DirectTrust tops 945M exchange transactions in 2021

DirectTrust tops 945M exchange transactions in 2021

DirectTrust, which enables electronic exchanges of protected health information among provider organizations and between clinicians and patients, announced this past week that it had observed a significant uptick in year-over-year exchange transactions.  

According to the metrics released this past Thursday, more than 945 million Direct Secure Messages were sent and received within the network in 2021: a 31% increase over the total in 2020, with an average of 79 million per month.  

“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, in a statement.  

“Our volume rebounded to over 100 million more transactions than we saw in 2019, making 2021 our best year yet,” he added.


Since its incorporation as a not-for-profit a decade ago, DirectTrust has aimed to facilitate interoperability and data exchange via its secure transactions, ultimately improving care coordination.  

In the fourth quarter of 2021, the company said, more than 254 million Direct Secure Messages were sent and received within the DirectTrust network – a million-odd decrease from the same quarter the previous year.  

However, the number of patients or consumers using Direct Secure Messaging reached more than 653,000. This represented a dip from the third quarter of 2021, but an increase of 16% from the fourth quarter in 2020.  

Meanwhile, the network also grew from year to year: The number of trusted addresses able to share PHI rose to nearly 2.8 million, with nearly 291,000 healthcare organizations engaging in Direct Secure Messaging. 

Recent new DirectTrust members include Meditech, Texas Health Services Authority and BISIL (Sigmify Health).  

Stuewe pointed to new use cases, such as ADT Event Notifications, as driving the growth.  

“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,” he said.  


DirectTrust has continued to see its numbers climb amidst ramped-up interoperability momentum.   

In early 2021, it hit 2 billion exchange transactions – a total that has now increased to 2.9 billion since the nonprofit began tracking in 2014.  

Later that year, it announced that it had acquired the assets of SAFE Identity, including its trust framework, allowing members to offer new services to their clients such as authentication credentials.  

“Additionally, this infrastructure allows DirectTrust to support an identity ecosystem for trusted and interoperable consumer credentials,” Stuewe told Healthcare IT News in August 2021.  


‘”Overall, we are excited that as we enter our tenth anniversary year that our network continues to thrive,” said Stuewe.

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Email: [email protected]
Healthcare IT News is a HIMSS Media publication.

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