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Recent and proposed rules from the Centers for Medicare & Medicaid Services (CMS) and the Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology (ASTP/ONC) focus on improving data exchange among patients, providers, payers, and health IT systems. Important developments include the CMS Interoperability and Prior Authorization Final Rule, the 2026 CMS Interoperability Standards and Prior Authorization for Drugs Proposed Rule, HTI-5, and continued support for TEFCA, the Trusted Exchange Framework and Common Agreement.
Key takeaways
- Federal rules are becoming more focused on reducing administrative burden and improving access to health information.
- CMS-0057-F requires impacted payers to support several interoperability APIs with many requirements beginning in 2027.
- CMS has proposed expanding electronic prior authorization requirements to certain drugs covered under medical and pharmacy benefits.
- HTI-5 proposes updates related to health IT certification, information blocking, FHIR, and AI-enabled interoperability.
- TEFCA is expected to support broader nationwide health information exchange in the years ahead.
- Practices should evaluate whether their current technology supports secure data exchange, patient access, payer communication, and more efficient administrative workflows.
For years, providers, payers, technology vendors, and patients have worked through disconnected systems, manual requests, incomplete records, and administrative delays. Now, federal rules and proposals are working to move the industry toward a more connected, standards-based healthcare system.
The goal of this next phase of interoperability is to improve payer-provider data exchange, make prior authorization more electronic, support nationwide health information exchange, reduce administrative burden, and help healthcare organizations use data more effectively.
As interoperability standards evolve, practices may need to think differently about their health IT systems, patient data workflows, prior authorization processes, and more. Organizations that prepare early will be better positioned to support compliance and create a smoother experience for staff and patients.
Why Interoperability Is Becoming a Bigger Priority
Interoperability helps answer common questions across the healthcare experience:
- Can a patient access their health information when they need it?
- Can a provider retrieve relevant records from another organization?
- Can a payer receive the information needed to make a prior authorization decision?
- Can health systems exchange data without relying on fax machines, portals, phone calls, or manual uploads?
When interoperability is limited, staff often have to bridge the gaps manually. That includes hunting down records, re-entering information, cross-referencing multiple portals, following up on authorization status, or explaining to patients why information is missing. The future of interoperability is designed to reduce barriers like these by making data exchange more automated, secure, consistent, and standards-based.
Key Interoperability Rules and Proposals to Watch
The following federal rules have a common goal of making health data easier to access and exchange while improving transparency, patient access, and efficiency.
| Rule or Initiative | What It Focuses On | Why It Matters for Practices |
|---|---|---|
| CMS-0057-F Prior Authorization Final Rule | Patient access, provider access, payer-to-payer exchange, provider directories, and prior authorization APIs | Supports better payer-provider data exchange and more electronic prior authorization |
| 2026 CMS Interoperability Standards and Prior Authorization for Drugs Proposed Rule | Electronic prior authorization for certain drugs and updated interoperability standards | Could expand automation and transparency for drug-related prior authorization |
| HTI-5 Final Rule | Health IT certification, information blocking, FHIR, and AI-enabled interoperability | May influence how certified health IT evolves |
| HTI-2 Final Rule and TEFCA | Governance, trust, privacy, security, and information exchange | Supports broader nationwide exchange of electronic health information |
| Information Blocking Enforcement | Preventing practices that interfere with access, exchange, or use of electronic health information | Reinforces compliant information-sharing practices |
AI Governance and Interoperability
AI is becoming part of the interoperability conversation because many AI tools depend on high-quality, structured data. AI is only effective when the data behind it is accurate, accessible, and secure. That makes interoperability key for future healthcare AI adoption.
In the future, practices will likely see AI-enabled tools that help with:
- Summarizing patient records
- Flagging missing documentation
- Supporting prior authorization workflows
- Identifying coding or billing issues
- Improving patient communication
- Reducing repetitive administrative tasks
What Practices Should Expect Next
Interoperability won’t change every workflow overnight. However, practices can prepare for more connected systems and more standardized data exchange with:
- More information-blocking enforcement
- Continued expansion of payer interoperability
- More automated prior authorization workflows
- Greater payer-provider data exchange
- Less reliance on manual administrative work
- Better patient access to health data
- More FHIR-based API functionality
- Increasing attention to AI governance and responsible data use
Practices that rely heavily on manual processes and workflows likely have the most opportunity for improvement.
Frequently Asked Questions
What is healthcare interoperability?
Healthcare interoperability allows different health information systems to securely access, exchange, and use patient data.
Why does interoperability matter for medical practices?
It can help practices reduce manual work, improve access to patient records, streamline payer communications, support prior authorization (PA) workflows, and give patients easier access to their health information.
How could interoperability affect prior authorization?
Interoperability can make prior authorization more electronic and transparent. Providers can exchange documentation and receive decisions through more standardized digital workflows than paper records and phone calls.
What should practices do now to prepare?
Practices should review current workflows, talk with software vendors about interoperability capabilities, monitor federal rule updates, and look for ways to reduce disconnected systems as well as manual administrative tasks.
