Translating 360X to FHIR

Last updated: Apr 2, 2026
PRODUCT OWNER

DirectTrust is an organization that provides a secure communication network and protocols to exchange healthcare data with your connections. Their 360 Exchange for Closed Loop Referrals (360X) protocol enhances care coordination, improves patient outcomes, and increases operational efficiency for handling patient referrals. It allows real-time determination and communication with a provider, as well as offers scheduling for a follow-up appointment all through an automated workflow. Learn more about 360X.

The 360X workflow: A requestor initiates a patient referral, a responder accepts or rejects the referral, then the referred service is scheduled, coordinated, and completed before a responder sends a visit summary.
Automated workflow for 360 Exchange for Closed Loop Referrals (360X)

Redox translates standard 360X messages between you and your connection, either to submit a referral to your connection or to act on a referral from your connection.

Who needs to translate from 360X to FHIR®

360X to FHIR® translation is helpful for these use cases:

  • A referring provider who wants to initiate patient referrals to a specialist.
  • A specialist who wants to respond to patient referrals from a requesting provider.

How 360X translation works

For referring providers: You send a referral request to Redox via standard 360X. Redox translates the data into a FHIR® notification, which we push to the specialist.

For specialists: You receive FHIR® notifications to begin acting on a referral request. Then you send FHIR® writeback operations to Redox with updates about the referral. Redox translates the FHIR® writeback operations to notifications for your connection.

We translate 360X data to FHIR® notifications to power Redox API actions like these:

Mappings between Redox FHIR® writebacks and notifications

We translate standard 360X messages into Redox FHIR® writeback operations or detailed FHIR® notifications (i.e., no lightweight FHIR® notifications available).

360X workflow
Redox FHIR® writeback
Redox FHIR® notification
Requestor initiates patient referral
(For referring provider) Redox translates your 360X patient referral to FHIR® ServiceRequest$referral-request
(For responding specialist) Redox translates a referring provider's 360X patient referral to FHIR® Order Referral Request
Specialist accepts or rejects referral
(For responding specialists) Redox translates your 360X accept or decline to one of these FHIR® writebacks:
(For referring provider) Redox translates a specialist's 360X accept or decline to one of these FHIR® notifications:
Referred appointment scheduled or updated
(For responding specialists) Redox translates your 360X new or updated appointment to FHIR® Appointment$referral-schedule-update
(For referring providers) Redox translates a specialist's 360X new or updated appointment to FHIR® Order Referral Schedule Updated
Referred appointment cancelled
(For referring providers) Redox translates your 360X cancelled referral to FHIR® ServiceRequest$referral-cancel
(For responding specialists) Redox translates your 360X update or cancellation to the relevant FHIR® writeback:
(For referring providers) Redox translates a specialist's 360X cancellation to FHIR® Order Referral Confirm Cancelled
Post-visit summary
(For responding specialists) Redox translates your 360X visit summary to FHIR® ServiceRequest$referral-complete
(For referring providers) Redox translates a specialist's 360X visit summary to FHIR® Order Referral Completed