By Kathryn Ayers Wickenhauser, Chief Strategy Officer
Whether anticipated or not, 2025 was quite a year! With a new Administration taking office in January, the industry experienced a period of recalibration, marked by both pauses to discern direction and focused sprints to pursue new opportunities.
Amid the change of the past year, one thing remains constant: the health technology industry thrives through collaboration and cooperation. As we look ahead to 2026, we understand that imperatives set forth by CMS and other agencies celebrate and require this spirit. Interoperability, security, and trust are not achieved in isolation.
DirectTrust is also built with an understanding of how critical fostering community is to our success. This past year, DirectTrust worked on and achieved quite a lot in pursuit of our goal of bolstering trust in health technology and related industries.
Strengthening Technical Trust Across the Ecosystem
Throughout 2025, DirectTrust’s accreditation and certification programs continued to anchor the industry. As our world becomes increasingly connected, we saw demand from organizations operating in healthcare seeking rigorous, independent verification of their security, compliance, and identity practices. As a result, we launched our Identity Provider Accreditation Program and the Beta group of our Artificial Intelligence Accreditation Program.
Furthermore, technical trust in new contexts continued to grow. We made meaningful progress toward Facilitated FHIR®, including issuing our first certificates to support FHIR-based exchange and advancing work aligned with TEFCA™-related workflows. These milestones reflect our continued commitment to supporting identity-verified and trusted exchange across both established and emerging modalities.
Additionally, we continued our alignment with cross-industry partners such as the Kantara Initiative™ through launching the first interoperable digital credential policy in partnership with the CARIN Alliance through the CARIN Digital Credential Policy.
Finally, we continue to support other industry initiatives supporting or strengthening our ecosystem by participating in efforts like the Health Sector Coordinating Council Cybersecurity Working Group.
Together, these efforts reinforced a clear signal from the market: DirectTrust is increasingly relied upon as an independent, neutral trust authority for healthcare.
Driving Adoption of Direct Secure Messaging
Direct Secure Messaging continued to grow in 2025, surpassing over 7 billion messages exchanged, with expanded adoption across care coordination, public health, behavioral health, and emerging use cases. We also expanded our educational footprint through a new Direct Secure Messaging blog series, tackling various issues related to Direct.
Additionally, work continued on our Metadata and Payloads Consensus Body that is helping pave the path for FHIR over Direct and additional use cases in 2026.
The DirectTrust Aggregated Directory continues to grow as a relied upon resource, with all eligible HISPs participating in publishing Direct addresses to the Directory, and continued discussion and efforts in improving the quality and accessibility of those addresses.
In a Quick Stat released from the Assistant Secretary of Technology Policy at the beginning of the year, Direct Secure Messaging is the most common way to send health information. We see the use of Direct continuing to rise, especially because it offers an identity-verified, secure, simple way to engage in the interoperable exchange of health information. We look forward to further supporting Direct through continued growth.
Partnerships, Collaboration, and Industry Leadership
Our community was a driving force throughout the year. Members led Workgroups, contributed to Standards Consensus Bodies, and supported the launch of new initiatives such as the Adoption Consultants Task Force and the Advocacy Workgroup, and collaborated across the ecosystem to solve shared challenges.
DirectTrust participated in the CMS Health Tech Ecosystem, including signing the CMS Pledge. Our members contributed formal comments on key federal initiatives, including CMS inpatient payment systems, the HIPAA Security Rule, NIST Privacy Framework 1.1, NIST identity guidance (800-63-4), and RFIs from the Administration for Children and Families.
As in years prior, we believe in connecting in person with the community through conference attendance and participation. We were excited to participate in national convenings such as the DirectTrust Annual Conference, ViVE, HIMSS, Civitas Networks for Health, CommonWell, eHealth Exchange, Sequoia Project, and the Health Sector Coordinating Council’s events to explore existing and emerging work.
Organizational Growth and Recognition
In 2025, we welcomed new team members, including Lisa Nelson and Greg Meyer, and hosted a highly successful annual conference that showcased the strength and diversity of our community. Members, volunteers, and staff were recognized across the industry for their leadership and contributions, including Becker’s Women in Health IT to Know and the Health Sector Coordinating Council Partnership Medallion, further elevating DirectTrust’s visibility and impact.
Looking Ahead
As we close out 2025, we do so with pride in what we accomplished and clarity about what lies ahead. The health technology landscape will continue to evolve, but trust remains foundational. With strong momentum, deep partnerships, and a committed community, DirectTrust enters 2026 prepared to continue serving as the backbone of secure identity, trusted exchange, and technical trust services across the health technology ecosystem.