DirectTrust is a non-profit health care industry alliance that has established and maintains rules, standards, and policies associated with the operation of the security and trust-in-identity layer for Direct exchange.   Taken together, these make up a Security and Trust Framework that supports both Direct exchange implementers and users, in the following ways.

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The DirectTrust-EHNAC accreditation program is endorsed by the Office of the National Coordinator for Health IT (ONC). At the end of March 2013 ONC awarded DirectTrust a cooperative agreement grant as part of the Exemplar HIE Governance Entity Program.