DirectTrust is a collaborative non-profit association of 121 health IT and health care provider organizations to support secure, interoperable health information exchange via the Direct message protocols.  DirectTrust has created a “trust framework” that extends use of Direct exchange to over 106,000 health care organizations and 1,582,373 Direct addresses/accounts.  This trust framework supports both provider-to-provider Direct exchange and bi-directional exchange between consumers/patients and their providers.