DIRECTTRUST
DirectTrust Direct secure messaging US healthcare framework.
Definition
DirectTrust framework: (1) Direct Project standard (ONC + S&I Framework 2010, S/MIME email-based clinical messaging protocol, uses XDR or XDM transport, X.509 certificates anchoring trust). (2) DirectTrust Anchor Bundle: list of trusted Certificate Authorities (CAs) anchoring Direct certificates, ~30+ CAs accredited (DigiCert + Entrust + EBIA + Visa Health + multiple regional). (3) DirectTrust HISP accreditation: Health Information Service Providers (HISPs) operate Direct messaging infrastructure on behalf customers, ~30 HISPs accredited 2024 (Surescripts + RelayHealth + Cerner Direct + Allscripts Direct + Updox + DataMotion + etc.). (4) Direct addresses: email-like format @direct.providername.com, e.g., john.smith@direct.hospital.org, used for clinical messaging vs personal email. (5) Use cases: (a) Provider-Provider clinical communication (referrals + transitions of care + consults + discharge summaries), (b) Patient-Provider (patient receives lab results + appointment reminders), (c) Payer-Provider (HEDIS quality reporting + prior authorization), (d) Public Health reporting (notifiable disease + immunization registries). (6) DirectTrust integration TEFCA: Direct messaging will integrate TEFCA via Qualified Health Information Networks QHINs. ~3M+ Direct addresses provisioned 2024 + ~700M+ messages cumulative, growing rapidly federal + state public health reporting.
Origin
Direct Project initiated 2010 by ONC + S&I Framework ; DirectTrust LLC founded 2012 Bedford MA ; ~3M+ Direct addresses 2024.
Example in context
Primary care physician PCP refers patient to cardiologist for chest pain workup ; PCP composes Direct message to cardiologist.direct@cardiologyclinic.org via Epic Direct messaging UI, attaches CCDA referral document, Epic Direct HISP signs S/MIME + encrypts + sends via SMTP to cardiologist HISP, cardiologist receives in EHR inbox, opens + accepts referral.
Related terms
- Carequality — complementary framework.