Direct and FHIR: Can They Work Hand-in-Hand? | Healthcare Informatics Magazine | Health IT | Information Technology Skip to content Skip to navigation

Direct and FHIR: Can They Work Hand-in-Hand?

August 14, 2017
by Rajiv Leventhal
| Reprints

The DirectTrust has 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 (Fast Healthcare Interoperability Resources) is a standards framework created by HL7, an American National Standards Institute (ANSI)-accredited SDO (standards developing organization) in the healthcare arena. Meanwhile, DirectTrust is a healthcare 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.

The white paper, “Direct, Direct Trust, and FHIR: A Value Proposition” is authored by Grahame Grieve, HL7 Product Director for FHIR, and by several members of the DirectTrust Policy Committee. It notes that FHIR is a new standard that defines a web API (application programming interface) and related specifications for health data exchange, while Direct is an existing federal standard that is used in the U.S. 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.

The paper specifically: 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 ecosystem does not standardize all aspects of establishing trust between systems,” Grieve said in a statement. 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,” added DirectTrust President and CEO David C. Kibbe, M.D. “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.”

Get the latest information on Health IT and attend other valuable sessions at this two-day Summit providing healthcare leaders with educational content, insightful debate and dialogue on the future of healthcare and technology.

Learn More



Healthcare Execs Anticipate High Cost Returns from Predictive Analytics Use

Healthcare executives are dedicating budget to predictive analytics, and are forecasting significant cost savings in return, according to new research from the Illinois-based Society of Actuaries.

Adam Boehler Tapped by Azar to Serve as Senior Value-Based Care Advisor

Adam Boehler, currently director of CMMI, has also been named the senior advisor for value-based transformation and innovation, HHS Secretary Alex Azar announced.

Vivli Launches Clinical Research Data-Sharing Platform

On July 19 a new global data-sharing and analytics platform called Vivli was unveiled. The nonprofit group’s mission is to promote, coordinate and facilitate scientific sharing and reuse of clinical research data.

Survey: More Effective IT Needed to Improve Patient Safety

In a Health Catalyst survey, physicians, nurses and healthcare executives said ineffective information technology, and the lack of real-time warnings for possible harm events, are key obstacles to achieving their organizations' patient safety goals.

Physicians Still Reluctant to Embrace Virtual Tech, Survey Finds

While consumers and physicians agree that virtual healthcare holds great promise for transforming care delivery, physicians still remain reluctant to embrace the technologies, according to a new Deloitte Center for Health Solutions survey.

Geisinger, AstraZeneca Partner on Asthma App Suite

Geisinger has partnered with pharmaceutical company AstraZeneca to create a suite of products that integrate into the electronic health record and engage asthma patients and their providers in co-managing the disease.