DirectTrust Standards develops standards and specifications

that enable and promote healthcare interoperability

using Direct exchange and / or trust frameworks.

History and Impact

A Consensus-Based Standards Legacy

The Direct Project launched in March 2010 to specify a simple, secure, scalable, standards-based way for participants to send authenticated, encrypted health information directly to known, trusted recipients over the Internet as part of what was known as the Nationwide Health Information Network. The Direct Project was structured as a consensus-based standards development organization since it’s inception, with participation and sanction from the Department of Health and Human Services (HHS) and the Office of the National Coordinator of Health IT (ONC), but with no affiliation with an accrediting authority.  The standards development mission of DirectTrust today grew from those voluntary discussions and workgroup meetings that began in April 2011 among stakeholders eager to develop standards suitable for the growth of such an exchange approach.

 The Direct Standard™ was first formalized in a document called the “Applicability Statement for Secure Health Transport” crafted from the Direct Project and published in April 2011, with updates in 2012 and 2015.

Rules of the Road

At the same time, a large group of interested parties, known as the “Direct Rules of the Road Workgroup”, began to grapple with the governance required to allow the scalable use of the Direct Standard™  in the healthcare industry. At issue was how best to establish trust among the operators a network in the issuance, exchange, and management of digital certificates, known as Public Key Infrastructure (PKI) technology.  In late 2011, a large group began assembling in anticipation of the creation of DirectTrust, an independent non-profit entity to support the rules and regulations for a trust framework. The work of the new organization would be complimentary to and supportive of rules and regulations as a part of the HITECH Act and Meaningful Use from HHS and the ONC.  DirectTrust was incorporated as a not-for-profit trade association in April of 2012. The membership of DirectTrust had a large overlap with the workgroups of the Direct Project.

The Road to ANSI Accreditation

In 2011, the ONC funded a position to support the maintenance of the Direct Standard™  and presided over the Implementation Work Group of the Direct Project. In 2017, ONC made it known that the Direct Standard™  needed a home in an independent organization to continue the standard’s maintenance and growth. As the organization with the most knowledge of the standard and an interest in its future, the DirectTrust Board of Directors determined the best course of action was to pursue American National Standards Institute (ANSI) Accreditation for an independent standards development function within DirectTrust.  

During 2018, DirectTrust applied for ANSI accreditation in order to provide a consensus-based approach to standards development. In March 2019 DirectTrust Standards became an ANSI Accredited Standards development organization and began to formalize the Direct Standard as an ANSI approved national standard.

Continuing Standards Development

DirectTrust Standards seeks to foster standards that enhance healthcare interoperability and identity or that have applicability to a Trust Framework. 

Descriptions of current DirectTrust Standards projects are available by clicking here or selecting Access from the menu.  Requests for new standards can be made by completing a Standard Proposal Request. The Standards Proposal Request shall be submitted to standards@directtrust.org

DirectTrust Standards Board 

Name Affiliated Organization DirectTrust Standards title 
John Blair MedAllies Standards Board Chair
Vince Albanese Haven Health Solutions Member
Scott Stuewe DirectTrust Vice Chair and President and CEO of DirectTrust
Luis Maas EMR Direct DS2019_01 Chair
Glen Crandall Department of Veterans Administration Observer
Greg Meyer Cerner Member, DS2019_01 Vice Chair, DS2019_02 Vice Chair
Nick Radov United Health Group Member
Bruce Schreiber MedAllies Member
Julie Maas EMR Direct DS2019_02 Chair


News and Events

3 Health IT Standards Driving Healthcare Interoperability in the US

Direct, FHIR, and cloud fax help healthcare organizations share information and are paving the path to semantic interoperability. Click here to read the full article.

EHR Intelligence: DirectTrust Developing Health Data Standards for Instant Messaging

A new DirectTrust initiative called Trusted Instant Messaging will produce health data standards for instant messaging. Click here for the full article in EHR Intelligence. 

Politico’s Morning eHealth: IM standard

Health data exchange organization DirectTrust is working on an instant messaging standard. That could help providers and patients securely and quickly transmit health information, the group announced today. To read the full post on Politico click here

Health Data Management: DirectTrust starts push for an instant messaging standard

DirectTrust, an accreditation body for health data exchange among known and trusted entities, will develop Trusted Instant Messaging+, also known as TIM+, a new standard to enable real-time secure transmissions. Click here for the full article in Health Data...

Healthcare Info Security: DirectTrust Launches Effort for Secure Instant Messaging

DirectTrust, best known for creating and maintaining the Direct protocol-based security and trust framework for secure email messaging in healthcare, has kicked off a new initiative to develop industry standards for secure real-time instant messaging. Click here to...

DirectTrust Developing Standard for Trusted Instant Messaging

Goal is to enable secure real-time electronic transmission of healthcare information incorporating trust network concepts Instant messaging and collaboration tools are becoming essential in healthcare settings, but this form of communication faces technical, security,...

DirectTrust alliance developing standard for trusted healthcare instant messaging

Read the full article here: https://www.healthcareitnews.com/news/directtrust-alliance-developing-standard-trusted-healthcare-instant-messaging

DirectTrust Announces Initiative to Develop Industry-First Standard for Trusted Instant Messaging, Call for Participation Goal of Trusted Instant Messaging+ (TIM+) is to enable secure real-time electronic transmission of healthcare information

DirectTrust Announces Initiative to Develop Industry-First Standard for Trusted Instant Messaging, Call for Participation Goal of Trusted Instant Messaging+ (TIM+) is to enable secure real-time electronic transmission of healthcare information See the press release...

Lahey Health System, Tufts Launch EHR Alerts, HIE Capabilities

DirectTrust is currently working to advance health data exchange standards using Direct exchange and trust frameworks by earning accreditation from the American National Standards Institute (ANSI.) Click here to read the full article

DirectTrust gets accreditation to develop health data exchange standards

DirectTrust, a nonprofit association of health IT and healthcare organizations, has taken a step forward in developing health data exchange standards. The nonprofit announced Tuesday that it has been accredited by the American National Standards Institute (ANSI) to...

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