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

August 14, 2017
by Rajiv Leventhal
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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.”

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