The Standard

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.

 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.

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. 

HL7, in collaboration with the Argonaut Project, is excited to announce the launch of a new website dedicated to the International Patient Access (IPA) standard:ipa.hl7.org. This site is designed to provide a central resource for healthcare organizations, policymakers and patients to understand, implement and support patient-controlled access to health data using the HL7® FHIR® standard.

A Milestone for Global Interoperability

IPA is a global standard aimed at empowering patients with access to their health records across different systems and countries. By defining a minimal yet meaningful set of FHIR-based profiles, IPA ensures that applications can seamlessly retrieve patient data regardless of geographic or system-specific differences.

The new website serves as a hub for information about IPA adoption, implementation guidance and ongoing development efforts. It provides insights into how healthcare systems worldwide can enable secure, authorized access to patient records through standardized APIs, reducing barriers to interoperability.

As the Trusted Exchange Framework and Common Agreement (TEFCA) moves ahead for FHIR usage within the framework, the use of the HL7 FAST UDAP Security for Scalable Registration, Authentication and Authorization FHIR IG (FAST Security) is becoming more important to the security framework for FHIR within the US and in other countries. As part of our mission, the FHIR At Scale Taskforce (FAST) wants to help people get ready for the TEFCA January 1, 2026, deadline to have Fast Security implemented for FHIR Exchange over TEFCA.

To help implementers, CISOs, and anyone interested in FHIR on TEFCA out, FAST is holding a 1-day event to introduce the Security IG and how TEFCA will use it and information about general TEFCA security, Security IG testing, and other aspects. This event is FREE on January 13, 2025, right before the FHIR Connectathon. If you’re interested in FHIR on TEFCA or want to know the latest in FHIR OAuth security, you can sign up at: https://info.hl7.org/fast-security

The latest FAST Focus webinar provided a comprehensive update on the progress and scope of the FAST Consent project, an initiative pivotal to streamlining data exchange in health IT. This quarterly series aims to engage the community, share updates, and encourage participation in ongoing FASTprojects. Below, we delve into the key takeaways from the session, with a spotlight on the objectives and contributions  

The FAST Consent Project: An Overview 

Consent management in healthcare is a complex issue that requires innovative solutions to manage and transmit consent records at scale. The FAST Consent project emerged in response to these challenges, focusing on how to make consent management effective across a diverse and multi-faceted ecosystem. Project leads—including Durwin Day, Mohammad Jafari, Kevin Day, Maidul Islam, Sam Schifman, and Jean Duteau—are spearheading efforts to define scalable consent handling strategies that align with both technical and legal requirements.