The HL7® FHIR® at Scale Taskforce (FAST) continues to translate national interoperability policy into implementable, real-world infrastructure. This month marks several major milestones, including the opening of the FAST Consent Ballot, the official publication of FAST Identity STU 2 and FAST Security STU 2, and continued progress on FAST National Directory toward STU 2. This reinforces the growing momentum toward CMS-Aligned Networks powered by FAST.
These advances demonstrate how standards, trust frameworks, directory infrastructure and testing at scale converge to support scalable, secure and interoperable data exchange across the healthcare ecosystem.
FAST Consent Ballot: Advancing Scalable, Network-Ready Consent
The FAST Consent Implementation Guide (Edition 1 – US Realm) has entered formal HL7 balloting, providing the industry with a practical, interoperable approach to consent management at scale.
The guide is designed to support:
- Computable and portable consent representations across organizational and network boundaries
- Subscription-based workflows for consent updates and downstream disclosures
- Alignment with FAST Identity, FAST Security, and FAST Directory infrastructure
- Use cases spanning payer-to-payer exchange, provider workflows, HIEs, and consumer-mediated access
Key dates
- Registration deadline: December 18, 2025
- Ballot period: December 19, 2025 – January 19, 2026
Broad participation from implementers, policymakers and network operators is essential to ensure the Consent IG reflects both real-world workflows and regulatory expectations.
FAST Identity STU 2: Interoperable Identity Matching at Scale
The publication of FAST Identity (Identity Matching) STU 2 delivers stable, implementer-validated guidance for interoperable identity matching across healthcare systems and networks.
FAST Identity STU 2 focuses on:
- Standardized FHIR-based representation of persons using Patient, Person and RelatedPerson profiles
- Consistent use of matching attributes and the FHIR $match operation
- Support for patient and non-patient identity matching across organizational boundaries
- Use of the HL7 Person Identifier as a persistent, interoperable identifier to support longitudinal identity correlation
- Interoperable matching patterns that work alongside external identity proofing and assurance frameworks
The HL7 Person Identifier plays a critical role in enabling scalable, network-level identity matching. This reduces duplication and improves downstream workflows for consent, security, directory exchange and trusted data sharing across CMS-Aligned Networks.
FAST Security STU 2: Production-Ready Trust Infrastructure
FAST Security STU 2 provides production-ready patterns for authentication, authorization and trust at scale using proven, standards-based approaches.
FAST Security STU 2 enables:
- Certificate-based trust between ecosystem participants
- OAuth 2.0 authorization profiles tailored for healthcare APIs
- Automated onboarding through dynamic client registration
- Reduced implementation and maintenance burden through reusable security patterns
These capabilities establish a consistent trust layer that supports secure FHIR API exchange across payers, providers, vendors and networks. This forms a critical foundation for CMS-Aligned Networks and TEFCA-adjacent exchange.
FAST National Directory: Progress Toward STU 2 and Testing at Scale
FAST National Directory continues to advance as a core enabler of automation and interoperability at scale, with active work underway toward STU 2. Directory efforts focus on adoption-ready patterns that support authoritative endpoint discovery, capability signaling and program participation indicators. These are all prerequisites for reliable exchange across CMS-Aligned Networks and TEFCA-connected ecosystems.
Momentum around Directory collaboration was recently highlighted in a joint webinar with HL7 Da Vinci, FAST and Trebuchet, which explored FAST National Directory use cases, operational workflows as well as the real-world challenges implementers face today. The discussion underscored the importance of aligning directory specifications with payer and provider realities and ensuring directory data can be used effectively in production environments.
Directory Collaboration Webinar Recording Available: https://youtu.be/9DL8hpM7RMU
To support implementer readiness, FAST will host a dedicated National Directory testing track during the January Virtual HL7 Connectathon, enabling participants to validate directory capabilities alongside FAST Identity, Security, Consent and Da Vinci workflows. This testing will focus on the following areas:
- Intelligent routing
- Reduced misrouted transactions
- improved reliability across multi-network exchange scenarios.
HL7 January Virtual Connectathon: Putting FAST Into Practice
FAST will participate in the January Virtual HL7 Connectathon, featuring four dedicated FAST tracks:
- Consent
- Identity
- Security
- Directory
The Connectathon provides a hands-on environment for implementers to test FAST implementation guides, validate cross-track workflows and collaborate directly with FAST subject-matter experts. Feedback gathered during testing informs ongoing specification refinement and supports testing at scale.
Powering CMS-Aligned Networks With FAST
Together, FAST Consent, FAST Identity, FAST Security and FAST National Directory form an integrated, standards-based foundation that directly supports the CMS vision for Aligned Networks.
By combining interoperable identity matching (including the HL7 Person Identifier), standardized trust and security, scalable consent models, directory infrastructure and testing at scale, FAST is helping the industry move from policy intent to operational reality.
Ongoing collaboration with HL7 Accelerators and ecosystem partners—including Da Vinci, CARIN Alliance and The Sequoia Project—continues to reinforce FAST’s role as a core enabler of nationwide, trusted interoperability.
Get Involved
- Register and vote in the FAST Consent Ballot
- Adopt and implement FAST Identity STU 2 and FAST Security STU 2
- Participate in the HL7 January Virtual Connectathon across Consent, Identity, Security and Directory
FAST is enabling the trusted infrastructure needed to connect the healthcare ecosystem and deliver on the promise of CMS-Aligned Networks. Now is the time to engage and help shape what comes next.
Follow the FAST Community
For those looking to stay informed or contribute, the FAST team welcomes you to join our listserv, engage through public calls, participate in testing at Connectathons or join FAST as a member to help shape our work. These collaborative efforts are key to building solutions that benefit the entire health IT ecosystem, ensuring that consent management is not only feasible but scalable across varied healthcare settings.
Be sure to follow the FAST LinkedIn page to stay up- to-date on where FAST is presenting and other timely news.
