Survey Highlights Challenges of Interoperability and Prior Authorization Rule

Details

According to the survey, 43% of payers and 47% of providers have not yet begun their API implementation work, indicating persistent interoperability challenges despite some progress since earlier surveys. Major hurdles identified include digitizing policies, meeting tight timelines, developing new workflows, and coordinating with third-party vendors and health plans. However, most organizations support a staggered implementation of CMS requirements and recognize the critical importance of education and technical training for successful adoption of FHIR APIs. Cost estimates for API implementation range mainly between $1 million and $5 million, leaving many organizations unsure about total expenses and resource needs. These findings suggest that industry efforts toward digitalizing healthcare data and achieving standardized information exchange face significant difficulties—not only technically but also in process design, workforce training, and financial planning.