Market Overview

DirectTrust Issues HL7 Co-Authored White Paper Identifying Ways to Use DirectTrust Assets with FHIR


WASHINGTON, Aug. 10, 2017 (GLOBE NEWSWIRE) -- DirectTrust today released a white paper that proposes how FHIR and Direct communities and technical specifications for each standard should relate to each other to offer new value. FHIR is a standards framework created by HL7, an ANSI-accredited SDO in the healthcare arena. DirectTrust is a health care industry alliance created by and for participants in the Direct exchange network used for secure, interoperable exchange of personal health information (PHI) between provider organizations, and between provider and patients, for the purpose of improved coordination of care.

FHIR is a new standard that defines a web API and related specifications for health data exchange. Direct is an existing federal standard that is widely used in the USA for the exchange of healthcare data. There are differing views across the healthcare system as to the correct relationship between the two standards and communities.

Direct, DirectTrust, and FHIR: A Value Proposition, which is offered to the DirectTrust and FHIR communities for their consideration:

  • identifies the context, advantages, and challenges for Direct and FHIR;
  • describes two main ways to use the existing Direct and DirectTrust assets with FHIR— using DirectTrust's trust framework to support FHIR's RESTful API and pushing FHIR resources in Direct Messages; and 
  • recommends the leadership of the DirectTrust and the FHIR communities seek opportunities to build engagement between the respective communities to build out both the technical specifications they describe, and their policy and adoption implications.

"The existing work in the FHIR eco-system does not standardize all aspects of establishing trust between systems," said Grahame Grieve. Grieve, FHIR's original architect, is Director of HL7's FHIR international programs and principal at Health Intersections, a Melbourne, Australia-based consultancy. "While FHIR offers SMART-on-FHIR as a way to delegate authorization, underlying trust frameworks are needed to provide a framework in which these are managed. Working with DirectTrust could potentially save the FHIR community from the costs of building a new trust framework by using one already proven to scale high identity assurance," Grieve concluded.

"Collaboration is key to getting the best out of standards," said DirectTrust President and CEO David C. Kibbe, MD, MBA. "We should take every opportunity to combine the strengths of different interoperability standards, so that they enrich and support each other. No single standard, either for transport, or for content, or for trust in identity, can do everything that is needed by providers and patients wanting to securely share and exchange health information using various tools and technologies. At DirectTrust, we're delighted to share insights and innovations with the HL7 FHIR implementation community this way."

Direct, Direct Trust, and FHIR: A Value Proposition is authored by Grahame Grieve, HL7 Product Director for FHIR, and David Kibbe, Luis Maas, Greg Meyer and Bruce Schreiber, members of the DirectTrust Policy Committee. It is not yet formally endorsed by HL7 or by the FHIR community.  The paper can be accessed at, or by contacting Ed Emerman at or 609.275.5162.

HL7 is one of several American National Standards Institute (ANSI)-accredited Standards Developing Organizations (SDOs) operating in the healthcare arena. Most SDOs produce standards (sometimes called specifications or protocols) for a particular healthcare domain such as pharmacy, medical devices, imaging or insurance (claims processing) transactions. HL7's domain is clinical and administrative data. FHIR® (Fast Healthcare Interoperability Resources) is a next generation standards framework created by HL7. FHIR combines the best features of HL7's Version 2, Version 3 and CDA® product lines while leveraging the latest web standards and applying a tight focus on implementability.

DirectTrust is a five-year old, non-profit, vendor neutral, self-regulatory entity initially created by and for participants in the Direct community, including Health Internet Service Providers (HISPs), Certificate Authorities (CAs), Registration Authorities (RAs), doctors, patients and vendors, and supports both provider-to-provider as well as patient-to-provider Direct exchange. In the period 2013 to 2015, DirectTrust was the recipient of a Cooperative Agreement Award from the Office of the National Coordinator for Health Information Technology (ONC) as part of the Exemplar HIE Governance Program. DirectTrust serves as a forum and governance body for persons and entities engaged in the Direct exchange of electronic health information as part of the Nationwide Health Information Network (NwHIN). DirectTrust's Security and Trust Framework is the basis for the voluntary accreditation of service providers implementing Direct health information exchange. The goal of DirectTrust is to develop, promote, and, as necessary, help enforce the rules and best practices necessary to maintain security and trust within the Direct community, consistent with the HITECH Act and the governance rules for the NwHIN established by ONC. DirectTrust is committed to fostering widespread public confidence in the interoperable exchange of health information. To learn more, visit


Robin Schoen
for Eagle Public Relations

View Comments and Join the Discussion!