With Deadlines Looming, Strategic Interoperability is Essential

For over 15 years, interoperability has been a priority for the healthcare industry, but new CMS mandates (particularly CMS-0057-F and CMS-9115-F) have created a renewed sense of urgency to deliver on the promise of full interoperability.

Many healthcare leaders have invested in new interoperability solutions to satisfy compliance requirements; however, that approach is no longer enough. An estimated $1 trillion is spent on administrative costs every year—but with increasing workloads, fragmented, inefficient workflows, and an overall lack of trust and collaboration between health plans, providers, and patients, the healthcare industry as a whole must be all-in on interoperability.

Advancing digital health capabilities by investing in comprehensive interoperability solutions is not just about meeting CMS deadlines, but achieving business and strategic goals over the long term. True interoperability is the only path to a better, more efficient, and more sustainable healthcare system that both drives value and puts consumers first.

Looming Deadlines for Interoperability Mandates

Announced last year, the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) is aimed at improving data sharing between health plans, providers, and patients and improving the prior authorization process. The rule also includes a requirement for payers to obtain patient consent in order to share medical information with other healthcare organizations.

Impacted payers are required to implement a HL7® FHIR® Patient Access API, and the deadlines are right around the corner. By January 1, 2026, payers must implement certain operational provisions, and by 2027, public reporting begins. The Trump administration has previously taken its time finalizing healthcare regulations, which has led to some uncertainty about whether or not organizations will ultimately be held to the deadlines in CMS-0057-F. However, new HHS initiatives—like the pledge to “fix the broken prior authorization system”—suggest the administration is moving full speed ahead.

The Health Tech Ecosystem & Interoperability Framework

In June, the White House hosted the “Make Health Tech Great Again” event in partnership with CMS. More than 60 major healthcare and information technology companies have committed to CMS’ Health Tech Ecosystem initiative designed to improve outcomes, reduce provider burden, and drive value.

The effort has two key focus areas:

• Promoting the CMS Interoperability Framework to improve data sharing between patients and providers, and;
• Increasing the availability of personalized tools so patients can make better health decisions

For the Interoperability Framework, CMS expects health systems, payers, and other industry stakeholders will be early adopters that will meet and showcase their performance against these objectives in Q1 of 2026. To be listed in the CMS-Aligned Network, the basic criteria includes areas such as patient and provider access, and data availability, and standards compliance. By July 4, 2026, health data networks must provide or facilitate access to data using FHIR APIs.

Why Investing In Interoperability Is Essential

If the deadlines for CMS-0057-F are indeed firm, healthcare leaders who previously turned a blind eye to the mandates will undoubtedly be forced to quickly implement, or even build, a comprehensive interoperability solution. The deadlines, however, are almost irrelevant.

Compliance will always be top of mind, but it should never be the only consideration. Healthcare leaders must move away from a compliance-first or compliance-only mindset and recognize that interoperability is also a business and strategic imperative that must be a priority now—and well into the future.

This approach is what we call strategic interoperability: an enterprise-wide capability to enable transparent data exchange that ultimately improves operations long-term and makes for a better, more efficient healthcare system.

Homegrown solutions or third-party solutions that only address the minimum requirements for compliance, however, aren’t enough. While this ad-hoc approach may be an immediate fix, true interoperability will never be achieved, and costs will be even higher over the long term. In the coming months, healthcare organizations must start to develop a strategy for full interoperability, and in a previous blog post, we outlined some key considerations to keep in mind.

With Edifecs’ Healthcare Interoperability Cloud, our all-in-one data management and integration platform, your organization can achieve true, strategic interoperability and support your long-term digital health strategy. Our flexible and adaptable platform supports improved care delivery & outcomes, reduced administrative costs, and ongoing compliance.

With our suite of solutions for FHIR, EDI, Prior Authorization and Member Consent Management, organizations can leverage a scalable and extensible tech foundation that supports greater efficiency, transparency, and collaboration, compliance with evolving regulatory mandates, and achieving strategic business objectives. To learn more, get in touch with our team today.