LAS VEGAS – This past week at HIMSS25, a panel of healthcare interoperability leaders convened for an ad hoc discussion about the ongoing evolution of FHIR API-based data exchange: How it can be advanced, how it can be expanded across the payers-provider-pharmacy-patient ecosystem, how certification should evolve and what the role of policymakers, agencies such as CMS and ASTP and technology developers should be over the next decade or so.
The session, “Ditch the Clipboard: Policy Ideas for DOGE and the Trump Administration,” shares a name with a recent Leavitt Partners whitepaper that served as the basis of the discussion.
Despite its title, session moderator, Leavitt Partners Principal Ryan Howells, emphasized that the panel talk was not a political discussion.
“The election is over,” said Howells. “We are now in a phase, for the next four years, of what the administration’s priorities are. This will not be a political discussion in terms of what’s right or what’s wrong or what’s happening with the administration. It’s more a discussion about what the priorities of this administration are and how do we align with those priorities to advance interoperability policy.
“It’s clear they want to do big, bold things. It’s clear that they’re actually doing generational change in the federal government,” he explained. It’s clear that they actually want to eliminate waste. Those things are clear. The question now becomes, how do we understand what those priorities are and how actively provide recommendations that could meaningfully move the ball in terms of interoperability and policy over the next decade plus.”
Howells was joined by Michael Westover, vice president of population health at Providence; Anna Taylor, associate VP for population health & value-based care at MultiCare Connected Care; and Jason Teeple, interoperability strategy leader and senior director of enterprise architecture at Cigna Healthcare.
Among the questions they sought to answer: What federal technology policies are needed – or are no longer needed – to create a truly patient-centered health care system? How does CEHRT need to evolve to support a modern, API-based, interoperable ecosystem? And what can we expect on this front from the new administration in the years ahead?
“What do we need to do over the next decade?” Howells asked. “Not the next administration, not the next couple of years. What do we need to do over the next decade to meaningfully advance data interoperability and data exchange? Because that’s how long it takes. Remember HITECHtook about 10 years, right? FHIR has taken more than 10 years.
“And so when we think about: What does this look like over the next decade? We need to really expand our thinking in terms of what’s needed. You see all those awesome vendors that are on the show floor there. They talk about things like AI, cloud-based computing, all the solutions that they have, which is really cool. But what do we need to do in order to enable that innovation ecosystem to thrive?”
Howells made the case that some current interoperability policies are “antiquated,” and, also, that there’s simply too many of them.
“We have too much regulation,” he argued. And we have a lot because we started to grow off of a certain program and started to add a bunch of things to start to certify individual functionality inside the EHR, to build the EHR.
“Well, now we’ve built them. We are now going to have to figure out a way to get the data to move between the systems. We don’t have a problem in building the functionality of the EHR anymore. We have a problem in exchanging the data between not only the EHR, but the payers, the pharmacies, the patients, everyone else in the ecosystem. How do we actually do that?
Howells also advocated for ironing out some discrepancies with policies between different agencies, and better alignment on timing of rule compliance.
“We’re a little out of sync based on policies in terms of the timing,” he said, for example, “for when USCDI is being in place and when the CMS rules need to take advantage. And that’s just the nature of the federal government. Sometimes we get a little bit out of sync.”
We also need to move towards a “more modern computing architecture,” he said.
“We believe that we need to redefine CEHRT,” said Howells. “We go back to the original definition of the HITECH Act, where it talks about hardware, software or packaged solutions sold as services that are designed for or support the use by healthcare entities or patients for the electronic creation, maintenance, access, or electronic health information.
“It does not say EHRs. This could be EHRs. It could be payers. It could be cloud-based solutions. It could be others as well. So if we think out, if we would redefine CEHRT and start to certify the APIs, which is the outbound call to the other systems – rather than certify the functionality inside the APIs – that becomes a different paradigm.”
Howells sees reasons for optimism in the years ahead. Particularly with under-utilized resources like the Inferno project on HealthIT.gov, which offers services for running select FHIR conformance tests.
With the CMS Interoperability and Prior Authorization Final Rule, by 2027 “every payer provider in the country is going to have to connect through these APIs,” he said. “You’re going to have to either spend a gazillion dollars making all these custom upgrades to individual tweaks in the APIs, or you can tell everyone to go to Inferno and say, this is the foundation for how we want to exchange data in the future.”
The Leavitt Partners paper offers detailed suggestions for:
-
Eliminating antiquated interoperability policy and better aligning it across the federal government
-
Improving patient access to health care data
-
Boosting health care data exchange to ensure faster implementation
-
of FHIR APIs for B2B data exchange
-
Improving the TEFCA
-
Automating quality measurement reporting
-
Adopting digital identity services for individuals, payers, and providers
“Since the passage of the HITECH Act, 21st Century Cures Act, and the promulgation of the CMS Interoperability Rules, significant work has been done to advance clinical and non-clinical data exchange in digital formats, but limited efforts have been done to advance non-EHR solutions and application programming interfaces required by Congress,” the report’s authors write.
However, “the promise of these policy actions is limited because of inconsistencies in the implementation of the required standards, lack of coordinated early adopter projects, regulatory and administrative drift from HITECH and the 21st Century Cures Act legislation. As a result, the pace at which technology moves is significantly outpacing rule making for the use of modern internet-based standards.”
The goal: “We need to improve both WHAT information we share and HOW we share the information to reduce billions of dollars in wasted private sector administrative spending; the burden on providers, people, and plans; and eliminate regulatory bloat.
“Most of the projects below could be accomplished in the first year of the [Trump] administration,” they add, and could “dramatically ease patient and provider burden, reduce redundant solutions, and eliminate wasteful spending” while supporting “interoperability and digital health across the country.”
Mike Miliard is executive editor of Healthcare IT News
Email the writer: [email protected]
Healthcare IT News is a HIMSS publication.
