Who precisely are you sending that message to? There is a little recognized problem in using legacy HL7 over VPNs to deliver data (lab results, image studies, reports, etc). The orderer is in the message regardless of whether you are trying to send to them or not. The CC list is in the message regardless as well. The attending, the primary, etc. all there but maybe not who you are routing to. Who are you routing it to? How is this a problem? In today's modern world of Software as a Service (SaaS), many of the EHRs get data delivery through a common gateway for many practices. If you route a message to a single practice with a locally installed EHR, then when the data source (e.g. hospital or an HIE as its proxy) sends a message to the practice, the practice endpoint and the EHR endpoint are one in the same. There is no confusion about who the message is for. When the EHR serves multiple practices is where we get the confusion. The endpoint of the practice is a spoke off of
Healthcare Information Exchange (HIE), HIE architecture, Direct Project HISP, and other Data Sharing topics.