Transactions now average 79 million per month

WASHINGTON, DC, US, February 17, 2022 / — DirectTrust today announced fourth quarter 2021 metrics, which include a significant uptick in year-over-year Direct exchange transactions, and the quarter’s Interoperability Heroes. DirectTrust is a non-profit healthcare industry alliance created to support secure, identity-verified electronic exchanges of protected health information (PHI) between provider organizations, and between providers and patients, for the purpose of improved coordination of care.

According to end of fourth quarter 2021 metrics:

• Direct exchange transactions: There were more than 254 million Direct Secure Messages sent and received within the DirectTrust network during the fourth quarter of 2021, bringing the total number of Direct Secure Messages during 2021 to more than 945 million, a 31% increase over the total number of Direct Secure Messages in 2020. Direct exchange transactions since DirectTrust began tracking transactions in 2014 reached nearly 2.9 billion at the end of the fourth quarter; an average of more than 79 million transactions per month.

• DirectTrust patient/consumer use: The number of patients/consumers using Direct Secure Messaging increased nearly 16% to more than 653,000, compared with the same period a year ago.

• DirectTrust trusted addresses: The number of trusted Direct addresses able to share PHI grew close to 12% to nearly 2.8 million, compared with the same quarter last year.

• DirectTrust organizations served: The number of healthcare organizations served by DirectTrust health information service providers (HISPs) and engaged in Direct Secure Messaging increased close to 13% to nearly 291,000, compared with the same time last year.

• DirectTrust membership: Recent new members include:

“In 2021 we saw a return to strong growth in message volume and in the number of organizations with access to Direct Secure Messaging, after seeing a dip related to the pandemic in 2020,” said Scott Stuewe, President and CEO of DirectTrust. “Our volume rebounded to over 100 million more transactions than we saw in 2019, making 2021 our best year yet. This growth appears to be fueled by new use cases, such as ADT Event Notifications. Our community is now working on improving the quality of our Directory. The cleanup associated with this effort, along with changes in strategy where some organizations are using Direct addresses based on departments or teams rather than individuals, may have resulted in a reduction in the total number of addresses in use. Overall, we are excited that as we enter our tenth anniversary year that our network continues to thrive.”

DirectTrust also announced its third class of Interoperability Heroes. The Interoperability Hero Initiative recognizes organizations, teams, and individuals integral to advancing interoperability. DirectTrust takes Interoperability Hero nominations based on significant contributions in a variety of categories, including fax alternatives, collaboration with others, identity-proofing, organizational efficiencies, and using Direct with other standards and networks (e.g., FHIR, Query).

The individuals, teams, and organizations nominated and recognized as Interoperability Heroes during the fourth quarter of 2021 are:

  • Arkansas SHARE (Anne Santifer and Justin Villines)
  • David K. Butler, MD – The Chartis Group
  • Kathleen Dahl, RN and Cynthia Olson, RN – Minneapolis VA Medical Center
  • Charles Jaffe, MD, PhD – HL7
  • Katherine Lusk – THSA
  • OpenNotes (Catherine DesRoches, DrPH)
  • Sheryl Turney – Anthem
  • Amy Shellhart – WellSky
  • Jennifer Smith – CommonWell Health Alliance
  • Andrei Zudin, PhD – Health Gorilla

“The Interoperability Hero Initiative has highlighted that regardless of organizational affiliation or specific standards deployed, many in health IT are laser-focused on advancing interoperability,” said Kathryn Ayers Wickenhauser, DirectTrust Director of Communications. “We’re eager to celebrate and shine a light on these Interop Heroes, and hope the stories shared not only indicate what is possible with interoperability, but also inspire action to follow suit.”

Charts detailing end of fourth quarter results are available here or by contacting Ed Emerman at [email protected] or 609.240.2766. Additional information about the fourth quarter 2021 Interoperability Heroes may be accessed here. More on the Interoperability Hero Initiative can be found at, and video spotlights on Interoperability Heroes may be found at

About DirectTrust
DirectTrust™ is a non-profit, vendor-neutral alliance initially created by and for participants in the healthcare and technology communities, including Health Information Service Providers (HISPs), Certificate Authorities (CAs), Registration Authorities (RAs), healthcare providers, pharmaceutical companies, consumers/patients, and health IT vendors. DirectTrust serves as a governance forum, trust community, standards organization, and accreditation body for persons and entities engaged in exchange utilizing PKI mechanisms for trusted, secure information exchange like Direct Secure Messaging and trusted, compliant document submission. The goal of DirectTrust is to develop, promote, and, as necessary, help enforce the rules and best practices necessary to maintain security and trust within its trust community. DirectTrust is committed to fostering widespread public confidence in the interoperable exchange of health information. To learn more, visit

Media Contact
Ed Emerman
Eagle Public Relations
[email protected]

View the full Press Release here.