Healthcare interoperability has reached an inflection point.

In 2026, success is no longer defined by the presence of APIs but by the ability tooperate securely, consistently, and at scale across networks, organizations, and increasingly, across borders.

This shift reframes interoperability as something far more consequential:
a shared trust problem spanning cybersecurity, financial sustainability, and patient safety.

At the center of this transformation is FAST Security, emerging not simply as a technical specification, but as thefoundational trust layer for a global healthcare ecosystem.

Interoperability Is Now a Cybersecurity Surface

As healthcare exchange accelerates—payer-to-payer data sharing, automated prior authorization, and network-based access—organizations are no longer just exposing APIs.

They are expanding an identity and authorization attack surface.

Each new connection introduces:

• Additional credentials to manage
• Increasingly complex authorization logic
• More exceptions and edge cases
• Greater exposure to misconfiguration and attack

This is not a scaling API problem; it is a scaling trust problem.

FAST Security directly addresses this by standardizing how trust is established, enforced, and audited across organizational boundaries.

FAST Security as the Foundation of Trust Architecture

FAST Security is not designed to operate in isolation.

It provides the core trust workflows—authentication, authorization, and onboarding—that enable the broader FAST ecosystem:

• FAST Identity → Who is trusted
• FAST Security → How trust is enforced
• FAST Consent → What is permitted
• FAST Directory → Where trust is discovered

Together, these form a layered, reusable trust architecture aligned with modern interoperability demands.

This architecture allows trust to move from fragmented, one-off integrations to repeatable, scalable infrastructure.

New implementation community builds on global collaboration to improve
real-time device data exchange for AI-enabled care

Imagine a patient in an intensive care unit, monitored by a dozen devices generating streams of critical data every second.  From operating rooms and ICUs to ambulatory clinics and patient homes, clinicians and care teams rely on a growing ecosystem of medical and personal health devices. Now imagine that data is siloed, unable to flow into the EHR and unreachable by the analytics platform that might detect a dangerous trend before a clinician does.

This fragmentation is a well-known challenge in healthcare IT. On March 5, 2026, HL7 International took a major step toward solving it with the launch of the Caliper FHIR® Accelerator, a new implementation community dedicated to improving how data from medical and personal health devices is exchanged, integrated and used across healthcare systems. 

Why Caliper, and Why Now?

Caliper builds on HL7’s 2025 work with founding members to define a collaborative community focused on device interoperability. The need is clear: healthcare organizations are generating more high‑frequency device data than ever, but too often this information cannot flow cleanly into EHRs, analytics platforms or AI‑driven applications.

By leveraging HL7 FHIR alongside established device communication frameworks, Caliper aims to create a scalable, standards‑based foundation for real‑time device data integration. The goal is simple but transformative: ensure that data from critical care equipment and patient‑facing technologies can be shared consistently, reliably and safely.

“Healthcare systems are entering a new phase where access to high-quality, real-time data is essential to safely deploying advanced analytics and AI,” said Rachel Dunscombe, CEO of HL7 International. “The Caliper Accelerator represents an important step forward in ensuring that device-generated data, whether from critical care equipment or patient-facing technologies, can be shared and used consistently across care environments worldwide. This kind of foundational interoperability is critical to improving both clinical outcomes and operational resilience.”

Upcoming Da Vinci Community Roundtable on February 25 at 4:00 pm ET

As the federal government signals stronger enforcement and clearer expectations for healthcare pricing transparency, the ability for patients to make informed decisions has become a cornerstone of modern care efforts. The HL7® Da Vinci Project Community Roundtable, taking place on February 25, 2026, from 4 – 5:30 p.m. ET, will bring together the pioneers who are turning these regulatory expectations into reality.

The January roundtable set the stage for 2026 by focusing on overall use case progress and adoption readiness. This February session, “Navigating Patient Cost Transparency Using HL7 FHIR: Insights from Industry Leaders,” zooms in on Patient Cost Transparency (PCT), moving from the "why" of transparency to the "how" of implementation. Attendees will hear directly from early adopters about how they are navigating the complexities of Good Faith Estimates (GFE) and building the infrastructure for a more patient-centric ecosystem.

The upcoming 90-minute session will focus on:

• The Evolving Transparency Landscape: An overview of how recent federal actions and the No Surprises Act are driving an industry effort to increase transparency and empower patients.
  
• Standardizing Good Faith Estimates: Insights into the HL7 FHIR-based approach to PCT and how it automates the exchange of cost data between providers and payers.
• Real-World Pilot Progress: First-hand accounts from Aetna/CVS Health and Kyruus Health on how they are leveraging FHIR along with their existing infrastructure and previous work to streamline implementation of PCT, as well as lessons learned.
• The Role of Innovative Apps: How standardized data enables accurate, real-time access to medical costs via consumer-facing applications prior to the delivery of care.
• Collaboration Strategies: What organizations should keep in mind when working in an ecosystem-based solution, where it’s not just one group involved but a whole mix of partners that need to collaborate for success.

How States Can Move From Fragmented Programs to Shared, Scalable Infrastructure Using FAST

The CMS Aligned Networks Pledge marks a clear inflection point in federal health IT policy. For the first time, Centers for Medicare & Medicaid Services (CMS) is not simply setting compliance requirements for individual programs—it is asking the healthcare ecosystem to operate as connected networks, capable of secure, real-time, standards-based data exchange across payers, providers, public health and patients.

For states, this shift is significant.

States are no longer just one participant among many. They are increasingly the anchor for trust, identity, consent and directory infrastructure that enable CMS-aligned networks to function at scale. Medicaid programs, state CIO offices and HIEs sit at the intersection of policy, operations and technology. The CMS Aligned Networks Pledge makes that role explicit.

This blog explains:

1. What the CMS Aligned Networks Pledge really changes for states
2. Why traditional, program-by-program approaches will not scale
3. How the  HL7® FHIR® at Scale Taskforce (FAST)  provides the infrastructure states can reuse across initiatives
4. How states can leverage existing systems and vendors without starting over

The CMS Aligned Networks Pledge: A Shift from Programs to Infrastructure

Historically, CMS initiatives have been implemented as discrete programs:

• A new reporting requirement
• A new API mandate
• A new exchange use case
• Trusted digital identity and patient matching
• Scalable security and partner onboarding
• Computable, portable consent
• Authoritative directories for endpoint discovery

The CMS Aligned Networks Pledge represents a different expectation.

CMS is signaling that future interoperability depends on shared infrastructure capabilities, including:

• Trusted digital identity and patient matching
• Scalable security and partner onboarding
• Computable, portable consent
• Authoritative directories for endpoint discovery

These are not features of a single application. They are ecosystem functions.

For states, this means success is no longer measured by whether a single system goes live, but by whether multiple programs can reuse the same trust and exchange foundations.

Those of us working across health policy, technology, and standards are reimagining a system where individuals experience better outcomes, lower costs, and greater trust in how their health information is used and shared.

At HL7® International, a global standards development organization with members and affiliates in more than 50 countries, we are meeting our challenge head-on through collaboration and innovation. The HL7® FHIR® at Scale Taskforce (FAST) Accelerator takes that mission further by tackling the hard problems of scalability: Identity, Security, Consent, and National Directory services. These components are the backbone that supports the CMS Health Tech Ecosystem and Aligned Networks Pledge.

Paired with the Da Vinci Project, which applies FHIR to payer–provider workflows like prior authorization, clinical data exchange, payer data exchange, and patient cost transparency. HL7 is aligning infrastructure with real-world use cases. Da Vinci has recognized the value of FAST standards by selecting FAST Security as part of their security recommendations in their core health record exchange (HRex) specifications, showing a convergency across the ecosystem.

Where Sequoia’s RCE Role Elevates the Work: TEFCA as the National Trust Layer

FAST isn’t building infrastructure in a vacuum. Its work aligns with the Trusted Exchange Framework and Common Agreement (TEFCA), led by The Sequoia Project as the Recognized Coordinating Entity (RCE) for ASTP/ONC. TEFCA is a national framework for the secure and trusted exchange of clinical data across networks.

The HL7® Da Vinci Project is extending the deadline to nominate outstanding contributors for its 2025 Community Champions recognition program. Community members now have until Friday, February 6, 2026, to submit nominations, giving an extra week to spotlight colleagues and collaborators who are making a real impact on healthcare interoperability.

The Community Champions program honors individuals from across the Da Vinci Project's diverse, multi-stakeholder ecosystem, including health plans, provider organizations, accountable care organizations (ACOs), and health IT vendors. As an HL7® FHIR® Accelerator, the Da Vinci Project brings together public and private sector leaders to advance standards that support automated workflows, real-time data exchange, reduced administrative burden and improved care coordination.

Since launching in 2020, the Community Champions program has recognized individuals who embody a spirit of “industry above self.” Champions are known for their collaboration, leadership, and commitment to advancing real-world adoption of HL7 FHIR standards in support of value-based care and a more connected healthcare system.

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 

 Overall Winner

The  Integrated Medical Management and Educational Gateway (IMMEG) Venous Management System (I-VMS) is an AI-enabled, standards-based platform that projects a vectorized atlas of the deep thoracic venous system onto routine chest radiographs. Using deep-learning landmark detection and HL7 FHIR®/DICOM interoperability, the system lets clinicians visualize the catheter trajectory and tip position in patient-specific anatomy, record planned versus actual placement, and build a reusable, longitudinal venous access record across organizations. The project was developed for Vanguard with support from Xzyos.ai. 

Clinical Problem and Context 

Central venous access is essential for chemotherapy, parenteral nutrition, dialysis and critical care, yet malposition and related complications—venous injury, thrombosis, infection, and device dysfunction—remain common and costly. Post-procedure assessment usually relies on plain chest X-rays, which do not directly visualize venous structures. As a result, clinicians infer anatomy indirectly; documentation is inconsistent; and comparing procedures over time is difficult. There is no consolidated, spatially normalized record of a patient’s venous history to guide future decisions.

Core Innovation

 I-VMS predicts anatomical landmarks (e.g., carina, first thoracic vertebra T1, lateral edge of the right rib) on a radiograph with a modified DenseNet121 model implemented in MONAI. These coordinates establish a patient-specific basis for an affine transformation that overlays a standardized, vector-based venous atlas onto the image. Clinicians can accept or adjust landmarks and annotate intended and actual entry and tip positions. Because annotations are stored in a normalized coordinate space, results are comparable across encounters and over time, enabling longitudinal analysis and population-level learning.

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.