receive your funds and, and EMR direct receives their forms including either the PayPal Identity Proofing or the Mailed Notarized Proofing, they will start the process to provide your providers with activation of the secure emails you have provided. This will take approximately one business week from the moment they receive all your documentation and payment, so please hurry.

As mentioned, in the next few days we will make available a video explaining how to use your key to transmit and receive clinical information. it is easy. You must be successful in doing so with at least one case before December 31st to be able to attest for the year.

We apologize for the delay but negotiating our agreement with EMR Direct took time.

Please do not hesitate to contact us for any questions at:

Very Best Regards,

Praxis Support


Practice Medicine the way it was meant to be.

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