SMTP represents Simple Mail Transfer Protocol. SMTP is widely utilized for e-mail transmissions across Internet Protocol (IP) networks.

The SMTP protocol started out purely ASCII text-based, it did not deal well with binary files or characters in many non-English languages. Because of this, standards such as Multipurpose Internet Mail Extensions (MIME) were developed to encode binary files for transfer through SMTP.

In healthcare, the MIME standard CCD documents can be treated as a MIME package in an SMTP e-mail. To make the SMTP e-mail secure, a secure version of MIME, called S/MIME, can be utilized. S/MIME along with certificates can be combined with SMTP to keep patient health information safe. The Direct Project provides the specifications for accomplishing this.

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