Interoperability

The Trump administration’s initiative to boost health data sharing could be a boon for interoperability, but the plan so far lacks detail — and challenges like data security, under-resourced providers and slow technology uptake could be barriers to success, experts say.

The initiative, announced in late July 2025 at the White House by leaders of the HHS and CMS, aims to improve long-standing challenges with health data exchange through partnerships with more than 60 companies, including firms like Amazon, Google, Epic and UnitedHealth. 

The plan includes two large focus areas: encouraging adoption of a voluntary blueprint for data sharing called the CMS Interoperability Framework and increasing the availability of digital health tools, like products for chronic disease management and care navigation.

The companies pledged to “deliver results for the American people” in the first quarter of 2026, the CMS said.

But that’s a quick turnaround — and though the initiative has set out criteria on how the interoperability framework should work, it isn’t clear yet how the plan will function, experts say. 

“It appears to me that most of the work is dependent on these 60 companies who’ve signed up, but I’m not actually sure how this is all going to get done,” said Beth Mosier, a director on consultancy West Monroe’s healthcare M&A team. “It seems to be, you volunteer and you figure it out. So I think there’s a lot left to be defined on how this is actually going to work.”

Improved data sharing can’t hurt

Still, the initiative has a worthy goal, given the healthcare sector’s challenges with data sharing, experts say. 

Interoperability and information sharing is a long-term problem for the industry, made harder by siloed data that doesn’t easily flow between providers and a reliance on dated technology like fax machines.

Many patients likely go to multiple providers who utilize separate patient portals, so consumers are piecing together their health data from several different places, Mosier said. Giving patients easier access to all their information could be empowering, allowing them to make data-driven decisions about their healthcare, she added.

The plan likely won’t hurt interoperability, and getting the CMS involved — the nation’s largest payer that processes more than one billion Medicare claims annually — could facilitate data sharing and accessibility, said Alex Nisenbaum, partner at law firm Blank Rome.

Plus, the ease of data flow is more important now than ever, as the sector tries to shift more care into value-based payment arrangements and adopt artificial intelligence tools, said Jennifer Goldsack, CEO of the Digital Medicine Society. 

AI needs to be trained on vast troves of data to function. Meanwhile, providers need access to data to adequately predict risk in value-based care arrangements. 

It’s likely less risky for the companies involved to work together with the CMS and the other pledged firms than to try and figure things out on their own, Goldsack said. Plus, the initiative, and the names of the companies who decided to sign on, have been very visible, which might incentivize them to commit to the project.

“If someone down the line then wants to take their toys and leave the sandbox, it’s not a good look,” Goldsack said. “And so I would imagine that there’s some commercial pressure to stay the course and deliver.”

A high bar for patient access

The “million dollar question” is how the initiative will work in practice, Nisenbaum said. 

One possibility is the data sharing pledge could build upon and enhance the Trusted Exchange Framework and Common Agreement, a governance framework for health data exchange that went live at the end of 2023, he said. 

TEFCA has built up momentum in recent years. Ten organizations have been designated as qualified health information networks, or QHINs, increasing from just five at TEFCA’s launch. 

Several QHINs, including CommonWell Health Alliance, eClinicalWorks, eHealth Exchange and Health Gorilla, have pledged to implement the interoperability framework and become CMS Aligned Networks.

However, the new initiative places an emphasis on putting data at patients’ fingertips, while TEFCA focused more on sharing among healthcare organizations to improve care coordination, Nisenbaum said. 

The expectations for patient data access are pretty high, Mosier said. Some of the criteria under the CMS’ framework include ensuring patients can access their electronic medical information through apps of their choice, as well as find their claims, explanations of benefits, prior authorizations and clinical data from current and past payers. 

“BYOD or bring your own device is basically what they’re talking about, and that has not been solved almost anywhere elegantly in healthcare, right?” Mosier said. “Patient portals and provider portals exist for a reason. [...] To support every device anyone may bring is a big commitment.”

Typically, when BYOD is implemented successfully, it uses a pretty basic interface, she said. And healthcare data can be complicated: What if clinical data from your doctor and your insurer don’t clearly match up? What if that information is confusing?

Even if the data is structured and complete, it can be hard to understand. For example, lab results can be confusing without a clinician at hand to explain what the tests mean. 

“It’s really hard for most people to digest and consume really complex healthcare data,” Mosier said. “I think it will create another level of support that will be needed for these healthcare consumers.” 

Data security, technology barriers

Additionally, there are plenty of challenges to overcome in health data sharing, including reticence from providers about adopting new technology and concerns about data privacy, experts say.

The Trump administration wants networks to facilitate access to data using the Fast Healthcare Interoperability Resources standard, or FHIR, a set of rules that defines how health data can be exchanged between computer systems regardless of how the information is stored. 

However, adopting FHIR can be challenging, Mosier said. Providers might implement the standard differently, and they could use different versions of FHIR — potentially complicating exchange as versions change over time. 

Data security is another concern. Some apps tasked with giving patients control over their health data might operate outside the HIPAA privacy and security law, Nisenbaum said.

“I think that is going to put the onus on patients to really understand the commitments that these companies are making with respect to collection, use and disclosure of health information,” he said.

That could prove challenging for patients. A 2022 survey from the American Medical Association found just 20% of respondents indicated they knew the scope of companies and individuals with access to their health data.

Plus, companies will have to shoulder a burden of their own when managing a complex and fragmented landscape of data privacy laws. Many states have their own data laws, and some have health-specific requirements, like California’s Confidentiality of Medical Information Act.

The initiative could spur more states to ink their own privacy legislation, as it only takes a few players using data for suspect purposes, like advertising, to draw regulatory scrutiny, Nisenbaum said.

“The majority of states don’t have these comprehensive privacy laws, right?” he said. “So, still room for regulation, assuming the federal government doesn’t pass something, which it has not been successful at for many years.”

Will under-resourced providers have a seat at the table?

Several health systems and providers have signed onto the pledge, including Cleveland Clinic, Intermountain Health and Providence, promising to participate in a CMS Aligned Network and accept patient data electronically.

However, the number of participating providers is small compared with the amount of health systems operating in the U.S. 

And several of the entrants are fairly large providers — which isn’t surprising, given that smaller physician practices are often “pulled along” when it comes to technology adoption, Nisenbaum said. 

Managing technical change at healthcare organizations can be challenging, and small practices often look to their vendors to meet data sharing requirements, he added.

And the experiences of large institutions likely won’t match health systems with fewer resources, like rural providers or financially struggling facilities. These health systems usually don’t have the bandwidth to participate in a working group, leaving the particular challenges they face by the wayside, Goldsack said. 

“Rural hospitals don’t have a chief innovation officer or a chief digital officer or a chief AI officer or a chief technology officer,” she said. “It’s the CEO doing it off their desk on a Thursday evening, and their tech budget is very small.”

Next steps

For now, the initiative has been clear about its goals, and has brought together a large group of organizations that have signed onto the pledge, Goldsack said. 

One indicator of the plan’s progress could center around how the companies involved are integrating the initiative into their development plans, Mosier said. 

“If we are hearing Amazon and UnitedHealth talk about this on a consistent basis and what they’re doing, then that’ll lead us in one direction,” she said. “And if this comes out as this big thing, and we don’t hear much about it three and five months later, that’s going to tell something else.”

The agency managing the federal government’s health IT efforts has a new leader, a spokesperson for the Assistant Secretary for Technology Policy/Office of the National Coordinator for Health IT confirmed to Healthcare Dive. 

Thomas Keane, a software engineer and interventional radiologist, began his role as national coordinator in June 2025, the spokesperson said. He previously worked at the ASTP and served as a senior advisor to the deputy secretary of the HHS, according to his biography on the agency’s website. 

Keane was also an administrator of the COVID-19 Provider Relief Fund, which offered funds to providers to assist with pandemic-related expenses and lost revenue, according to his bio.

Additionally, he led the development of the Agency for Healthcare Research and Quality’s National Nursing Home COVID Action Network, an initiative that provided training to nursing homes on infection prevention and safety.

The ASTP, a decades-old agency previously known only as the ONC, reorganized last summer to expand its oversight over technology, data and artificial intelligence policy.

Keane’s appointment comes at a time of upheaval for the HHS as the Trump administration culls thousands of jobs and plans to slash the department’s budget.  

More changes could be coming. In a more detailed budget proposal released late last week, the HHS requested $130 million to establish the Chief Technology Officer, which would include ASTP and coordinate the department’s cybersecurity and health IT work.

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By InterSystems

Imagine you’re running a marathon. The starting line is full of promise, and with each mile, you pass encouraging milestones. But then comes the wall — the dreaded point when your legs ache, your lungs burn, and every step is arduous. In that moment, what pushes you forward isn’t just willpower. It’s the months of training, the foundation you’ve built, and the steady support that’s carried you thus far.   

Healthcare's digital transformation is much the same: a marathon, not a sprint. It’s about endurance, planning, and connecting the right elements over time. And as organizations gear up for the next phase of this race — powered by AI and predictive analytics — success depends entirely on the foundation they have built.  

At the core of that foundation is one critical capability: interoperability. Without it, AI strategies stall, costs climb, and opportunities for improved care are missed. No matter how sophisticated your AI running gear, your success depends on whether your data foundation can keep pace.

The Wall We Face: Fragmented Data, Fragmented Care

Despite the enormous strides made in healthcare technology, many systems still operate in isolation. EHRs, imaging platforms, wearables, and claims data all hold pieces of the story, but in different formats and languages. As a result, clinicians are left with partial stories, patients with disjointed care, and executives facing unpredictable costs and redundant processes.

During care transitions — whether a patient is discharged from the hospital, referred to a specialist, or entering rehab — gaps in information can lead to readmissions, redundant testing, and poor outcomes. Clinicians, burdened by toggling between systems, spend more time wrestling with tech than treating patients. And patients themselves feel the frustration of navigating disconnected portals and inconsistent communication.

This fragmentation makes scaling AI nearly impossible. Predictive analytics, personalized care plans, automated prior authorization, and other AI-driven innovations can only perform when powered by complete, accurate, and connected data.

This is the “wall" healthcare must push through, and interoperability as strategic infrastructure is what helps clear the path forward.

Pushing Past the Wall: AI-Ready, Real-Time Data

True interoperability means more than data exchange. It’s about integrating, normalizing, and making data actionable in real time — ensuring data flows seamlessly across your ecosystem to fuel healthcare decisions .

Take Healthix, the largest public health information exchange in the U.S. Connecting over 20 million patient records across 9,000 facilities, Healthix used InterSystems technology to create consent-aware alerts that notify providers of care events in real time while meeting privacy requirements. The result? Smarter emergency care, fewer missed handoffs during care transitions, and stronger continuity across the patient journey.

This same capability — real-time, comprehensive data sharing — is exactly what makes AI-ready healthcare possible. Hospitals that routinely engage in fully interoperable data exchange see the highest availability (92%) and usage (70%) of clinical information at the point of care, enabling more timely and data-driven decisions. It's the infrastructure that transforms disconnected information into the fuel that powers intelligent care delivery.

Helping Everyone Keep Pace in the AI Era

• Clinicians gain unified care records and AI-powered insights, reducing documentation fatigue while enabling more personalized, proactive care decisions.
• Patients experience coordinated, person-centered care with transparent access to their complete health story across all touchpoints.
• Executives achieve measurable financial benefits: lower operating costs by eliminating waste and duplicate services, streamlined administrative operations, and more accurate data for value-based contracts and organizational changes like mergers or IT migrations.

Running Smart: Strategy Over Speed

This seamless connectivity isn’t a “nice to have.”  It’s essential infrastructure that determines whether your AI investments will succeed or stall at the starting line.

Think of emerging technologies like AI and predictive analytics as performance enhancers in our marathon. But even the most advanced tools can’t function without a strong digital foundation. That’s why leading health systems treat interoperability as strategic infrastructure, not a backend IT project.

The Continuous Race Forward

The truth is, there is no final “finish line” in healthcare’s digital marathon. But there are critical milestones like AI-powered predictive care, connected care, and sustainable financial performance that mark real progress.

Every mile covered with interoperable, AI-ready systems is a mile closer to a future where care is coordinated, data drives intelligent decisions, and patients truly benefit from connected health ecosystems.

So, as the healthcare industry pushes toward its AI-powered future, the question isn't just whether we’re running fast enough. It’s whether we’re running smart with the right foundation to support the distance ahead.

Because when data flows, care works — and AI transforms it.

Regulators finalized an interoperability and technology rule in August 2025 that aims to lessen administrative burden on providers, including through updates to prior authorization processes.

The Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology’s HTI-4 rule lays out new and updated health IT certification criteria for electronic prior authorization, electronic prescribing and real-time prescription benefit checks. 

The regulation should help clinicians spend less time on paperwork, the ASTP said. “We believe that this work will help patients and providers determine patient benefits at the point of care,” Dr. Thomas Keane, assistant secretary for technology policy and national coordinator for health IT, said during a press briefing.

The regulation, officially named the Health Data, Technology, and Interoperability: Electronic Prescribing, Real-Time Prescription Benefit and Electronic Prior Authorization final rule, should boost efficiency in the healthcare sector, saving $19 billion in labor cost savings over 10 years, regulators said in a fact sheet. 

It also comes on the heels of other moves by the Trump administration to reform prior authorization policies, where providers have to ask for approval from insurers before performing services or prescribing drugs. 

Clinicians argue the practices result in care delays that can ultimately harm patients. That comes on top of providers’ hefty burden of administrative work and other tasks in electronic health records, which clinicians say requires them to work overtime and contributes to burnout. 

To help automate some of this work, the HTI-4 rule adds and updates criteria for software to receive certification by regulators. The Health IT Certification Program is a voluntary program that outlines standards and functionality for health IT, like EHRs.

On prior authorization, the regulation adopts three new criteria: one that allows providers to request information from payers about coverage requirements, another that offers a method for clinicians and other EHR users to quickly collect the data needed for a prior authorization request, and a third that allows providers to submit requests through their IT systems and check the request’s status. 

The final prior authorization criteria are a little different than originally proposed, said Alex Baker, deputy director of the alignment and engagement division of the office of policy at ASTP. 

The proposed regulation, first announced in 2024, had only included one criterion that included all of the capabilities. But regulators broke them into three to provide more flexibility, allowing IT companies to certify products based on just one functionality instead, he said.

HTI-4 also adds new criteria for functionality for application programming interfaces, or APIs, linked to the prior authorization standard, including allowing workflow triggers in an EHR for clinical decision support tools. Another criteria allows users to be notified by a server of an event, like an update on a prior authorization request. 

Outside of prior authorization, the rule adopts a new criterion for real-time prescription benefit information, so providers and patients can easily compare drug prices, see out-of-pocket costs and check prior authorization requirements. 

Additionally, HTI-4 updates criteria for electronic prescribing, which enables prescription data to be shared between providers, pharmacies and payers.

The rule is part of a series of interoperability regulations released over the past couple years. HTI-4 includes some provisions from the HTI-2 proposed rule, which was first released in July 2024. 

Other parts of the initial HTI-2 proposal were finalized in other regulations, including one published in December 2024 that focused on the Trusted Exchange Framework and Common Agreement, or TEFCA, and another on an information blocking exception that aimed to preserve access to reproductive healthcare.

The HTI-1 regulation, finalized in December 2023, is a sweeping rule that included transparency requirements for artificial intelligence in certified health software.

More than 1,000 hospitals and 22,000 clinics that use Epic are live on the federal government’s health information sharing framework, the electronic health record vendor said in June 2025.

Epic plans to transition all of its customers to the Trusted Exchange Framework and Common Agreement, or TEFCA, by the end of 2025, according to Matt Doyle, Epic’s Interoperability Software Development Lead.

Currently 41% of Epic’s customers are live with TEFCA, while 43% are working to implement the data sharing network. The remaining 16% are in planning stages, Doyle said in an emailed statement.

TEFCA is a major initiative for healthcare interoperability, setting technical requirements and exchange policies for companies to pull together clinical information sharing networks across the country.

The framework went live in December 2023 with five Qualified Health Information Networks, organizations that represent health systems, insurers or health IT vendors that can query and receive information from other networks.

Epic’s network, Epic Nexus, was one of the original QHINs designated at TEFCA’s launch. 

The government framework lowers barriers to health data sharing, allowing more providers in rural and underserved communities to easily exchange information and improve care, Epic said. The company had previously said it would move all of its customers onto TEFCA by the end of 2025.

The number of QHINs has also expanded since TEFCA went live. This spring, e-prescribing giant Surescripts’ data exchange said it had received QHIN status, bringing the number of designated information sharing networks to nine. 

Oracle Health, an EHR competitor with Epic, is also looking to earn QHIN designation. The technology giant submitted its application in February.

Epic is a major player in healthcare technology as the nation’s largest EHR vendor. The vendor controlled more than 42% of the acute care hospital market last year, according to a report published this spring by healthcare IT research firm Klas Research.

Regulators in December 2024 finalized a scaled down version of a sweeping rule that aims to boost health data interoperability. 

The final regulation is focused on provisions related to the Trusted Exchange Framework and Common Agreement, a governance framework for data exchange. However, the final rule did not include a number of other sections, like first-of-its-kind certification criteria for health IT tools used by public health agencies and payers, that were in the proposed rule.

The scope of the rule and the number of comments made it challenging to finalize the proposed regulation in its entirety quickly, a spokesperson for the Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology told Healthcare Dive. But the proposals may be included in later final regulations.

The Health Data, Technology, and Interoperability: Patient Engagement, Information Sharing, and Public Health Interoperability rule, or HTI-2, doesn’t feature a number of provisions included in the proposed rule released this summer, like certification criteria aimed at easing public health data exchange — a major concern during the COVID-19 pandemic. 

The final rule also doesn’t include certification standards for payer application programming interfaces, which could speed prior authorization requests, another big issue for providers who say the process takes too much time and can harm patient care.

But those provisions could be featured in later rulemaking, an ASTP/ONC spokesperson told Healthcare Dive.

“We (ASTP) have focused on a specific set of proposals we could finalize and publish in the Federal Register to be responsive to the public comments,” the spokesperson said. “Comments received in response to other proposals from the proposed rule are beyond the scope of this final rule and are still being reviewed and considered for purposes of issuing subsequent final rules, including another potential final rule before the end of this administration.”

The final rule largely focuses on TEFCA, which went live in 2023 and sets technical requirements and exchange policies for companies to pull together clinical information sharing networks across the country. 

The framework designates Qualified Health Information Networks that facilitate data sharing between healthcare organizations like providers, payers and healthcare IT vendors. There are currently seven designated QHINs, and Oracle Health said it would apply for the status in late October. 

The latest regulation sets provisions that will support reliability, privacy, security and trust in TEFCA, according to the ASTP/ONC.

For example, the rule lays out the requirements for designating QHINs, like requiring networks to be able to exchange data among more than two unaffiliated organizations or being able to keep up transaction volume that meets users’ demands. 

Organizations seeking QHIN status will also have to maintain certain privacy and security policies, like having an independent third party conduct an annual security assessment or employing a chief information security officer.

The regulation also implements standards for onboarding QHINs, as well as policies for suspending and terminating networks. 

Finally, the rule set a new TEFCA Manner Exception, which says organizations that only exchange data via TEFCA won’t be considered to be information blocking if they follow certain criteria.

The regulation is set to publish on the Federal Register on Dec. 16, 2024, and it will go into effect 30 days later. 

Surescripts’ data exchange has been designated a Qualified Health Information Network under the federal government’s health information sharing framework, the e-prescribing giant said in April 2025. 

As a QHIN, Surescripts will be able to transfer health data through the Trusted Exchange Framework and Common Agreement, or TEFCA, a framework created by the HHS’ Assistant Secretary for Technology Policy to facilitate the exchange of health records among providers, patients, payers and public health agencies. 

Surescripts’ addition brings the total number of QHINs to nine, according to the Sequoia Project, the recognized coordinating entity that oversees TEFCA.

TEFCA sets technical requirements and exchange policies so the healthcare sector can more easily share patient information. The framework went live in late 2023 with five designated QHINs.

They represent health systems, insurers or health IT vendors and can query and receive information from other networks after they’re accepted, complete onboarding and pass security and technology checks.

“The QHIN designation process is intentionally rigorous to ensure a high bar for the nation’s health information sharing infrastructure,” Mariann Yeager, CEO of the Sequoia Project, said in a Tuesday statement. 

Surescripts, which offers products to electronically send prescription information from providers to pharmacies, share medication histories and check patients’ prescription coverage, said it would apply to become a QHIN two years ago. 

At the time, the company said more than 250,000 clinicians had used its Record Locator and Exchange to find and share clinical information in 2022. Last year, the tool was used by more than 416,000 providers, according to Surescripts. 

Surescripts is one of several new QHINs added since TEFCA became operational. CommonWell Health Alliance and Kno2 received the designation in early 2024, and eClinicalWorks, an ambulatory electronic health record vendor, became a QHIN in January. 

Oracle Health, which acquired EHR company Cerner in 2022, also said it would apply to become a QHIN last fall. 

Surescripts’ acceptance as a QHIN comes months after private equity firm TPG Capital bought a majority stake in the e-prescribing company. Its other investors, CVS Health, Cigna-owned pharmacy benefit manager Express Scripts and two pharmacist trade groups, retain a minority interest.