DirectTrust White Paper Promotes EHR Usability and Health Data Exchange

DirectTrust and HL7 recently released a white paper proposing ways Fast Healthcare Interoperability Resources (FHIR) and “Direct” standards can work together to achieve technical improvements to health data exchange. HL7 is a standards developing organization (SDO) accredited by the American National Standards Institute (ANSI). DirectTrust is a collaborative nonprofit association of 124 health IT and healthcare provider organizations to support secure, interoperable health information exchange via the Direct message protocols. DirectTrust provides a health information exchange network for secure, interoperable protected health information (PHI) exchange between provider organizations as well as providers and their patients.

In the white paper, insight is offered for a number of uses for FHIR. FHIR is made up of a web application programming interface (API) and related specifications designed. The short five-page paper, “Direct, DirectTrust, and FHIR: A Value Proposition,” was created to identify 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.

According to the paper, “FHIR API itself specifies no particular security arrangement. The focus of the existing implementation work on SMART-on-FHIR is around authorization mediated by a human as part of the interaction. In this context, the authentication of the user is delegated to the authorizing server. The existing work in the FHIR eco-system does not deal with establishing trust between systems. To authenticate system-to-system communication, some trust framework will be needed – either point to point agreement about certificates and other security tokens, or some mediated trust community will need to provide a framework in which these are managed.”

In combination, these health information exchange standards could promote interoperability improvements across the healthcare industry. Overall, interoperability is the name of this game here, despite the industry colloquialisms. Despite the stereo instruction-style writing within the paper, DirectTrust puts one thing forward with this piece: Interoperability is created by collaboration. Without this, there can be nothing else.

As reported by EHR Intelligence, “Collaboration is key to getting the best out of standards,” said DirectTrust president and CEO David Kibbe, MD. “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,” Kibbe said

The news site also makes this interesting observation: This white paper intended to improve interoperability across the healthcare industry follows a similar effort earlier this year to promote EHR usability and health data exchange using the Direct standard.

The work is noble, and the focus is singular: Promote EHR usability and health data exchange.

Scott Rupp's picture

Scott Rupp


Scott E. Rupp is a writer and an award-winning journalist focused on healthcare technology. He has worked as a public relations executive for a major electronic health record/practice management vendor, and he currently manages his own agency, millerrupp. In addition to writing for a variety of publications, Scott also offers his insights on healthcare technology and its leaders on his site, Electronic Health Reporter.

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