# NDH Trust Framework - National Directory of Healthcare Providers & Services (NDH) Implementation Guide v2.0.0-current

* [**Table of Contents**](toc.md)
* [**Artifacts Summary**](artifacts.md)
* **NDH Trust Framework**

## Extension: NDH Trust Framework 

| | | |
| :--- | :--- | :--- |
| *Official URL*:http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-trustFramework | *Version*:2.0.0-current | |
| * Standards status: *[Trial-use](http://hl7.org/fhir/R4/versions.html#std-process) | [Maturity Level](http://hl7.org/fhir/versions.html#maturity): 4 | *Computable Name*:TrustFramework |

A trust framework typically requires the use of signed artifacts and public certificates to ensure security, integrity, and trust in digital communications and transactions. For trust frameworks that use private PKI there is no need to use this extension unless the goals is to provide access to endpoints via the endpoint reference on any of the relevant resources (e.g., careteam, healthcareService).

**Context of Use**

**Usage info**

**Usages:**

* Use this Extension: [NDH Endpoint Profile](StructureDefinition-ndh-Endpoint.md)
* Examples for this Extension: [Endpoint for Acme of CT Portal](Endpoint-AcmeOfCTPortalEndpoint.md) and [Endpoint for Coordination of Care](Endpoint-CoordinationOfCareEndpoint.md)

You can also check for [usages in the FHIR IG Statistics](https://packages2.fhir.org/xig/hl7.fhir.us.ndh|current/StructureDefinition/base-ext-trustFramework)

### Formal Views of Extension Content

 [Description of Profiles, Differentials, Snapshots, and how the XML and JSON presentations work](http://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#structure-definitions). 

 

Other representations of profile: [CSV](StructureDefinition-base-ext-trustFramework.csv), [Excel](StructureDefinition-base-ext-trustFramework.xlsx), [Schematron](StructureDefinition-base-ext-trustFramework.sch) 

#### Terminology Bindings

#### Constraints

### Notes:

A trust framework is a structured set of rules, policies, protocols, and standards that define how trust is established, managed, and maintained between different entities (such as organizations, systems, or users) involved in the exchange of healthcare information. It provides the guidelines and technical specifications to ensure secure, interoperable, and reliable data exchange. SMART, UDAP, and DirectTrust are examples of trust frameworks.

Sometimes, people refer to CareQuality, CommonWell, or TEFCA as trust frameworks, although they are actually trust communities. These communities agree to follow a trust framework to securely exchange health information. In practice, different communities may use the same trust framework with some additional rules. As a result, implementers may use the terms trust framework and trust community interchangeably.



## Resource Content

```json
{
  "resourceType" : "StructureDefinition",
  "id" : "base-ext-trustFramework",
  "extension" : [{
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
    "valueCode" : "pa"
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
    "valueInteger" : 4,
    "_valueInteger" : {
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
        "valueCanonical" : "http://hl7.org/fhir/us/ndh/ImplementationGuide/hl7.fhir.us.ndh"
      }]
    }
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
    "valueCode" : "trial-use",
    "_valueCode" : {
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
        "valueCanonical" : "http://hl7.org/fhir/us/ndh/ImplementationGuide/hl7.fhir.us.ndh"
      }]
    }
  }],
  "url" : "http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-trustFramework",
  "version" : "2.0.0-current",
  "name" : "TrustFramework",
  "title" : "NDH Trust Framework",
  "status" : "active",
  "date" : "2026-03-30T14:03:58+00:00",
  "publisher" : "HL7 International / Patient Administration",
  "contact" : [{
    "name" : "HL7 International / Patient Administration",
    "telecom" : [{
      "system" : "url",
      "value" : "http://www.hl7.org/Special/committees/pafm"
    },
    {
      "system" : "email",
      "value" : "pafm@lists.hl7.org"
    }]
  }],
  "description" : "A trust framework typically requires the use of signed artifacts and public certificates to ensure security, integrity, and trust in digital communications \nand transactions. For trust frameworks that use private PKI there is no need to use this extension unless the goals is to provide access to endpoints via the endpoint \nreference on any of the relevant resources (e.g., careteam, healthcareService).",
  "jurisdiction" : [{
    "coding" : [{
      "system" : "urn:iso:std:iso:3166",
      "code" : "US",
      "display" : "United States of America"
    }]
  }],
  "fhirVersion" : "4.0.1",
  "mapping" : [{
    "identity" : "rim",
    "uri" : "http://hl7.org/v3",
    "name" : "RIM Mapping"
  }],
  "kind" : "complex-type",
  "abstract" : false,
  "context" : [{
    "type" : "element",
    "expression" : "Endpoint"
  }],
  "type" : "Extension",
  "baseDefinition" : "http://hl7.org/fhir/StructureDefinition/Extension",
  "derivation" : "constraint",
  "differential" : {
    "element" : [{
      "id" : "Extension",
      "path" : "Extension",
      "short" : "NDH Trust Framework",
      "definition" : "A trust framework typically requires the use of signed artifacts and public certificates to ensure security, integrity, and trust in digital communications \nand transactions. For trust frameworks that use private PKI there is no need to use this extension unless the goals is to provide access to endpoints via the endpoint \nreference on any of the relevant resources (e.g., careteam, healthcareService)."
    },
    {
      "id" : "Extension.extension",
      "path" : "Extension.extension",
      "min" : 1
    },
    {
      "id" : "Extension.extension:trustFrameworkType",
      "path" : "Extension.extension",
      "sliceName" : "trustFrameworkType",
      "short" : "Trust Framework Type",
      "min" : 1,
      "max" : "1",
      "mustSupport" : true
    },
    {
      "id" : "Extension.extension:trustFrameworkType.extension",
      "path" : "Extension.extension.extension",
      "max" : "0"
    },
    {
      "id" : "Extension.extension:trustFrameworkType.url",
      "path" : "Extension.extension.url",
      "fixedUri" : "trustFrameworkType"
    },
    {
      "id" : "Extension.extension:trustFrameworkType.value[x]",
      "path" : "Extension.extension.value[x]",
      "type" : [{
        "code" : "CodeableConcept"
      }],
      "binding" : {
        "strength" : "extensible",
        "valueSet" : "http://hl7.org/fhir/us/ndh/ValueSet/TrustFrameworkTypeVS"
      }
    },
    {
      "id" : "Extension.extension:qualifier",
      "path" : "Extension.extension",
      "sliceName" : "qualifier",
      "short" : "A qualifier associates with an endpoint to provide additional context or information about that endpoint in a trust framework community. \nQualifiers are used to help other members of the community understand the capabilities, compliance status, or other relevant characteristics of an endpoint.",
      "min" : 0,
      "max" : "1",
      "mustSupport" : true
    },
    {
      "id" : "Extension.extension:qualifier.extension",
      "path" : "Extension.extension.extension",
      "max" : "0"
    },
    {
      "id" : "Extension.extension:qualifier.url",
      "path" : "Extension.extension.url",
      "fixedUri" : "qualifier"
    },
    {
      "id" : "Extension.extension:qualifier.value[x]",
      "path" : "Extension.extension.value[x]",
      "min" : 1,
      "type" : [{
        "code" : "string"
      }]
    },
    {
      "id" : "Extension.extension:signedArtifact",
      "path" : "Extension.extension",
      "sliceName" : "signedArtifact",
      "short" : "By utilizing a signed artifact, you can identify which Certificate Authority has issued the certificate for the entity that \nsigned the artifact. Verifying the issuing Certificate Authority is crucial because it adds an additional layer of trust and security, ensuring that the entity involved \nin the data exchange is legitimate and that their digital identity has been properly validated.",
      "min" : 0,
      "max" : "1"
    },
    {
      "id" : "Extension.extension:signedArtifact.extension",
      "path" : "Extension.extension.extension",
      "max" : "0"
    },
    {
      "id" : "Extension.extension:signedArtifact.url",
      "path" : "Extension.extension.url",
      "fixedUri" : "signedArtifact"
    },
    {
      "id" : "Extension.extension:signedArtifact.value[x]",
      "path" : "Extension.extension.value[x]",
      "min" : 1,
      "type" : [{
        "code" : "base64Binary"
      }]
    },
    {
      "id" : "Extension.extension:publicCertificate",
      "path" : "Extension.extension",
      "sliceName" : "publicCertificate",
      "short" : "Public certificates help in affirming that an entity is indeed who they claim to be. These certificates are used to establish \nsecure connections via the Mutual TLS (Transport Layer Security) protocol. Public certificates issued by Certificate Authorities are fundamental in establishing a \nsecure and trustworthy digital environment. They enable secure communication, ensure data integrity, and facilitate authentication and trust across a wide range of \nonline interactions.",
      "min" : 0,
      "max" : "1"
    },
    {
      "id" : "Extension.extension:publicCertificate.extension",
      "path" : "Extension.extension.extension",
      "max" : "0"
    },
    {
      "id" : "Extension.extension:publicCertificate.url",
      "path" : "Extension.extension.url",
      "fixedUri" : "publicCertificate"
    },
    {
      "id" : "Extension.extension:publicCertificate.value[x]",
      "path" : "Extension.extension.value[x]",
      "min" : 1,
      "type" : [{
        "code" : "base64Binary"
      }]
    },
    {
      "id" : "Extension.url",
      "path" : "Extension.url",
      "fixedUri" : "http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-trustFramework"
    },
    {
      "id" : "Extension.value[x]",
      "path" : "Extension.value[x]",
      "max" : "0"
    }]
  }
}

```
