By Scott Stuewe, President and CEO

When we first announced the theme for this year’s DirectTrust Annual Conference, Trust at the Crossroads, we talked about healthcare reaching an important point of convergence. Identity, interoperability, cybersecurity, artificial intelligence, privacy, policy, and emerging technologies are no longer separate conversations—they depend on one another.

Looking across this year’s agenda, you can see that idea reflected throughout the program.

Our goal was not simply to assemble experts to talk about the big trust and interoperability challenges facing healthcare. We wanted to create an environment where attendees could dig into some of the questions the industry is actively trying to answer, hear different perspectives, and, importantly, participate in the conversation.

Building Consensus Around Digital Identity

We are especially excited to welcome Utah Chief Privacy Officer Christopher Bramwell, who is doing some of the most interesting work I’ve seen around digital identity.

Christopher has been helping lead Utah’s State Endorsed Digital Identity initiative and, perhaps even more importantly, working to build consensus around digital identity beyond the state itself. It’s an ambitious and potentially groundbreaking effort to create greater trust in digital interactions across government, healthcare, financial services, and other parts of our lives.

What I find particularly interesting about Utah’s approach is where they started: with policy. Before deciding what technology everyone should use, they worked to establish agreement around the rules, principles, and outcomes they were trying to achieve.

We sometimes have a tendency to start with the technology and work backward. Christopher’s day one keynote, Establishing a Consensus on What Trust Takes, will give us an opportunity to hear from someone tackling the much harder question: How do we establish enough common ground to make trusted digital identity work at scale?

Improving Exchange Where It Matters

One session I’m particularly excited about on day two will introduce the work of our Interoperability Progressive Standards Usability Program (IPSUP) to improve document-based exchange for maternal health. The session will share results from the IHE 2026 Maternal Health Plugathon we are supporting a couple of weeks before the Conference, and examine how Direct-based exchange can become smarter, more timely, and more useful at critical points in patient care.

Direct Secure Messaging already provides essential interoperability infrastructure for referrals, transitions of care, event notifications, electronic case reporting, and many other forms of health information exchange. Work like this demonstrates how Direct can be extended to address new challenges and improve care for expectant mothers and newborns.

Identity is part of that equation as well. Getting the right information to the right place at the right time depends on knowing who is participating in the exchange and establishing the trust necessary to act on that information. That’s one reason I see our work around Direct, identity, standards, and trust as increasingly interconnected rather than separate efforts.

When AI Challenges the Rules

Another session I always look forward to is our debate. This year’s topic is Standards vs. AI: A Fight to the Death or to a Draw?

The premise is intentionally provocative: If artificial intelligence can map both the format and meaning of healthcare data, could standards for information exchange eventually become largely irrelevant?

I have my own thoughts on the proposition, but that’s almost beside the point. Standards have been foundational to healthcare interoperability, and AI is developing at an extraordinary pace. Bringing together smart people to argue both sides gives us an opportunity to challenge some assumptions and think seriously about what the relationship between the two may look like in the years ahead.

Putting Organizational Identity Into Practice

We’ll also get much more hands-on with organizational identity through a workshop on Verifiable Legal Entity Identifiers, or vLEIs.

I’ve shared recently why I believe organizational identity and delegated authority are becoming critical to interoperability. At the conference, attendees will get to see how these credentials are issued and how they can work in real-world digital interactions.

It isn’t enough to know who someone is. We also need to know what organization they represent and what authority they have to act on its behalf. As healthcare exchange becomes more automated, we need ways to establish that trust at scale.

From Talking About Problems to Working on Them

We’ve deliberately made more of this year’s program interactive.

Our Lightning Tabletop sessions will tackle fraud, abuse, and cybersecurity incidents by turning the usual incident-response discussion around. Rather than only asking what organizations should do after something happens, participants will work through what technologies, policies, or strategies might have prevented the incident in the first place.

Conferences are valuable because we learn from experts, but they’re even more valuable when we put people with different experiences and perspectives together and give them a problem to solve. We don’t expect every session to end with an industry-wide answer, but we do expect people to leave with new ideas, new relationships, and a better understanding of how others are approaching many of the same challenges.

The Future of Direct

Maternal health is just one example of how Direct continues to evolve. Sessions including The Future of Direct and New and Emerging Use Cases for Direct will explore where Direct is headed and how it can support new workflows and use cases.

To me, that fits naturally alongside conversations about AI, identity, cybersecurity, and verifiable credentials. The common thread isn’t a particular technology. It’s establishing the trust needed to make healthcare exchange work.

Join the Conversation in Kansas City

This year’s agenda is organized largely into two tracks. One focuses more heavily on interoperability and Direct, while the other explores identity, cybersecurity, fraud prevention, and emerging trust models. Organizations may find value in bringing colleagues with different roles and perspectives so they can divide, conquer, and compare notes.

Healthcare is at a point where AI is challenging some of our assumptions about standards, identity is becoming inseparable from interoperability, cyber threats are forcing us to rethink prevention, and automated exchange is creating new questions about trust and authority.

Those are crossroads worth exploring together.

I hope you’ll join the conversation October 20–21 in Kansas City at the 2026 DirectTrust Annual Conference, Trust at the Crossroads.