Collaborating on specifications to drive healthcare interoperability and trusted exchange

Standards Mission

DirectTrust Standards seeks to foster standards that enhance healthcare interoperability and identity or that have applicability to a Trust Framework.

Standards Application

Access the application to become a member of DirectTrust Standards

Standards History

A Consensus-Based Standards Legacy

The Direct Project launched in March 2010 to specify a simple, secure, scalable, standards-based way for participants to send authenticated, encrypted health information directly to known, trusted recipients over the Internet as part of what was known as the Nationwide Health Information Network. The Direct Project was structured as a consensus-based standards development organization since its inception, with participation and sanction from the Department of Health and Human Services (HHS) and the Office of the National Coordinator of Health IT (ONC), but with no affiliation with an accrediting authority. The standards development mission of DirectTrust today grew from those voluntary discussions and workgroup meetings that began in April 2011 among stakeholders eager to develop standards suitable for the growth of such an exchange approach.

The Direct Standard® was first formalized in a document called the “Applicability Statement for Secure Health Transport” crafted from the Direct Project and published in April 2011, with updates in 2012 and 2015.

Rules of the Road

At the same time, a large group of interested parties, known as the “Direct Rules of the Road Workgroup”, began to grapple with the governance required to allow the scalable use of the Direct Standard® in the healthcare industry. At issue was how best to establish trust among the operators a network in the issuance, exchange, and management of digital certificates, known as Public Key Infrastructure (PKI) technology. In late 2011, a large group began assembling in anticipation of the creation of DirectTrust, an independent non-profit entity to support the rules and regulations for a trust framework. The work of the new organization would be complementary to and supportive of rules and regulations as a part of the HITECH Act and Meaningful Use from HHS and the ONC. DirectTrust was incorporated as a not-for-profit trade association in April of 2012. The membership of DirectTrust had a large overlap with the workgroups of the Direct Project.

The Road to ANSI Accreditation

In 2011, the ONC funded a position to support the maintenance of the Direct Standard® and presided over the Implementation Work Group of the Direct Project. In 2017, ONC made it known that the Direct Standard® needed a home in an independent organization to continue the standard’s maintenance and growth. As the organization with the most knowledge of the standard and an interest in its future, the DirectTrust Board of Directors determined the best course of action was to pursue American National Standards Institute (ANSI) Accreditation for an independent standards development function within DirectTrust.

During 2018, DirectTrust applied for ANSI accreditation in order to provide a consensus-based approach to standards development. In March 2019 DirectTrust Standards became an ANSI Accredited Standards development organization and began to formalize the Direct Standard as an ANSI approved national standard.

Continuing Standards Development

DirectTrust Standards seeks to foster standards that enhance healthcare interoperability and identity or that have applicability to a Trust Framework.

Descriptions of current DirectTrust Standards projects are available here.

DirectTrust Standards Board



Standards Board Chair, DS2019_02 Chair

Tag Design Agency LLC

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Vince Albanese

Vince is an innovator and successful serial entrepreneur whose skills span decades of success and cutting-edge innovation.  He is a Co-Founder/CEO/CTO of Haven Technologies which is focused on delivering enterprise-grade blockchain solutions to healthcare and finance entities.  Vince is also the CTO of CommPro Worldwide.

He was a founder of the Oracle Process Manufacturer’s Users Group, i2 Technologies Rhythm Users Group, the Green Armada Foundation, and Discover Alliance. Additionally, Vince has taken an integral role within DirectTrust and is Chair of the TIM+ Consensus Body and Co-Chair of the Innovation Priorities Workgroup.



President and CEO


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Scott Stuewe

Scott Stuewe is a 25+ year veteran of the healthcare information technology industry. As President and CEO of DirectTrust, Scott drives visibility and utilization of the Direct Standard™ to contribute to nationwide interoperability. Under his tenure, the organization achieved the landmark milestone of two billion Direct Secure Messages sent and received over the DirectTrust Network. Previously, Stuewe was Director of Strategy and Interoperability at DataFile Technologies, a health information management company, and served more than 24 years at Cerner, including as Cerner Network’s Director of National Interoperability Strategy, where he drove participation in the CommonWell Health Alliance and the bridge with Carequality.



DS2019_01 Co-Chair


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Vassil Peytchev

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DS2019_01 Chair


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Brian Frankl

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DS2020_03 Chair

Secure Exchange Solutions

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Stuart Beaton

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Lisa Nelson



DS2020_03 Co-Chair

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Lisa Nelson

Lisa Nelson is a medical informatics consultant and business innovator with over 20 years of experience in the development and use of health information technology (HIT) standard.

Lisa has been a contributing author on multiple national standards for the use of digital health records and clinical quality measures. She is active in the development and adoption of the HL7 CDA and FHIR standards. She participated in the creation of Consolidated CDA, co-authored the HL7 CDA specification for patient generated documents, authored the Personal Care Plan document IG and she supports the C-CDA on FHIR project. She is a founding member of the HL7 CDA Examples Task Force and is Co-Chair HL7 CDA Management Group. At DirectTrust she participates in the Directory Data Quality Tigerteam, Release of Information Workgroup, and IX4HS Workgroup. She was a co-author for the Event Notifications via the Direct Standard™ implementation guide.



Standards Board Co-Chair, DS2021_04 Chair

Practical Markets

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Brian Handspicker

Brian (BD) Handspicker is CTO for Open City Labs, Inc., as well as an independent consultant working through PracticalMarkets, Inc. and the Stewards of Change Institute. These companies specialize in community care solutions across socialcare, healthcare, education and justice. Brian is actively involved in healthcare and socialcare interoperability standards, including HL7 Gravity Project (Social Determinants of Health), FHIR Clinicalcare SDOH IG, HL7 Human and Social Services, DirectTrust Innovations Priorities, and as Chair of DirectTrust’s Information Exchange for Human Services (IX4HS) Consensus Body. He is a Fellow of the National Interoperability Collaborative (NIC) and Technical Lead for NIC’s Project Unify.



DS2021_04 Co-Chair


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Courtney Baldridge

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Joseph Schneider



DS2022_05 Chair


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Joseph Schneider

Dr. Joseph Schneider is a practicing pediatrician at UT Southwestern in Dallas.  He also teaches informatics at UTSW and UT Dallas.  He worked as a CMIO for 13 years until 2016.  He has a Columbia MBA with 15 years of business experience prior to medical school including managing a medical device company. 

He is a founder/past chair of the Texas Medical Association’s HIT Committee.  In the American Academy of Pediatrics, he is past chair of the HIT Council and an Oberst Award recipient.  He co-authored ASTM’s 2003 Continuity of Care Record standard, one of the first interoperability approaches.

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