This article compares FHIR and custom REST APIs regarding their roles in exchanging risk adjustment data within the healthcare sector. It explains that APIs are foundational to system integration, enabling real-time data exchange and moving beyond traditional batch processing or manual workflows.
While US law grants patients the right to access medical records (via HIPAA/21st Century Cures Act), data retrieved through FHIR APIs remains limited. The key challenge is not merely providing data, but ensuring its 'trustworthiness' and 'provenance.'
The Workgroup for Electronic Data Interchange (WEDI) has launched a free testing directory to assist organizations in preparing for the CMS Advancing Interoperability and Improving Prior Authorization Final Rule, due by January 1, 2027. This platform allows healthcare entities and payers to test required FHIR APIsโincluding Prior Authorization, Payer-to-Payer, Patient Access, and Provider Accessโaccelerating industry data exchange readiness.
The American Dental Association (ADA) is soliciting input from dental stakeholders regarding a proposed Centers for Medicare & Medicaid Services (CMS) rule concerning interoperability standards and prior authorization for drugs. The rule aims to mandate standardization using FHIR and NCPDP, improving process transparency, which significantly impacts the industry.
TPIsoftware developed an AI-powered procedure code assignment tool compliant with SMART on FHIR. This tool uses Natural Language Processing (NLP) to automatically identify details from radiology reports, aiming to improve coding accuracy and reduce billing rejection risks.
eHealth Exchange received the 2026 Points of Light Award from KLAS Research. This recognition highlights its successful implementation of regulated FHIR APIs, enabling HEDIS quality reporting through collaboration with entities like NCQA.
This monthly review summarizes several key developments concerning electronic health records and data sharing in the US. Key regulatory trends include new proposed rules from CMS regarding drug prior authorization, and legal disputes surrounding the definition of Health Information Networks (HINs), focusing heavily on interoperability issues.
Onyx Technology LLC's OnyxOS is a modular operating system designed to transform raw healthcare data from mere exchange information into actionable operational intelligence. Built on an FHIR-native foundation, it enables the derivation of concrete outcomes from connected data.
Joseph Kleiman, president of Buzz Health, warned that current e-prescribing infrastructure is unprepared for new proposed Centers for Medicare & Medicaid Services (CMS) mandates. He cited fragmented systems, reliance on outdated processes like fax and phone calls, and a lack of standardized data exchange as major obstacles.
Saga IT offers deep expertise across all generations of the MEDITECH platform (Expanse, 6.x, MAGIC). They handle diverse integration needs, including FHIR R4 API development and HL7 v2 interfaces.
The Centers for Medicare & Medicaid Services (CMS) has announced a new pledge within its Health Tech Ecosystem initiative. This aims to bring together payers, providers, EHR vendors, and developers to implement electronic prior authorization workflows, addressing the long-standing issue of costly delays in care.
The market is accelerating due to three converging forces: regulatory pressure, structural ecosystem changes, and elevated standards set by participants. This drives increased investment in FHIR, highlighting a growing gap between mere compliance (meeting specifications) and actual interoperability (working in production).
This article warns that non-compliance with the FHIR standard is not merely a technical issue but creates broad organizational risks, including financial penalties, competitive disadvantage, and reputational damage. Specifically in the US, regulations like ONC's information blocking rules and CMS requirements are strict, making compliance mandatory.
West Coast Informatics announced the launch of AutomapAIโข, a platform that transforms fragmented clinical data into standards-aligned, AI-ready assets. The tool automatically performs semantic normalization on local codes and unstructured text, enabling healthcare organizations to reduce integration costs and establish advanced analytical foundations.
The US Department of Health and Human Services (HRSA) has released the 'UDS Plus Age Extension,' an FHIR extension for the 2023 Uniform Data System (UDS) Patient Level Submission (PLS). This specification is designed to record a patient's age at a specific time, serving as a critical component in clinical information exchange.
The US government (CMS) mandates that multiple payers, including Medicare Advantage, implement four specific FHIR APIs by January 2027. This significantly digitizes patient data access and prior authorization processes, demanding standardization and transparency in healthcare information exchange.
AWS offers specialized services like HealthLake (FHIR) and HealthImaging to standardize medical data and enable advanced analysis. This suite of solutions unifies fragmented EHR data, supporting diverse applications from genomic analysis to information extraction from clinical documents using AI.
Agnotic provides a solution to automate labor-intensive clinical workflows, such as prior authorization and discharge planning, through integration with Electronic Health Records (EHRs). The system utilizes FHIR R4 events as triggers, building workflows at the data layer to ensure upgrade resilience and maintain comprehensive audit trails, aiming to reduce administrative burden and improve care quality in healthcare settings.
CMS has mandated that Medicare Advantage (MA) organizations publish network information to the Medicare Plan Finder. This requires attestation in HPMS by September 1, 2026.