Introduction
FHIR is a new standard that defines a web API and related specifications for health data
exchange. Direct is an existing federal standard that is widely used in the USA for the exchange
of healthcare data. There are differing views across the healthcare system as to the correct
relationship between the two standards and communities. This white paper proposes a way to
understand how the FHIR and Direct communities and technical specifications for each standard
should relate to each other. The authors describe two main ways to use the existing Direct and
DirectTrust assets with FHIR: pushing FHIR resources in Direct Messages, and; using
DirectTrust certificates with the RESTful API.
Note: this document is published by DirectTrust, and was prepared with the assistance of
Grahame Grieve, the product director for the FHIR standard, as a position paper for
consideration by the Direct and FHIR communities. It is not yet formally endorsed by HL7, or by
the FHIR community.

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