The stars are aligned to move interoperability forward, Chopra says
The nation’s first Chief Technology Officer says federal involvement and timelines will incentivize the industry to act.
Put Aneesh Chopra in the optimistic category in assessing the prospects for success for the recently announced CMS Interoperability Framework.
Chopra has long had a front-row seat on the tortured, winding road to interoperability. He served as the first Chief Technology Officer in the Obama Administration. He now is the chief strategy officer at Arcadia, a data platform that acquired CareJourney, which he founded about a decade earlier.
He believes that the country is much further along in efforts to achieve interoperability than it was about 10 years ago, when federal health agencies first tried to build critical mass within the industry to facilitate data sharing. Today, more economic and data forces are aligned, and the federal government will be more involved both as a participant and as an influential convener, he believes.
He observes that the Centers for Medicare & Medicaid Services announced immediately that it had nailed down voluntary commitments from 60 healthcare and technology organizations, with more joining in vocal support of the initiative after the July 30 announcement. Some of the prominent nationally recognized provider systems voicing support include Cleveland Clinic, Intermountain, Providence and Elevance Health.
There are ambitious goals ahead, with next March 31 looming as a deadline for achieving initial goals, he says. “By making it a wider, more open tent, competition will help us get more people to the finish line,” he says. “I have high confidence that we will hit the March 31 goals.”
Interoperability with a purpose
The federal initiative has two main components – implementing the CMS Interoperability Framework and achieving the patient access final rule, which focuses on consumer access to health information via application programming interfaces and achieving data exchange between payers to facilitate exchange of clinical and claims data.
The wider use of the Fast Healthcare Interoperability Resources (FHIR) standard is expected to facilitate data sharing initiatives, and the CMS Interoperability Framework plans dovetail with efforts to improve the prior authorization process, part of a previous rule that puts pressure on payers and providers alike “to improve prior authorization processes through policies and technology, to help ensure that patients remain at the center of their own care.”
Chopra says previous interoperability interventions by the federal government struggled because interoperability was pursued through “supply side regulation” that involved consumer-facing APIs. While that worked in certain instances, interoperability was more difficult to achieve in business-to-business interactions that had the long-term target of supporting value-based care and population health.
The current CMS initiative builds on the work that’s gone into the Trusted Exchange Framework and Common Agreement (TEFCA), which has an overall goal of establishing “a universal floor for interoperability across the country,” according to the Office of the National Coordinator for Health Information Technology.
Still, work needs to be done to fully take advantage of TEFCA and interoperability, Chopra says. Providers and payers need to commit to sharing data with each other to streamline prior authorization and gain other efficiencies, he says. That specific need was highlighted by Micky Tripathi, former head of the Office of the National Coordinator for Health Information Technology, in his farewell blog from the post on January 19, 2025.
In aligning itself with the new CMS initiative, Arcadia is pursuing deeper collaboration with customers to enable them to “connect to health data networks that accelerate consumer-directed health data access, fuel value-based care and reduce administrative friction across the healthcare ecosystem.”
QHINs to jump-start the effort
Qualified Health Information Networks spelled out as part of TEFCA will help enable data exchange, but ramping up capacity for interoperability will be a key. Isolated use cases that demonstrate point-to-point data exchange will not be enough to enable many-to-many information sharing that will be needed to make the whole thing sing, he explains.
FHIR use will be mandatory among all players, which places a lot of responsibility on the standard. However, while FHIR is a mature standard, “deployments vary considerably in the markets.” Bulk use of FHIR will be crucial, and HL7 and other organizations have been working to ensure its use will scale to support increased use.
CMS brings critical mass to the party, as it supports care for 11 million Americans in shared savings programs, as well as 13 million to 15 million citizens in various other CMS care programs, Chopra says. With federal programs demonstrating that FHIR can be used at scale, other payers need to get on board, he contends. “CMS will be an active participant in this work,” he adds.
Challenges remain, such as ensuring patient identities and securing patient information, but there appears to be an industry groundswell for the initiative, recognizing that there’s momentum to achieve interoperability.
“C’mon, it’s not 2016 anymore,” Chopra says. The industry has been making baby steps since President Bush cited the need to digitize healthcare more than 20 years ago. “This is not your father’s Oldsmobile now. It will happen.”
Fred Bazzoli is Editor in Chief of Health Data Management.