DirectTrust Interoperability Report Suggests Best Practices, Improvements

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DirectTrust releases its Report on DirectTrust Interoperability Testing and Recommendations to Improve Direct Exchange.

DirectTrust, a non-profit trade alliance that advances secure standards-based health information exchange (HIE) via the Direct Protocol, will present its Report on DirectTrust Interoperability Testing and Recommendations to Improve Direct Exchange during the DirectTrust Mini-Conference co-located at the 12th Annual World Health Care Congress on Sunday, March 22, 2015 at 2 pm at the Washington Marriott Wardman Park in Washington, D.C. Last year there were nearly 23 million Direct exchange transactions, and the report is the compilation of two years of best practices and observations on how to efficiently implement interoperability within the context of Stage 2 Meaningful Use.

"The infrastructure for Direct exchange is robust and exchanges are going quite smoothly for most people and organizations attesting to Stage 2 MU 'transitions of care' objectives," said DirectTrust President and CEO David C. Kibbe, MD, MBA. “The report's goal is to get HISPs, EHRs, PHRs, and their customers up to speed using Direct even more quickly, and also to improve the network's processes and policies for more consistent, reliable end-to-end data transfers via Direct."

The challenge-solution format is designed to help Direct service providers and end-users avoid potential stumbling blocks and trouble-shoot any issues that may arise. In addition, it includes a number of recommendations to the Office of the National Coordinator for Health Information Technology (ONC), the health exchange community, electronic health record (EHR) vendors, as well as members of Congress. The focus is improving interoperable communications among providers using EHRs for Meaningful Use programs.

Among the recommendations are:

  •     Changes to the Applicability Statement, which is the technical description of the Direct standard
  •     Acceptance within the industry of new guidance that will remove ambiguity through best practices
  •     Adding ONC certification proving EHR interoperability in the field, not just in testing labs

Although parts of the report are highly technical in nature so as to benefit engineers implementing interoperability, the report will also prove valuable to CIOs, CTOs, doctors and others in healthcare operations who need specific guidance on solving business problems and managing different scenarios.

"The network is a collaborative community of more than 35,000 healthcare organizations," said EMR Direct CEO Julie Maas. "The report is really a consolidation of shared experiences on overcoming growing pains that are common in such a dynamic system. Solutions evolve and issues resolve. That's what happens when a group is dedicated to finding answers instead of placing blame."

Dr. Kibbe pointed to the report's accounts of a growing number of health information service providers (HISPs) that have successfully implemented Direct exchange. Despite initial, and understandable, skepticism, as well as a number of technical variables — compatibility of systems, claims specifics, etc. — HISPs are demonstrating proof of interoperability between systems.

"Interoperability is hard work, but DirectTrust's skeptics are becoming extinct," he said. "Our hope is that this report provides near term and actionable steps that can be taken to realize the goals for Direct as a first step in interoperability on a national scale, equally vital to patients and consumers as it is to providers and provider organizations."

DirectTrust-EHNAC accreditation means that strict privacy, security, and trust-in-identity controls are in place to ensure that messages and attachments sent over the Internet remain encrypted end-to-end, and that senders and receivers are identity-proofed. In addition to medical practices, clinics, hospitals, pharmacies and laboratories, DirectTrust technology is also being adopted by a growing number of federal agencies, such as the Veterans Administration, U.S. Postal Service, and Indian Health Services.

The interoperability report is the latest in a series of advances made by DirectTrust. Their network grew nearly 970 % last year, and it recently launched a pilot program to create a national directory of Direct email addresses – about 660,000 accounts – for accredited members and their customers.

Those interested in attending DirectTrust's conference presentation or attaining accreditation are advised to visit

About DirectTrust
DirectTrust is a nonprofit, competitively neutral, self-regulatory entity created by and for participants in the Direct community – including health information service providers (HISPs), certificate authorities, registration authorities, doctors, patients, and vendors. It supports both provider-to-provider, as well as patient-to-provider Direct exchange. The goal of DirectTrust is to develop, promote and, as necessary, help enforce the rules and best practices needed to maintain security and trust within the Direct network, consistent with the HITECH Act and the governance rules for the NwHIN established by the ONC. DirectTrust is committed to fostering widespread public confidence in the Direct exchange of health information. DirectTrust is the recipient of a two-year Cooperative Agreement with the Office of the National Coordinator for Health IT, ONC, under the Exemplar HIE Governance Program, and has been supported in part by a grant associated with the Cooperative Agreement. To learn more, please visit

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David C. Kibbe, MD
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