Today we honor the life and legacy of Clement J. McDonald, MD, who passed away on May 21, 2026.

Known worldwide as the one and only "Clem", he was a luminary in the field of biomedical informatics. Clem was a titan, world renowned for his innovations in electronic medical records, clinical decision support, multi-institution health data exchange, and especially in the global standards that enable computers to share and understand health data.

As a co-founder and life-long member of HL7 International, Clem's vision for interoperability enabled by consensus standards is encoded in our DNA.

A Pioneering Career

Clem grew up on Chicago's West Side, graduated from Notre Dame in three years, and attended the University of Illinois College of Medicine. He completed his internal medicine residency at Cook County Hospital and the University of Wisconsin, after which he joined Indiana University and the Regenstrief Institute in 1972. There he built one of the world's first electronic medical record systems and published the first randomized controlled trials demonstrating that computerized clinical decision support could improve care.

He rose through the academic ranks at the Indiana University School of Medicine to become Distinguished Professor of Medicine and the Sam Regenstrief Professor of Medical Informatics, and served as Director of the Regenstrief Institute from 1990 to 2006. He also developed the Indiana Network for Patient Care, a groundbreaking statewide health information exchange. Throughout this time, he also practiced primary care internal medicine in a safety-net clinic for more than 25 years (that ran on the EMR he created).

In 2004, Clem joined the U.S. National Library of Medicine where he first served as Director of the Lister Hill National Center for Biomedical Communications and Scientific Director of its intramural research program, and later serving as Chief Health Data Standards Officer — a position he held until his passing.

Reflections from the ADAPT Chief AI Officers on Innovation Panel Discussion, November 2025

After decades of working toward seamless health data interoperability, we find ourselves at another pivotal moment. The rapid adoption of Artificial Intelligence (AI) in healthcare presents us with a familiar challenge wearing a new face: how do we ensure these powerful new tools work together transparently, accountably, and in the service of better health for people everywhere?

At a recent ADAPT conference panel, I had the opportunity to reflect on what our interoperability journey can teach us as we venture into standardizing intelligence, not just data. Here are some key insights from that conversation.

The Journey Continues

First, a grounding perspective: this is a journey, not a destination. Despite all the progress we've made in healthcare interoperability, too often, people still move faster and further than their health information. The ability for any digital tool—including AI—to help people make better health decisions is always limited by the scope of data in its purview and its capability to make sense of it.

Even the most powerful AI we can imagine must overcome the same boundaries we've always faced: technical, organizational, business, and jurisdictional barriers that prevent us from seeing the complete picture of health information relevant for individuals or populations.

However, HL7's decade-plus journey with Fast Health Interoperability Resources (FHIR® ) has taught us something crucial: open standards are a potent fuel for innovation. The vibrant, open, collaborative community around FHIR wasn't just a nice byproduct—it was the key force that created a well-tuned specification and enabled it to flourish in the marketplace.

Open standards level the playing field, reduce barriers to participation, and free organizations from proprietary formats. They unlock new connectivity, preserve data sovereignty, and most fundamentally, enable new digital freedoms. As we approach AI standardization, maintaining this commitment to openness isn't guaranteed, but it's the future we're fighting for.

The U.S. Department of Health and Human Services (HHS), in collaboration with over 45 of the nation’s largest health insurers, has announced an important step forward in transforming the problematic processes of prior authorization. By pledging to reduce delays, increase transparency, and standardize processes by 2027, these organizations have signaled a long-overdue shift toward easing administrative burdens and improving access to evidence-based care.

The pledge spans insurance markets (commercial coverage, Medicare Advantage and Medicaid managed care) and will benefit an impressive 257 million Americans. But turning that vision into reality will require more than declarations. It will demand the kind of trusted technical infrastructure that HL7’s community has built together for over 35 years.

 As implementation begins, prior authorization reform demands scalable, open and consensus-driven standards.