Most Promising Health Data Exchange Project: Direct Project

The most promising healthcare data exchange I see coming is the Direct Project. Sure, it’s not the nirvana of health information exchange, but it’s a really reasonable step in the right direction. Plus, it’s something that’s feasible and achievable.

Aaron Stranahan wrote a great post on the ICA HITme blog which talks about a key characteristic of the Direct Project.

Earlier I mentioned that whitelists were only half the story. Rather than create a whitelist as a list of addresses, Direct focuses on which third parties (or CA’s) an organization trusts to vouch for addresses. In this way, a “circle of trust” can be created without the administrative overhead of listing out every address unless an organization really wants to. Instead, each organization exchanging Direct messages can decide for itself with which entities, and by extension the processes they represent, they’ll interact.

As you may have guessed, building a whitelist of CA’s involves key exchange. In this case, your Direct service provider, aka “HISP,” will collect the public key, for whichever third parties you trust, to sign off on messages you will receive. In the world of Direct, these public keys are called “Trust Anchors” as a nod to the idea of the circle of trust these third parties represent.

So, that’s it- Direct is about whitelists, but with a twist that simultaneously reduces administrative burden and ensures that messages are encrypted following best practices. It’s a whitelist on steroids! Next time someone asks why they can’t send a Direct “email” message to their gmail account you’ll know it’s because gmail isn’t in your organization’s circle of trust.

One of the biggest challenges to any HIE program is knowing who everyone is and in whom you trust. I love the way Direct Project is approaching this “Trust Circle.” It’s reasonable and is a major reason why I believe that Direct Project will be a major success. I’ll be glad once every EHR vendor supports the Direct Project.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference,, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.


  • I agree the Direct Project promises to finally create the pipeline that may allow us to get beyond the fax machine. I hope and trust that those now purchasing health information technologies will select solutions that will do not close off the connections between HISP’s ,and that do not charge for each Direct Addressee. Are not these practices attempts to sabotage successful interoperability and patient engagement?

  • As a consumer, I’d prefer my information be available more quickly so that my health care providers can make decisions while I’m in the office.

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