DirectTrust

What DirectTrust does

DirectTrust is a Washington, DC-based non-profit organization founded in 2012 that establishes and operates the trust infrastructure for nationwide health information exchange. Its core technology is the Direct Secure Messaging protocol — a PKI-based, certificate-bound messaging standard — supported by the DirectTrust Aggregated Directory of nearly 2 million Direct addresses and a Trust Framework with Trust Bundles and accredited Identity Providers. DirectTrust's product portfolio includes Direct Secure Messaging, the Aggregated Directory, certificate issuance, PKI Trust List, and third-party accreditation programs (HISP, Cloud Fax, AI Accreditation, and the CMS-recognized CARIN-CFA). Following the 2021 acquisition of SAFE Identity and the 2023 merger with EHNAC, the organization expanded its identity, credentialing, and accreditation capabilities.

Name

DirectTrust

Legal name

DirectTrust

Website

https://directtrust.org

Company type

Private

Founded year

2012

Operating status

Operating

Headcount range

101–250 employees

Short description

DirectTrust is a Washington, DC-based non-profit that operates the trust framework, PKI, and accreditation infrastructure enabling secure Direct Secure Messaging and interoperability across 189,000+ healthcare organizations and federal agencies.

Ownership category

akta.pro rank

Product category

Healthcare Interoperability Standards

akta.pro primary industry

Consent, Preference & Data Rights Management (incl. HIPAA/GDPR support) (HLACAIAG)

Keywords

• Healthcare interoperability standards
• Secure health messaging
• Health information exchange
• Trust framework services
• PKI certificate services

Headquarters

HQ city

Washington

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Software

Cost components

Personnel, Technology or R&D, Operations, Marketing or Sales, Infrastructure

Revenue model

1. Membership Dues: DirectTrust operates as a non-profit membership organization with 100+ contributing members including healthcare providers, HIEs, technology vendors, and federal agencies. Membership provides access to standards development, advocacy efforts, service discounts, and co-branded educational materials.
2. Accreditation Services: Third-party accreditation programs for healthcare organizations including EHNAC-accredited entities, HITRUST partnerships, and the new AI Accreditation Program. Organizations pay assessment fees for compliance validation against security and interoperability standards.
3. Directory and Certificate Services: Directory services including the Aggregated Directory, PKI trust list, and certificate issuance for Direct addresses. These services support the operational infrastructure of the DirectTrust network.

Go-to-market motion1 record

Distribution channels4 records

Marketing channels6 records

Core offering

DirectTrust operates a trust infrastructure for healthcare data exchange, providing Direct Secure Messaging (a nationwide, certificate-bound secure messaging protocol), the DirectTrust Aggregated Directory (a nationwide provider lookup service by name, NPI, or organization), and the Trust Framework (policies, standards, and identity verification requirements). It also delivers third-party accreditation programs evaluating healthcare organizations against security, privacy, and operational standards, plus digital certificate issuance services to enable authenticated, encrypted health information exchange.

Product overview

DirectTrust is a non-profit organization operating a platform-based ecosystem for healthcare data exchange trust infrastructure. The core offering consists of Direct Secure Messaging (a nationwide certificate-bound messaging protocol), the DirectTrust Aggregated Directory (provider lookup service), and the Trust Framework (identity verification and certificate policies). These are supported by accreditation programs for third-party validation of security and privacy practices, certificate issuance services, and standards development (including The Direct Standard®, TIM+, and Event Notifications via Direct). Following the 2023 merger with EHNAC and 2021 acquisition of SAFE Identity, the portfolio expanded to include broader accreditation programs and enhanced identity/credential services. The organization also offers membership programs, roundtables, and an annual conference for community engagement.

Differentiator

Problem solved

Functional benefit

Products and services

• Direct Secure Messaging A nationwide, certificate-bound, secure messaging protocol enabling trusted health information exchange between healthcare organizations, providers, and patients with delivery confirmation and encryption. It is the foundational interoperability standard for Direct messaging and is available in every certified EHR.
• DirectTrust Aggregated Directory A nationwide directory of Direct addresses contributed by participating HISPs, enabling provider lookup by name, NPI, or organization, with endpoint metadata for use case disambiguation.
• Trust Framework A comprehensive trust framework including policies, standards, and requirements that govern identity verification, certificate issuance, and interoperability requirements for participating organizations.
• DirectTrust Accreditation Programs Third-party accreditation programs evaluating organizations against DirectTrust and EHNAC criteria for security, privacy, and operational practices, including HISP accreditation, Cloud Fax accreditation, and AI accreditation programs.
• Certificate Issuance Digital certificate issuance services for healthcare organizations and providers to enable authenticated, encrypted Direct messaging and identity verification within the trust framework.
• Trust Bundles Curated collections of trusted certificates and endpoints that enable participating organizations to validate and trust incoming Direct messages from verified senders.
• PKI Trust List A list of trusted Certificate Authorities and their certificates used to validate digital certificates in the DirectTrust ecosystem for authentication and encryption.
• Trust Framework IdP List A list of accredited Identity Providers operating within the DirectTrust trust framework, enabling federation and authentication for healthcare data exchange.
• Membership Program Organizational membership providing benefits including influence over standards development, access to industry experts, peer networking, brand championing, service discounts, and advocacy representation.
• Artificial Intelligence Accreditation Program Accreditation program v1.0 for AI in healthcare that strengthens governance, risk management, and oversight for artificial intelligence systems used in the healthcare ecosystem. Two organizations achieved accreditation following beta participation.
• CARIN-CFA Accreditation Program Accreditation program recognizing the CARIN Code of Conduct for Consumer-Facing Applications, recognized by CMS as an approved pathway for consumer-facing health applications to demonstrate alignment with criteria for listing in the Medicare App Library.

Quantifiable outcome

• Over 1 billion cumulative Direct messages sent and received since 2014
• +3 more outcomes

Named customers14 records

Segments4 records

Ideal customer profiles4 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration4 records

Feature6 records

Partnerships

Twelve partnerships are on record, tiered flagship, core and minor.

• EHNAC (Electronic Healthcare Network Accreditation Commission)flagshipStrategic or Co-development Partner · 4 January 2023DirectTrust completed merger with EHNAC effective January 4, 2023, creating a combined organization to enhance trust and accreditation in healthcare data exchange. The merger streamlines accreditation processes and strengthens security and standards, impacting nationwide healthcare trust frameworks.
• SAFE IdentitycoreStrategic or Co-development Partner · 31 August 2021DirectTrust acquired SAFE Identity's assets including its Trust Framework to expand interoperability services. The acquisition enables new use cases including secure interactions with federal agencies, medical device security, and healthcare credentials for consumers.
• CARIN AlliancecoreStrategic or Co-development PartnerPartnership to recognize CARIN Code of Conduct for Consumer-Facing Applications (CARIN-CFA) Accreditation as an approved pathway for consumer-facing health applications to demonstrate alignment with CMS criteria for listing in the Medicare App Library.
• The Sequoia ProjectcoreStrategic or Co-development PartnerCollaboration on interoperability initiatives including the Data Usability Taking Root Movement with AHIMA. DirectTrust participates in Data Usability Workgroup meetings and contributes to data usability implementation guides.
• HITRUSTcoreStrategic or Co-development PartnerPartnership for integrated accreditation services combining DirectTrust's trust framework with HITRUST's security and privacy certification programs.
• Johns Hopkins University Applied Physics LaboratoryminorStrategic or Co-development PartnerPartnership with JHAPL to provide independent counsel to the Consumer Credentials Workgroup evaluating standards, technologies, and services needed for DirectTrust to act as identity providers for API-based health information exchange.
• HIMSSminorGTM or Marketing PartnerNon-profit partner of HIMSS conferences, participating in educational sessions and interoperability showcases.
• ViVEminorGTM or Marketing PartnerNon-profit partner of ViVE conference, exhibiting in the InteropNow! Pavilion and presenting educational sessions.
• American Health Information Management Association (AHIMA)coreStrategic or Co-development PartnerPartnership on Data Usability Taking Root Movement to make electronic healthcare information more useful. DirectTrust contributes to data integrity and directory improvement initiatives.
• Leavitt PartnersminorStrategic or Co-development PartnerHealthcare policy and analytics firm participating in SEDI summit discussions on trust infrastructure for digital health data exchange.
• GLEIF (Global Legal Entity Identifier Foundation)minorStrategic or Co-development PartnerInternational organization providing legal entity identifiers (LEI) proposed as tools for verifiable organizational identity in healthcare data exchange.
• healthKERIminorStrategic or Co-development PartnerOrganization focused on health entity identification proposing solutions for healthcare trust infrastructure and digital health data exchange.

Scale indicators6 records

Recent moves6 records

Expansion highlights6 records

Direct peers

• The Sequoia Project: Non-profit interoperability organization that operates initiatives such as eHealth Exchange, Carequality, and TEFCA-related work. Direct peer to DirectTrust as a neutral, member-driven convener advancing cross-organization health data exchange, and an active collaborator on the Data Usability Workgroup.
• CommonWell Health Alliance: Non-profit health information network offering vendor-neutral person-centric record locator and exchange services. Comparable to DirectTrust as an interoperability utility used by EHRs and providers, with overlapping membership and a complementary (rather than identical) exchange modality.
• Civitas Networks for Health: National non-profit network of HIEs and health data utilities formed from the merger of SHIEC and the Strategic Health Information Exchange Collaborative. Direct peer as a membership-based convener of state and regional HIEs that rely on DirectTrust's trust framework and directory.
• HL7 International: Standards-developing organization behind FHIR, CDA, and other healthcare interoperability specifications. Direct peer in the sense that DirectTrust's Direct Standard sits alongside HL7 specifications; both shape how healthcare data is exchanged and how EHRs are certified.
• eHealth Exchange: Nationwide health information network operated under The Sequoia Project that connects federal agencies, providers, and HIEs. Comparable to DirectTrust as a backbone for cross-organization clinical exchange, with federal-agency participation analogous to DirectTrust's VA and HHS relationships.
• CARIN Alliance: Non-profit multi-stakeholder collaborative advancing consumer-directed health data exchange. Direct peer as a convening body that has partnered with DirectTrust on the CARIN-CFA Accreditation Program, recognized by CMS for the Medicare App Library.

Broad incumbents

• HITRUST: Larger, more established security and privacy certification body whose CSF assurance program is widely adopted in healthcare. Both DirectTrust (via EHNAC) and HITRUST accredit healthcare entities against security/privacy standards, and the two have a formal partnership for integrated assessments.
• American Health Information Management Association (AHIMA): Established non-profit professional association for health information management. Comparable to DirectTrust as a non-profit authority shaping data integrity, documentation, and information governance standards in healthcare, and a partner on the Data Usability Taking Root Movement.
• CAQH (Council for Affordable Quality Healthcare): Non-profit alliance that operates healthcare administrative-data exchange utilities (e.g., CAQH CORE, COB Smart). Comparable to DirectTrust as a multi-stakeholder non-profit creating shared infrastructure and standards for interoperable data exchange between providers, payers, and vendors.

Emerging players

• Kantara Initiative: Non-profit focused on digital identity, identity assurance, and federated trust frameworks. Comparable to DirectTrust's trust framework work, but broader across sectors; an emerging player where healthcare identity overlaps with cross-industry federation.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat6 records

Key risks5 records

Key highlights7 records

Customer concentration

• Xx.com/directtrustorg
• LinkedInlinkedin.com/company/directtrust
• Facebookfacebook.com/directtrust-883390355049517

Revenue estimate

Valuation estimate

Number of profiles

Profiles9 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A2 records

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about DirectTrust