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.

 Winner of the Transformative Impact in Healthcare Award

What do you do when the people who taught you everything start to forget? My father is fighting Parkinson's and early dementia. My mother manages diabetes and congestive heart failure. My three siblings and I are a team — a family armed with love but disarmed by the chaos of a dozen medications, forgotten instructions, and missed questions. We were losing the battle against complexity, and that feeling is where this story truly begins.

 The seed for what would become Let's Talk Doc was planted six or seven years ago. My friend and partner, Diane Nguyen, and I saw the cracks in the system through our own eyes. I saw it in my parents' home, and she saw it as an immigrant facing the silent fear that a single misunderstood word on a form could alter her family's care. We tried to build something back then, a small solution born from our shared frustrations. But the technology wasn't ready. The idea was a spark, but we couldn't yet build the engine.  

Years passed. Then, earlier this year, Diane reached out. The world had changed. Technology had finally caught up to our ambition. "It's time," she said. "Let's try again."

 This is not a business venture for us. It’s a mission.

New Group Advances Workflow and Process Interoperability Using HL7^® FHIR^®

HL7 is pleased to announce the official launch of its HL7 Business Process Modeling (BPM) Community of Practice. Now open for membership, the community is dedicated to advancing interoperability, process consistency, and process automation through the use of formal modeling techniques promoting better modeling, sharing, and execution of clinical and administrative workflows across the healthcare ecosystem.

BPM Community of Practice builds upon three open standards-based languages – referenced together as “BPM+”, and include:  

• BPMN (Business Process Model and Notation): For prescriptive workflows
• CMMN (Case Management Model and Notation): For reactive activities
• DMN (Decision Model and Notation): For complex decision-making rules

The use of these standards, in concert, allows inherent ambiguities in natural-language guidelines to be clarified, providing precise, automatable guidance to improve care quality and consistency. Organizations use BPM+ to model and streamline processes, ensuring accurate and scalable healthcare delivery, process consistency, comparability, and repeatability.

“HL7’s focus is on bringing together communities to advance all aspects of interoperability, and that includes workflow and care processes,” said Ken Rubin, Community Coordinator of the HL7 BPM Community of Practice. “This launch marks an important step in providing the healthcare industry with tools, models, and frameworks to manage care processes more effectively, consistently, and collaboratively.”

Community Roundtable Featuring Clinical Advisory Council Insights on FHIR Adoption on June 25 at 4 pm

 Join the Vulcan Interoperability Bridge Webinar | Thursday, June 12 at 1:00 PM ET 

The story of clinical research has always been one of astounding breakthroughs… and barriers. It’s the story of research, regulators and technologists working together, and more recently, the story of equitable access and activated patients empowered to share their experiences. Clinical research is evolving — and it’s happening through the collective efforts of a passionate, deeply engaged community.

On June 12, we invite you to be part of that evolution.

The Vulcan Interoperability Bridge Webinar, hosted by the Vulcan FHIR® Accelerator in collaboration with the FDA, will bring together clinical research sponsors, EHR providers, life science leaders, technology innovators, academic medical centers and more — all working toward a future where HL7 Fast Healthcare Interoperability Resources (FHIR)-based interoperability enables smarter, faster and more connected clinical research.

Behind this movement is a simple truth: we can’t innovate in isolation. This is precisely where Vulcan makes a difference by breaking down barriers. Every delay in data sharing, every barrier caused by disconnected systems, slows the path from discovery to patient benefit.

Community Roundtable Featuring Payer Data Exchange Implementation Guide on May 28 at 4 pm

If you're looking for a real-world take on how the healthcare industry is putting the HL7 Da Vinci Project’s Payer Data Exchange (PDex) Implementation Guide into action, you won’t want to miss this event! The 90-minute virtual community roundtable will feature how organizations are using FHIR-based APIs to improve transparency and value-based care.

How Organizations Are Using PDex in Production Today

After a brief update on the PDex Implementation Guide from Da Vinci’s technical director, attendees will hear about implementation considerations and first-hand implementer accounts from those actively applying PDex to solve real-world data exchange challenges:

• Blue Cross Blue Shield Association + InterSystems will discuss the immense potential of payer-to-payer APIs to increase patient transparency and improve value-based care in light of the high levels of churn of the impacted population, resulting in care gaps and a need to provide patients with longitudinal records of care. Presenters will highlight the relevant Implementation Guides and the workflow issues inherent in the process that are being worked on. 
  
  
• Availity, Healow Insights, and Humana will explore their experience with payer-to-payer data sharing using PDex—including workflow impacts, scaling considerations, and member-centered outcomes. Availity and Humana will share its observations and lessons learned along their payer-to-payer implementation journey through internal development, coordinating with their cohort of payers, and participating in Connectathons. Then Healow will highlight its experiences from two years in PDex production. 

New publication outlines opportunities for accelerating and improving the use of AI to support payment integrity and reduce fraud, waste, and abuse

Last week, HL7 International released a new report outlining the actions needed to fully realize the benefits of artificial intelligence (AI) in improving payment integrity and reducing fraud, waste, and abuse. Reducing Fraud and Improving Payment Integrity in Healthcare Through the Use of AI brings together insights from payers, providers, and technology experts to define AI opportunities and emerging solutions, current challenges, implementation strategies, and standards needed to increase transparency and trust.

“The U.S. spends more than $900 billion annually on administrative complexity, waste, and improper payments,” said Charles Jaffe, MD, PhD, CEO of HL7 International. “This publication identifies practical and standards-based approaches to harnessing AI for one of healthcare’s most persistent and costly challenges.”

Key recommendations from the report include:

• Developing standards for explainable AI in healthcare with specific transparency requirements and bias mitigation protocols.
• Creating standards and infrastructure for trust and verification of AI-generated results.
• Establishing frameworks for human-in-the-loop validation that balance automation with clinical expertise.
• Implementing pilot programs focused on provider-payer collaboration that create mutually beneficial scenarios for all stakeholders.

How AI for Deterministic Approaches Can Fix PA Denials

A recent survey by the American Medical Association (AMA) revealed a growing concern among physicians: over 60% believe that unregulated AI tools are systematically denying necessary patient care. “Emerging evidence shows that insurers use automated decision-making systems to create systematic batch denials with little or no human review, placing barriers between patients and necessary medical care,” said AMA President Bruce A. Scott, MD, reacting to the survey results.

This alarming trend exacerbates the already burdensome prior authorization (PA) process in the US, delaying essential treatments and placing undue strain on providers, payers and patients alike.

At Smile Digital Health, we believe that AI should support—not override—good medical judgment. That’s why we developed KALM Services (Knowledge Authoring Lifecycle Management), with AI capabilities designed to exponentially accelerate the creation of deterministic computable policies for prior authorization workflows and other use cases like clinical reasoning and quality measure evaluations.

Are you a member of a technical team that’s beginning its journey toward implementing HL7's Fast Healthcare Interoperability Resources (FHIR^®) application program interfaces (APIs)? Then don’t miss an upcoming three-day online educational event offering two technical tracks tailored to your needs. 

Two days of interactive content delivery and demonstrations will be followed by a Connectathon that will provide implementers and developers with the opportunity to test FHIR-based solutions and exchange data with other FHIR interfaces.  

Organizations that want to fast-track implementing HL7 FHIR APIs to automate workflow, maximize efficiency and meet federal requirements of the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) should encourage their technical teams attend this online event. 

“We designed two tracks for technical team members at provider and payer organizations, as well as technology vendors, who are looking for a crash course on making the most of FHIR,” says Viet Nguyen, M.D., Technical Director of the HL7 Da Vinci Project. (Da Vinci has developed implementation guides for putting FHIR to use in supporting value-based medicine.) 

The HL7 FHIR at Scale Taskforce (FAST) is going international! As part of our mission to accelerate FHIR adoption and interoperability around the globe, FAST is taking its work beyond the U.S. to engage with the international health IT community. 

For the first time ever, FAST will be hosting a dedicated track at the HL7 FHIR Connectathon in Madrid, featuring two of our most critical and widely applicable Implementation Guides (IGs): 

🔐 FAST Security - https://build.fhir.org/ig/HL7/fhir-udap-security-ig/branches/main/ 
🆔 FAST Identity - https://build.fhir.org/ig/HL7/fhir-identity-matching-ig/ 

While these IGs were originally developed under the U.S. ONC's efforts to advance FHIR adoption, their guidance is intentionally broad and applicable globally. In fact, we're in the process of transitioning them to universal realm status, and your international input is vital. 

Why Participate? 
🌍 Help shape these key IGs to meet global needs 
🧪 Test and validate implementation with FAST experts
📚 Attend deep-dive breakout sessions focused on Security and Identity
🚀 Prepare for the future – FAST Security is a required standard for TEFCA FHIR exchange starting January 1, 2026 in the U.S.