Using Direct Messaging to facilitate the electronic transfer of information between two healthcare providers, or between a provider and a patient, not only improves the patient experience but also helps meet the exchange requirements of the Centers for Medicare and Medicaid Services (CMS) Electronic Health Record (EHR) incentive program. While significant progress has been made in implementing Direct Messaging, many aspects concerning the role of a Health Information Service Provider (HISP) and some of its future functionalities remain untested in the marketplace. The goal of this project was to demonstrate interoperable health information exchange using Direct Messaging specifications.