In the real world of ambulatory practice, the most popular provider-to-provider communications technology is still the fax machine.1 Think about this—the fax machine was invented in 1842; 30 years before the telephone.2 Newer, more sophisticated methods of communication can help ambulatory practices become more efficient and provide better care to patients. In fact, on August 6, 2018, Centers for Medicare and Medicaid Services Administrator, Seema Verma, posed a goal for the digital health information industry to replace the current use of fax machines in physician offices to send patient information. Federal mandates regarding EHR use are helping drive dissemination of new communications technology in ambulatory care. According to CMS requirements, to qualify for meaningful use stage 1 incentives, practices are required to have an EHR that enables them to send Direct secure messages. Direct secure messaging (Direct) refers to a specific protocol introduced by the US Department of Health and Human Services. This protocol provides standards for sending authenticated, encrypted health information to trusted recipients over the Internet. A patient’s chart can be attached to the message.