Direct Secure Messaging:
DirectTrust maintains and governs the Accredited Trust Anchor Bundle (ATAB), which is a vetted collection of trust anchors from Accredited Certificate Authorities (CAs) participating in Direct Secure Messaging. These CAs issue certificates to identity-proofed organizations and individuals for use within secure healthcare workflows, such as referrals, care coordination, and transitions of care. All certificates within this trust framework conform to DirectTrust’s technical and policy standards and are interoperable across the entire DirectTrust network. The ecosystem includes dozens of accredited HISPs (Health Information Service Providers) and CAs that ensure strong identity, privacy, and security foundations for millions of Direct addresses in production use today.
Query-Based Exchange:
A subset of DirectTrust Accredited Certificate Authorities (CAs) issue certificates specifically for Query-Based Exchange use cases, such as participation in eHealth Exchange and Carequality. DirectTrust coordinates the certificate issuance intake process and manages the relationships among participants, implementers, and the CAs. This coordination ensures that certificates meet the unique technical and governance requirements of these national exchange frameworks while preserving trust and interoperability.
Facilitated FHIR:
DirectTrust operates a Root Certificate Authority (CA) dedicated to Facilitated FHIR as part of a new trust infrastructure designed to support FHIR-based exchange under TEFCA (Trusted Exchange Framework and Common Agreement). This Root is purpose-built to issue intermediate certificates to DirectTrust Accredited CAs who will support scalable, standards-based API exchange between QHINs and TEFCA participants. As the TEFCA ecosystem evolves, DirectTrust is well positioned to serve participants with automated certificate issuance aligned to future FHIR exchange needs under the governance of the Recognized Coordinating Entity and applicable policies.
