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DirectTrust making progress on its FHIR Directory Improvement Initiative

DIrectTrust is transitioning its 2.6M+ address Directory to a FHIR server that will automate updates and improve its accuracy and usability.
By admin
Sep 12, 2022, 8:00 AM

DirectTrust has moved from the first phase of its Directory Improvement Initiative and plans to begin work soon on an application programming interface (API) based on the Fast Healthcare Interoperability Resources (FHIR) standard that will allow for automated address updates to the DirectTrust Directory.

Entities with a Direct address can exchange encrypted clinical data using a transport method known as Direct Secure Messaging, which DirectTrust oversees on behalf of the Office of the National Coordinator of Health IT (ONC). This form of messaging lets providers with different electronic health record (EHR) systems and/or at different institutions exchange information for purposes such as care transitions, referrals, diagnostic testing, and public health reporting.

According to the most recent DirectTrust data, more than 2.6 million unique addresses spread among 306,000 healthcare organizations and nearly 670,000 patients. All told, these entities have sent roughly 75 million messages per month since DirectTrust began tracking transactions eight years ago.

Under the Direct Secure Messaging model, separate entities known as health information service providers (HISPs) are responsible for tasks such as encrypting and decrypting messages, authenticating the identity of anyone sending messages, and maintaining lists of Direct addresses.

Since each HISP maintains its own list of addresses in a CSV file, the larger DirectTrust Directory has been an aggregation of multiple files. Not surprisingly, this has been difficult to manage at scale. An aggregated list is difficult to search, as an organization or individual provider may appear multiple times. It also depends on a time-consuming manual process for validating and updating records.

In March, DirectTrust announced its Directory Improvement Initiative, which boils down to three steps: Understanding the most pressing accuracy problems, improving Directory search, and enabling real-time updates.

The first step is largely complete. Among other things, DirectTrust has released a rules engine to validate data associated with each Directory record, from a physical address and phone number to a national provider identifier number and medical specialty code. Along those lines, the organization is making quality reports available to HISPs to help them see how accurate their Directory entries are.

Meanwhile, the second step has begun, as DirectTrust has synchronized the flat-file CSV Directory with a FHIR server. With this version of the Directory in place, HISPs will be able to update addresses using a FHIR-based API “by the end of the year,” according to DirectTrust.

HISPs will have the option to update all records as well as individual records with an API call. This will eliminate the need to aggregate and submit a new CSV file, though DirectTrust will still accept CSV files for the time being.

With automated Directory updates in place, providers should be able to locate the correct Direct address faster and more readily share information with members of a patient’s care team, streamlining communication and improving care coordination.


Brian Eastwood is a Boston-based writer with more than 10 years of experience covering healthcare IT and healthcare delivery. He also writes about enterprise IT, consumer technology, and corporate leadership.

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