Once considered a critical component of meaningful use, DSM (Direct secure messaging) within an EHR poses significant limitations to referral management. While it conveys information electronically within a practice, DSM alone does not provide for comprehensive data exchanges between PCPs and consulting physicians. The Journal of General Internal Medicine notes that communication breakdowns affect care delivery between two practices on different systems. Specialists report that, 86% of the time, they do not receive information from the PCP prior to the referral visit. Additionally, poor referral tracking leads to inappropriate or unnecessary referrals and inefficiencies in care delivery. DSM in EHRs presents inevitable challenges for both primary and specialty care practices.