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Bitfocus Joins with DirectTrust to Enable Closed-Loop Referrals

In October 2022, Bitfocus joined DirectTrust to participate in the new Information Exchange for Human Services (IX4HS) standards development effort. IX4HS will enhance system-to-system client referral capabilities across health and human services.

What is DirectTrust?

DirectTrust™ is an American National Standards Institute (ANSI) accredited standards development organization focused on secure communications of sensitive data such as between patients/clients and their providers. ANSI Accreditation ensures that DirectTrust’s standards are created through a transparent, inclusive, and consensus-based process. This results in industry-vetted, accessible, and clearly documented standards such as the flagship standard supporting Direct Secure Messaging, otherwise known as the DirectStandard®.

As easy as email, Direct Secure Messaging can allow different health and human services providers to send secure communication within a multi-vendor framework (i.e., sending messages between different software systems) using machine-readable messages. Machine-readable messages streamline processes by automatically allowing information to be integrated into the receiving software system without duplicate manual entry. 

The DirectTrust initiative specifically relevant to Bitfocus’ new membership is called Information Exchange for Human Services (IX4HS). IX4HS enables secure communication between healthcare providers and human services organizations and between different human services organizations. This greatly expands opportunities for system-to-system referrals, information exchange, information requests, and care coordination. In short, it facilitates the IX4HS’ Whole Person Care approach to serving clients.


How does being a DirectTrust member benefit Bitfocus customers?

For Bitfocus, the goal is to participate in the creation of a standard for secure, nationally-accessible, inbound, and outbound client service referrals. Bitfocus plans to implement this feature within its Clarity Human Services software product, for its customers. 

Using Direct Secure Messaging and the new IX4HS standard, any health or human services agency served by a DirectTrust Accredited Health Information Service Provider (HISP) will be able to refer to and from customer-configured providers within Clarity Human Services. Now, Clarity Human Services referral possibilities will go far beyond existing providers within a Bitfocus customers’ installation, to a nationwide offering of available health and human services providers. 

Since the DirectTrust network for Direct Secure Messaging is only powered by HISPs, each referral network provider is also an accredited DirectTrust member. DirectTrust performs all HISP credentialing to ensure security and standards compliance, which in turn benefits Bitfocus’ customers. 


What possibilities does DirectTrust open for your organization?

DirectTrust referrals to services outside of a customer’s Clarity Human Services installation are easier, more secure, national in scope, and more capable than competing standalone referral alternatives. These secure messages are as easy as email and can be sent across providers and software platforms for closed-loop referrals, case management, and care coordination. This is, of course, provided there is client consent to share their data. Moving forward, the IX4HS group within DirectTrust will be developing automation workflows for orchestrating the referral process. 


Do you have a use-case scenario to show how this works?

There are many possible use-case scenarios of varying complexity, but the following diagram offers one simple use-case addressing housing instability referral communication. 

Figure 1

Figure 1


In the Figure 1 use-case scenario, a human services client (“service recipient”) works with a caseworker at a local health services agency to make an electronic referral using the Direct Standard® protocol from their service provider to their local Continuum of Care’s coordinated housing entry system. The health services caseworker already knew of the coordinated entry system beforehand, so a service provider directory lookup is not needed. The local coordinated housing entry system runs within Clarity Human Services software, which receives the referral, and locates available housing. Housing resources are located by the Continuum of Care service provider’s caseworker, using Clarity’s Coordinated Entry System. Finally, a referral loop closure message using the same infrastructure and protocols confirming placement is returned to the initiating health services agency.  

The infrastructure and protocols in Figure 1 include secure transmission of the initial referral message from the health services agency software system to the sender’s associated Health Information Service Provider (HISP). The sender’s HISP uses DirectTrust protocols to encrypt and communicate the referral to the referral recipient’s associated HISP, which decrypts the message upon receipt. The recipient’s HISP then forwards the message to Clarity Human Services for handling by the Continuum of Care service provider’s caseworkers. The referral loop closure’s return message simply reverses the steps, as each workflow actor can both send and receive messages in either direction.

This is an extremely simple use-case, and real-world complex workflows will be enumerated and specified through the IX4HS standards development process.


What's coming up?

Beyond the game-changing opportunities for referrals, case management, and care coordination, Bitfocus is also excited to be a thought partner in developing IX4HS and other DirectTrust standards, such as patient matching and record location through their Privacy-Enhancing Health Record Locator Service (PEHRLS) Consensus Body. 

Another increasingly important topic within health and human services is closed-loop referrals, specifically for Social Determinants of Health (SDOH). Simple IX4HS standards may be used to transmit standardized Health Level Seven® (HL7®) International SDOH referrals between clinical systems and human services provider organizations. 

Additionally, for 2023, IX4HS’ preliminary goals include:

  • Propose simplified referral standards to Integrating the Healthcare Enterprise (IHE) and HL7 Social Determinants of Health, by end of Q1 2023

  • Propose modifications to the DirectTrust and HL7 Fast Healthcare Interoperability Resources (HL7 FHIR®) National Directory for human services providers, by end of Q1 2023

  • Create a text message referral standard based on Trusted Instant Messaging Plus (TIM+), starting in Q1 2023

  • Create a Family and Household data standard, starting in Q2 2023

  • Create assessments and eligibility standards, starting in Q4 2023 

Bitfocus hopes to partner with existing and new customers to implement all these exciting (and future) features. Stay tuned, or contact Eric Jahn to find out more!

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