HIMSS 2026 Insights: The Challenges of Health Data Interoperability Between FHIR and National Architecture
Episode 24 - HIMSS 2026 Roundup - by FHIR Data guy
Summary
Based on the author's experience at HIMSS 2026, the article argues that true interoperability is hindered not merely by technology (like AI), but fundamentally by the underlying incentive structures—specifically, who benefits financially from data sharing. The US faces challenges where data exchange is an economic and policy problem, not just a technical one.
Details
This article analyzes the gap between the unified national healthcare digital architecture proposed by the National Academy of Medicine (NAM) and the reality observed at HIMSS 2026. NAM advocates for treating data infrastructure as a 'common good' utility, requiring standardized semantic foundations (FHIR-native) and a single framework of trust (for identity, consent, and security). However, the author notes that many vendors at HIMSS are merely engaging in 'FHIR-washing,' using FHIR as a thin translation layer over proprietary legacy databases, thereby maintaining vendor lock-in. Furthermore, the focus on Generative AI has led to neglecting foundational data architecture ('plumbing'). The core resistance stems from viewing patient data not as a shared public utility, but as a guarded asset by large EHR providers and vendors who rely on being gatekeepers. Therefore, achieving true interoperability requires resolving these underlying incentive misalignments through policy levers and cross-sector collaboration, rather than relying solely on technical solutions.
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