In this episode of The Dish on Health IT, host Tony Schueth is joined by co-host Alix Goss and special guest Amy Gleason, Strategic Advisor to Centers for Medicare & Medicaid Services (CMS) and Administrator of the U.S. Department of Government Efficiency (DOGE) Service, for a wide-ranging discussion on how health IT modernization is evolving under a pledge-driven, incentive-backed federal strategy.

The conversation begins not with policy, but with lived experience.

From Emergency Room to Interoperability Advocate

Amy shares how her early career as an emergency room nurse exposed the dangers of fragmented information. Providers were expected to make critical decisions without access to complete patient histories, while patients, often in pain or distress, were unrealistically asked to recall complex medical details.

That professional frustration became deeply personal when her daughter went more than a year without diagnosis for a rare autoimmune disease, juvenile dermatomyositis (JDM). Multiple specialists saw pieces of the puzzle, but no one could see the full picture across charts and settings. Amy reflects that if today’s AI tools had been applied to her daughter’s complete longitudinal record, the condition may have surfaced sooner.

That experience shaped her philosophy. Technology must converge with policy and trust in ways that tangibly improve care.

Why Pledges Instead of Rules?

Tony presses on a central theme. Amy has argued that we cannot regulate our way to success. Why pursue voluntary pledges instead of federal rulemaking?

Amy explains her frustration returning to government in 2025 to find interoperability policies she helped draft in 2020 still not fully effective until 2027. Seven years is an eternity in technology. Meanwhile, the industry had technically complied with numerous mandates including Meaningful Use, Cures Act APIs and CMS interoperability rules, yet many workflows still felt broken.

In her view, regulation created a floor but not always real transformation.

The CMS Health Tech Ecosystem Pledge was launched as a different model. The federal government used its convening power to articulate a clear vision and challenge industry to deliver minimum viable products within six to twelve months rather than years.

Initially announced with roughly 60 companies, the pledge initiative has grown to more than 600 participants collaborating in working groups. The three initial patient-focused use cases include:

Improving data interoperability

“Killing the clipboard” through digital identity and QR-based sharing

Leveraging conversational AI and personalized recommendations for chronic conditions such as diabetes and obesity

Amy describes live demonstrations at a Connectathon showing OAuth-enabled data retrieval, QR ingestion into EHR workflows and AI-powered recommendations built on patient data. The goal is not perfection by the first milestone, but real-world minimum viable functionality that can iteratively improve.

Alix notes that from the standards community perspective, this approach feels aligned with long-standing calls for industry-driven collaboration, though it remains early to measure widespread impact.

Carrots, Sticks and Rural Health

The discussion turns to incentives.

Amy outlines the administration’s carrots and sticks strategy:

Stick: Enforcement of information blocking, with penalties up to $2 million per occurrence

Carrots: Financial incentives such as the $50 billion Rural Health Transformation Program and the CMS ACCESS Model, which pays for technology-enabled outcomes

The Rural Health Transformation Program directs money to states with expectations that ecosystem-aligned interoperability and app participation be incorporated into funding proposals. CMS retains oversight and clawback authority to ensure funds support rural providers.

The ACCESS Model represents a significant shift. Technology-enabled care platforms can register as Medicare Part B providers and be paid for measurable outcomes in tracks such as cardiometabolic disease, musculoskeletal conditions and behavioral health. Providers remain in the loop and receive compensation for referral and care plan oversight.

Alix underscores that rural providers face steep financial and workforce constraints. Standards participation, implementation and technology upgrades require resources that are often scarce. The success of these incentives will depend on whether they reduce burden rather than add to it.

AI: Evolution, Risk and Reality

AI becomes a central thread of the episode.

Amy compares AI adoption to autonomous vehicle models. Some scenarios allow tightly controlled automation, such as medication refills, while others require a human in the loop for higher-risk decisions. She points to a Utah prescription refill pilot as an example of bounded automation, where malpractice coverage and clearly defined use cases mitigate risk.

When Tony asks who owns risk in this evolving landscape, Amy emphasizes the need for light but clear regulatory pathways rather than fragmented state-by-state oversight.

Patients, she notes, are already there. Millions are asking health-related questions weekly through AI tools. The more pressing issue is ensuring those tools are grounded in structured medical data rather than incomplete memory or unverified inputs.

She shares a striking story. Her daughter was excluded from a clinical trial due to a misclassification of ulcerative colitis. By uploading her records into an AI model, they identified a more precise diagnosis, microscopic lymphocytic colitis, which did not disqualify her from the trial. For Amy, this demonstrates both the power and inevitability of AI use.

Alix adds caution. AI is only as strong as the data beneath it. Dirty, inconsistent and poorly structured data limits performance. Standards and terminologies remain essential to fuel high-fidelity models and safeguard trust.

FHIR, Deregulation and the Data Foundation

The conversation addresses an emerging tension. If regulatory burdens are being reduced, does that signal less need for structured standards like FHIR?

Amy candidly admits she initially wondered whether AI might reduce the need for FHIR altogether. After discussions with labs and technologists, she concluded the opposite. Standardized data dramatically improves AI performance and reduces error.

Deregulation is about removing unnecessary burden, not abandoning foundational data structures.

Alix reinforces that FHIR enables discrete, normalized data capture that supports both legacy transactions and AI evolution. While future innovations may emerge, today FHIR remains the backbone for scalable interoperability.

Prior Authorization and HIPAA Modernization

The episode dives into prior authorization modernization across medical and pharmacy domains.

Amy notes growing interest among pledge participants to expand into pharmacy prior authorization testing, diagnostic imaging, real-time benefit checks and bulk FHIR performance testing.

Alix provides insight into ongoing work within the Designated Standards Maintenance Organizations to incorporate FHIR-based approaches into HIPAA-named standards, particularly for prior authorization. She highlights testing beyond Connectathons, including implementer communities and real-world pilot efforts.

Both stress the importance of public comment periods and industry engagement, describing participation as a civic responsibility for health IT professionals.

Trust as the Core Enabler

The final segment centers on trust.

Amy explains that the ecosystem initiative aims to reinforce trust through:

Stronger digital identity verification such as Clear, ID.me and Login.gov

Certification frameworks such as CARIN and DIME for patient-facing apps

A new national provider directory to replace fragmented provider data sources

Transparency dashboards showing data requests, volumes and purpose

Rather than replacing frameworks like TEFCA, she describes the pledge model as an accelerator layered above the regulatory floor.

Transparency acts as sunlight, enabling visibility into who is accessing data and for what purpose.

Final Takeaways

In closing, Amy urges providers not to sit on the sidelines. Too often, she says, providers feel change is imposed on them. The pledge environment is designed as an open forum where they can directly shape what works or does not work in real workflows.

Alix echoes the call. Standards require participation. Organizations must allocate budget and staff to engage, comment and collaborate. It truly takes a village.

Tony concludes by framing the episode’s core message. Regulation establishes baseline expectations, but voluntary movements can demonstrate what is possible before mandates reach the Federal Register.

Across pledges, payment reform, AI evolution and trust frameworks, the episode underscores a consistent theme. Modernization in health IT depends not only on policy direction, but on shared accountability and active participation from every stakeholder in the ecosystem.

Listeners are reminded that POCP is available to support organizations in understanding the implications of federal initiatives, enforcement priorities and their strategic implications. Reach out to us to set up an initial consultation. 

The episode closes, as always, with the reminder that Health IT is a dish best served hot.

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In this episode of The Dish on Health IT, host Tony Schueth, CEO of Point-of-Care Partners (POCP), is joined by colleagues Mary Griskewicz, Regulatory Resource Center Lead, and Janice Reese, Senior Consultant and Program Manager of FHIR at Scale Taskforce (FAST), for a wide-ranging discussion on two major proposed rules released in mid-December 2025: the HTI-5 proposed rule from the Assistant Secretary for Technology Policy (ASTP) and CMS’s latest proposal on healthcare price transparency.

Rather than treating these rules as abstract policy exercises, the conversation focuses on what the government is trying to accomplish, how these proposals may reshape the interoperability and data access landscape, and why stakeholder participation during the comment period is not optional if the industry wants workable outcomes.

Setting the Stage: How Proposed Rules Become Reality

The episode opens with a level set for listeners who do not spend their days in the Federal Register. Mary walks through how proposed rules originate, typically from legislation or executive policy, and how they move from proposal to public comment to either a final rule, an interim final rule, or, in some cases, a complete pause or reset.

She emphasizes a point that often gets overlooked: every public comment is read and reviewed. The agencies group and analyze the comments section by section and respond to themes and concerns in the final rule text. Janice builds on this by explaining that the comment period is where high-level policy intent meets operational reality. The most effective comments are not lengthy manifestos, but specific, experience-based feedback that highlights feasibility issues, sequencing challenges, and unintended consequences.

HTI-5: From Experimentation to Execution

The discussion then turns to HTI-5, with Mary outlining the core problem the rule is trying to address. Prior certification requirements placed a significant burden on vendors, often locking innovation into long development cycles while the market waited for updates. HTI-5 seeks to modernize this approach by reducing prescriptive certification requirements and relying more on modern, open architecture, particularly FHIR-based APIs, to enable faster, more scalable data exchange.

Janice frames HTI-5 as a clear signal that the industry is moving out of the experimentation phase and into execution. By reinforcing a “FHIR-first” direction while pulling back on some certification detail, the rule implicitly raises expectations for real-world performance. As FHIR becomes the default, security, identity, consent, and trust cannot be treated as optional or inconsistently implemented components.

From a FAST perspective, this shift is critical. HTI-5 creates the regulatory space, but the infrastructure and implementation guidance needed to make trusted interoperability work at scale must come from industry-led collaboration. Janice explains that FAST’s work on security, identity, consent, and national directory services is about operationalizing trust so organizations are not reinventing these foundations on their own.

Information Blocking, Automation, and Trust at Scale

A pivotal moment in the conversation centers on HTI-5’s clarification that information blocking explicitly includes automated and AI-driven access. Mary underscores that automation is now central to how data moves across the healthcare ecosystem. When access decisions are embedded in APIs, workflows, and algorithms, trust becomes the defining requirement.

Janice expands on this by noting that the issue is not just whether data can be accessed, but whether access is appropriate, provable, and governed. As automation increases, expectations shift toward accountability, auditability, and consistent enforcement of identity and consent. FHIR APIs, once viewed as certification checkboxes, are becoming the primary channel for data exchange across networks, including consumer-facing applications.

Stakeholder Impacts: Vendors, Providers, and Payers

The episode then walks through how HTI-5 affects different stakeholder groups. For health IT vendors and digital health companies, Janice describes a trade-off: fewer certification guardrails provide flexibility but also remove a layer of protection. Vendors will be judged less on formal compliance artifacts and more on how their systems perform across networks at scale, including security, identity management, and reliability.

Mary cautions that vendors should not interpret HTI-5 as traditional deregulation. With HTI-6 already on the horizon, organizations that underinvest now risk facing more stringent outcome-based expectations later. Tony reinforces this point, arguing that the real risk is collective. A single high-profile failure due to weak security or identity practices could undermine trust across the ecosystem and invite a regulatory response that affects everyone.

For providers and health systems, the shift means becoming more informed consumers of technology. Certification alone will no longer guarantee interoperability or trustworthiness. Providers will increasingly need to ask vendors how solutions perform in environments beyond a single one and how identity, consent, and security are handled across organizational boundaries.

From a payer perspective, Mary explains that while HTI-5 does not directly change prior authorization requirements, it fundamentally reshapes the data access environment. As FHIR APIs become the default, plans will be expected to exchange data more dynamically and through automated workflows. This raises expectations around timeliness, quality, and trust, and accelerates a shift from managing transactions to managing trust at scale.

Price Transparency: Compliance Without Clarity

The conversation then transitions to CMS’s proposed price transparency rule, with Tony noting the absence of POCP’s usual price transparency expert and setting expectations for a higher-level discussion. Mary explains that this tri-agency proposal builds on earlier rules by clarifying standards, easing some reporting burdens, and refining requirements around machine-readable files, metadata, and reporting timelines.

While these changes offer some relief to plans, Janice highlights a deeper challenge. Making pricing data available does not make it meaningful. Without consistent ways to connect clinical concepts to billing codes and pricing structures, patients and employers are left with technically accurate but practically unusable information. True transparency will require better integration of pricing data into real-time workflows, supported by APIs, governance, and trust frameworks.

Mary also reminds listeners that employers are a critical stakeholder often overlooked in these discussions. As purchasers of coverage, they rely on usable pricing data to understand utilization and manage costs, making their perspective essential during the comment period.

The Closing Message: Comment, Participate, Get Involved

The episode closes with a strong call to action. Mary urges listeners to “get off the bench” and engage, regardless of which rule is at issue. Comment periods directly affect compliance programs, product roadmaps, and competitive positioning. Janice reinforces that policy alone cannot solve interoperability challenges. Progress depends on shared implementation guidance, testing, governance, and sustained participation in standards organizations and multi-stakeholder initiatives, including FAST.

The final takeaway is clear: HTI-5 and the price transparency proposal are not just regulatory events. They are inflection points. Organizations that participate now can help shape outcomes that are achievable, scalable, and trusted. Those that sit out will be left reacting to decisions made without their operational realities at the table.

Listeners are reminded that both proposed rules have comment deadlines in late February, and that POCP is available to support organizations in understanding the implications and crafting effective comments. The episode closes, as always, with the reminder that Health IT is a dish best served hot.

This episode of The Dish on Health IT features Denny Brennan, Executive Director of the Massachusetts Health Data Consortium (MHDC), in conversation with host Tony Schueth, CEO of Point-of-Care Partners (POCP), and co-host Ross Martin, MD, Senior Consultant with POCP. Together, they examine how MHDC is translating national interoperability policy into practical, statewide action, specifically around the CMS-0057 rule.

After brief introductions, the conversation quickly turns to MHDC’s long history and why it matters. Founded in 1978, before the internet, MHDC guided Massachusetts through nearly every major health IT transition: HIPAA, Meaningful Use, ICD-10, and now interoperability and automation. Denny explains that this continuity has created something rare in healthcare: sustained trust across payers, providers, vendors, regulators, and associations. That trust, he notes, is what allows competitors to work through shared infrastructure problems that no single organization could solve on its own.

From there, the discussion turns to why the MHDC community chose to coordinate and support members in their CMS-0057 compliance journey, versus just letting each member organization go it alone. Denny emphasizes that while healthcare is regulated federally, it functions locally. Each state has its own mix of insurers, hospital systems, rules, and market pressures. In Massachusetts, where long-standing relationships already exist, MHDC saw an opportunity to move faster, test real workflows, and generate lessons that could inform efforts far beyond the state.

The discussion then moved to how work to improve prior authorization became such a high-priority focus. Denny describes how the process has grown into one of the most disruptive administrative burdens for clinicians. Rules vary by plan, criteria change frequently, and the information providers need is often hard to access in real time. The result is defensive behavior. Offices routinely submit prior authorizations “just in case,” often by fax or phone, simply to avoid denials and treatment delays. That inefficiency, he explains, ripples outward by slowing patient care, driving up providers' overhead, and requiring health plans to spend more time and resources processing and reviewing the required PA alongside the unneeded submissions.

The financial impact quickly becomes apparent. Denny points to evidence showing that administrative costs consume a massive share of U.S. healthcare spending, with prior authorization playing a meaningful role. If automation is implemented through a neutral, nonprofit infrastructure, MHDC believes there is a much greater chance that savings will flow back into premiums and public program costs rather than being swallowed by inefficiency.

Ross adds an important dose of realism. Prior authorization friction, he notes, is not always accidental. In some cases, operational complexity functions as a utilization control mechanism. That creates a built-in tension between access, cost containment, and patient experience, and helps explain why national reform has moved slowly despite widespread frustration.

At that point, the conversation shifts from why this is broken to how MHDC is trying to fix it. Denny walks through MHDC’s operating model: convene the full ecosystem early and often. In a recent deep-dive session, roughly 60 representatives from health plans, providers, and the state participated in a working session focused on what an automated prior authorization workflow could realistically look like. MHDC brought a draft framework to the table. The community pressure tested it and surfaced workflow conflicts, operational blind spots, and policy misalignments that no single organization could see on its own.

That collaborative process, Denny explains, is the real engine behind adoption. When stakeholders help build the solution themselves, implementation becomes a shared commitment rather than a compliance exercise. It also reduces resistance later because decisions are not delivered top-down. They are constructed collectively.

The discussion then turns to FHIR adoption and why, while real, progress has taken time. Denny traces the turning point back to the 21st Century Cures Act, which reframed patient access to health data as a legal right and categorized data blocking as a regulatory violation. That policy shift, combined with the growing maturity of API-based interoperability, created the conditions for real-time data exchange to finally move from theory to practice.

Ross provides a historical perspective from the standards side. Earlier generations of health data standards were conceptually elegant but extremely difficult to implement consistently. FHIR changed that equation by aligning healthcare data exchange with the same API-driven architecture that supports the modern web. He points to accelerating real-world adoption, particularly from large EHR platforms, as evidence that FHIR has entered a phase of broad, practical deployment.

Although pharmacy prior authorization falls outside the formal scope of CMS 0057, Denny makes clear that MHDC could not ignore it. For many physicians, especially in oncology, dermatology, and primary care, PA for prescriptions is far more frequent and far more disruptive than PAs for medical services. If MHDC solved only one side of the problem, much of the daily burden for clinicians would remain unchanged.

Pharmacy prior authorization, however, introduces a new level of complexity. PBMs, pharmacists, prescribing systems, payers, and patients are all involved, often across fragmented workflows. Denny explains that the challenge looks less like a pure technology gap and more like an orchestration problem. It is about getting the right information to the right party at the right moment across multiple handoffs.

Ross shares insights from the pharmacy PA research work conducted with MHDC and POCP. One of the most striking findings was the massive year-end renewal surge that hits providers every benefit cycle as authorizations tied to prior coverage suddenly expire. He also reflects on a recent national electronic prior authorization roundtable, where deep stakeholder discussion ultimately led most participants to conclude that today’s technology alone still is not sufficient to fully solve pharmacy PA. The tools are improving, but the problem remains deeply multi-layered.

As the episode winds down, the tone shifts toward practical calls to action.

Denny challenges the industry to separate where competition belongs from where collaboration is essential. Contract negotiations may be adversarial by nature, he notes, but interoperability initiatives cannot succeed under the same mindset. Real progress depends on bringing collaboratively minded people into the room. These are people willing to solve shared infrastructure problems even when their organizations compete elsewhere.

Ross builds on that message with a longer-term challenge: sustained participation in standards development. Organizations cannot sit back and hope others shape the future on their behalf. Active involvement in national standards organizations is critical. This is not for immediate quarterly returns, but to influence the systems everyone will be required to use in the years ahead.

The episode closes with a clear takeaway. MHDC did not wait for perfect conditions. It moved when the pieces were good enough, tested real workflows with real stakeholders, adjusted in the open, and began sharing lessons nationally. In an industry often slowed by fragmentation and risk aversion, this conversation offers a grounded look at what forward motion actually looks like when collaboration, policy, and technology finally align.

You can find this and other episodes of The Dish on Health IT wherever you get your podcasts, including Spotify and Healthcare Now Radio. If you found this conversation valuable, share it with a colleague and be sure to subscribe so you never miss an episode. Have an idea for a topic you would like us to cover in future episodes? Fill out the form and tell us about it. Until next time, Health IT is a dish best served hot.

In this episode of The Dish on Health IT, host Tony Schueth, CEO of Point-of-Care Partners (POCP), is joined by colleagues Brian Dwyer, POCP’s Business Strategy Lead, and Seth Joseph, Managing Director at Summit Health Advisors, to unpack their takeaways from the HLTH25 conference in Las Vegas. Together, they reflect on the energy of the event, the conversations shaping the future of health IT, and interviews recorded live from Podcast Row.

The trio kicks off by comparing notes on how HLTH has evolved from a flashy innovation show to something more grounded, a space where serious conversations about interoperability, investment, and operational impact are starting to take hold. Seth notes the event’s “coming-of-age” moment, where hype gave way to maturity. Brian agrees, adding that the buzz of startups pitching and investors circling was balanced by a sense of realism about implementation and outcomes.

AI dominated every conversation, but with a more pragmatic tone than in years past. The hosts discuss how AI is shifting from novelty to necessity, moving from “AI for AI’s sake” to purpose-driven use cases. Interview clips from leaders like Taha Kass-Hout with GE Healthcare spotlight “agentic AI,” where autonomous systems could act as trusted colleagues in care delivery, even participating in tumor board decisions to help extend expertise to rural or underserved regions. The group connects this to the ongoing challenge of ensuring data quality and interoperability as the foundation for any AI success story.

Laurie McGraw of Transcarent and Kyle Kiser of Arrive Health bring different but complementary perspectives. Laurie underscores AI’s potential to bend the cost curve only if applied safely and effectively, while Kyle highlights the growing complexity of affordability and the need for intelligent systems to help patients and providers navigate fragmented benefits and prescription pricing. Seth and Brian note that the shift toward patient empowerment, fueled by AI and transparency, could signal a broader cultural change in healthcare where consumers wield more influence.

The discussion expands into value-based care with insights from McKesson’s John Beardsley, who questions whether the industry has truly cracked the code after two decades of running at value-based care and interoperability. John also raises an important tension: small innovators are doing exciting things with AI, but scaling those solutions across full workflows remains the real test. The hosts debate whether new payment models, potentially powered by AI-driven insights, could finally make value-based care viable.

Policy and regulation also take center stage as Christopher Chen, MD, MBA, Chief Medical Officer at the Washington State Health Care Authority, shares how state and federal efforts are aligning to accelerate interoperability, reduce provider burden, and modernize prior authorization processes under CMS-0057. The hosts reflect on the importance of federal leadership to align incentives across payers, providers, and technology vendors, echoing lessons learned from the early days of ePrescribing.

Other memorable interview moments include John Beardsley’s commentary on the CMS Interoperability and Patient App Pledges and how better understanding how NCPDP and FHIR standards bridge pharmacy and clinical data silos could help move the needle. Brian and Seth build on that theme, envisioning a future where agentic AI and patient-facing apps work together to drive true engagement and accountability for health outcomes.

In the final stretch, the hosts revisit recurring topics such as physician burnout, administrative burden, and structured data chaos, tying them back to the industry’s broader need for smarter implementation and aligned incentives. From Christopher Chen’s relaying an anecdote about seeing structured data turned into unreadable images that are faxed in to Arrive Health’s use of AI to prevent unnecessary transactions, the episode surfaces a consistent theme: technology alone won’t fix healthcare, but when paired with aligned incentives, collaboration, and business transformation, it can finally make measurable progress.

The episode closes with optimism. Tony, Brian, and Seth agree that while the system is strained, it’s also full of momentum, from maturing AI applications to government action and renewed industry alignment. As Tony puts it, “There’s a lot to be hopeful about and a lot of work left to do.”

Listen to the full episode to hear interviews from the HLTH25 floor, including thought leaders discussing interoperability, agentic AI, and the real-world changes needed to make healthcare innovation stick.
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In this episode of The Dish on Health IT, POCP CEO and host Tony Schueth sat down with Dr. Julia Skapik (SVP & CMO at PurpleLab, practicing physician, member of the HL7 Da Vinci Clinical Advisory Council, and outgoing HL7 International board chair) and Dr. Steven Waldron (Chief Medical Informatics Officer at the American Academy of Family Physicians and Co-Chair of the Da Vinci Clinical Advisory Council). Together, they explored how clinicians are shaping interoperability and standards development through the HL7 Da Vinci Project’s Clinical Advisory Council (CAC).

Tony opened by framing the discussion: interoperability looks different at the point of care, and the provider voice is critical in making standards practical. Julia and Steve introduced themselves by highlighting both their clinical work and their roles within Da Vinci. Julia described her experience with clinical data exchange and Data Exchange for Quality Measures (DEQM) work, and Steve explained how his decades in clinical informatics led him to co-chair the CAC.

Why HL7 Da Vinci Project Exists

Steve provided a primer on HL7 and the role of implementation guides in constraining optionality, so standards work in the real world. He emphasized Da Vinci’s collaborative model—bringing payers, providers, and vendors together. Julia added that Da Vinci’s strength lies in defining practical, feasible solutions the government can later adopt into regulation. She noted this industry-led, government-leveraged approach is why Da Vinci solutions have gained traction.

The Da Vinci Project CAC’s Role

Julia explained the CAC gives clinicians a venue to contribute without the unrealistic expectation of weekly hours of standards work. The council distills provider feedback and ensures workflows make sense in practice. Steve underscored its strategic role: CAC members participate in Da Vinci’s steering committee (though without voting power) and help produce content that reflects clinician priorities.

Clinical Challenges and Opportunities

When asked about top challenges, Steve focused on accelerating adoption. Clinicians are tired of multiple payer portals; they need solutions that simplify, not add layers. He noted Da Vinci studies early adopters to identify what’s working and how to spread best practices. Julia brought in her day-to-day frustration: being blindsided when payers second-guess treatment plans after the fact. For her, seamless data flow at the point of care would let providers close loops quickly and reduce burden.

Progress to Date

Julia highlighted how Da Vinci has reduced tensions between payers and providers by creating space for collaborative problem-solving. She pointed to patient access and real-time eligibility/coverage checks as areas where providers feel real relief. Steve added that having clinicians consistently “at the table”—via CAC, open invitations, and health system involvement—is a big step forward, even if imperfect.

Workflow Alignment and Usability

The conversation then turned to the CAC’s recent report on usability and workflow. Julia stressed that standards must fit into diverse care settings. Training, audit data, and clarity about why data matters are crucial—otherwise, boxes won’t get clicked, and data quality suffers. She provided examples, such as prior authorization questions, that should be resolved automatically to avoid burdening providers. Steve expanded on the strategic approach: learning from innovators, cataloging obstacles (like ROI calculation), and identifying opportunities (education, ROI tools, developer engagement). He illustrated how real-time prior auth workflows must account for triaging between clinicians and back-office staff, not just “dump” everything on providers.

Prior Authorization Pain Points

Both guests dug deep into prior authorization. Julia cited a successful MultiCare Regents pilot and her own frustrations with stuck ePA requests and payer variability. She described patients enduring multiple unnecessary visits due to PA roadblocks. Steve echoed this, recalling clinicians’ frustration with nonsensical requirements (e.g., annual PA for diabetes test strips). He argued that half-measures—like real-time denials without alternatives—aren’t enough; systems need to provide actionable options to avoid delays in care.

Policy and Regulation

The panel then addressed broader policy topics. On CMS’s recent digital ecosystem pledge, Steve was skeptical: pledges are good, but clinicians want action and alignment across TEFCA, QHINs, and standards. Julia compared pledges to past attestations—checking boxes without measuring outcomes. Both agreed that alignment of business cases with regulatory requirements (as in CMS-0057) is key to sustainable progress.

When asked about price transparency and quality measures, Julia shared insights from her PurpleLab work on claims analytics, arguing that integrated data can drive smarter decisions for providers, payers, and patients. Steve stressed the importance of transparency to spur competition among clinicians and the promise of moving beyond claims data toward richer clinical data exchange via Da Vinci’s CDex and PDex work. Julia added a practical note: today, provider office care coordinators and payer care coordinators rarely communicate. Standards that connect those two sides could be transformative.

Final Thoughts

Steve’s call to action: clinicians should engage where they can—whether by advocating within their organizations or learning through Da Vinci’s education tracks. Julia encouraged listeners to press their vendors and payers: “What are you doing with Da Vinci? Will you support these solutions on my behalf?” She emphasized that early involvement is both strategic and practical as regulations like CMS-0057 loom.

Tony closed by thanking Julia and Steve for bringing the clinical voice to life and reminded listeners that interoperability is a dish best served hot.

Related Materials

• HL7 Da Vinci Confluence Page
• Accelerating DV Adoption by Providers – CAC Insights Report
• CAC Statement on Prior Authorization Burden Reduction Ballot
• HL7 Da Vinci LinkedIn Page
• HL7 Da Vinci Project: MultiCare & Regence Case Study on Early Implementation & Real-World ROI
• Catching FHIR: Lessons Learned from Achieving the First Prior Authorization Automation via HL7® FHIR®

In this episode of The Dish on Health IT, Tony Schueth and Rob Dribbon are joined by Neikisha Charles Director of Quality Improvement and Risk Management of Bedford Stuyvesant Family Health Center (Bed-Stuy), a federally qualified health center (FQHC) in Brooklyn, NY. Together, they dig into common misconceptions about FQHCs and shine a spotlight on the opportunities they present for strategic engagement across the healthcare ecosystem—especially for health IT and life sciences organizations.

Neikisha opens with her personal journey: starting as a data analyst at Bed-Stuy in 2021 and quickly rising into her current leadership role because of her knack for using data to drive quality improvement. Her story illustrates the increasing sophistication of FQHCs and sets the tone for a broader conversation about how these organizations are evolving.

To help orient listeners who may not fully understand the role of FQHCs, Neikisha provides a clear definition: FQHCs are federally funded community-based providers mandated to offer care to all residents in underserved areas, regardless of insurance status. They are deeply attuned to social determinants of health and committed to removing access barriers for vulnerable populations.

Rob adds context from his years in pharma, highlighting the unique value proposition of FQHCs—namely, their holistic and integrated approach to care. He urges listeners not to overlook these organizations simply because they’ve historically focused on commercial health systems.

Neikisha then debunks a major myth: that FQHCs only serve uninsured or homeless patients. In fact, Bed-Stuy primarily serves Medicaid-managed populations, but also sees commercially insured and uninsured individuals, offering services on a sliding scale. Services range from primary care and mental health to dental, podiatry, and optometry, along with extensive care coordination and social support services.

When asked what health IT vendors and life sciences companies may be missing, Neikisha makes it clear: FQHCs are not tech or data-poor. Bed-Stuy uses a robust EHR (eClinicalWorks), the Azara DRVS population health platform, and Artera for two-way patient communication. These tools aren’t just window dressing—they are integrated into care delivery to close gaps, improve compliance, and monitor population health in real time.

She offers a compelling case study: When colorectal cancer screening rates began to drop, Neikisha led a data-driven campaign using Azara to identify noncompliant patients, Artera to send targeted outreach texts, and a partnership with Exact Sciences to offer Cologuard kits to patients by mail. The result? A 12.3% increase in screening compliance over 18 months.

Rob underscores the significance of this approach—not just the smart use of technology, but also the community-level relationships and the trust that make this kind of intervention effective.

The discussion then shifts to interoperability. Neikisha notes the complexities of data exchange and the importance of dedicated roles like a Director of Health Integration to manage relationships and reporting. Bed-Stuy is connected to a regional health information organization (RHIO), uses platforms like Azara to track transitions of care, and maintains read-only EMR access with key partners to streamline care coordination. While true vendor-agnostic interoperability remains elusive, FQHCs are actively working with what’s available.

Tony brings the conversation back to the bigger picture: What gaps do vendors and life sciences partners need to close? Neikisha points to the need for better education about what FQHCs actually do and who they serve. She challenges companies to co-create solutions with FQHCs—offering tools that reflect real-world workflows and support sustainable partnerships rather than transactional engagements.

The episode wraps with both Rob and Neikisha emphasizing the untapped potential of FQHCs. With over 30 million Americans relying on them for care, these organizations are not fringe players—they are essential infrastructure. And as Neikisha puts it, they’re “here to stay.” To partner successfully, the first step is simple: reach out, learn what’s needed, and build something meaningful together.

Related Content

• What Are FQHCs, & Should Life Sciences Manufacturers Even Care About Them?
• HIT Perspectives May 2025: FQHC Myth vs Fact 
• Bedford Stuyvesant Family Health Center Brooklyn NY - Primary Care Services 

In this episode of The Dish on Health IT, host Tony Schueth sits down with two of the industry's sharpest minds leading the charge to fix one of health IT’s most persistent headaches: digital consent management. Janice Reese, Senior Consultant at Point-of-Care Partners and Program Manager for the FHIR at Scale Taskforce (FAST), and Mohammad Jafari, Co-Lead of FAST’s Consent Work, offer an unflinching look at why consent is still so messy—and what it’ll take to make it scalable, interoperable, and actually work for patients.

The conversation kicks off with a reality check. While the question “Who can access what data and when?” might sound simple, it quickly falls apart in practice. Consent today is often paper-based, fragmented, non-interoperable, and rarely computable. Mohammad explains how even digitized forms—often scanned PDFs—are barely better than paper when it comes to machine-readability and cross-system portability. The burden lands on both sides: patients are stuck filling out redundant forms at every touchpoint, and providers face access barriers that can delay or limit care.

But the episode isn’t just a critique, it’s a roadmap forward. Janice and Mohammad walk listeners through how FAST is approaching consent differently. Rather than focusing on the content of specific consents (like for research or behavioral health), the team is building a foundational infrastructure: a FHIR-based implementation guide that supports core consent operations, like requesting and revoking consent, delegating authority, and syncing consent decisions with digital identity and security frameworks. In other words, FAST is working on the plumbing that everyone else can build on.

What sets this work apart is its real-world grounding. The team has prioritized broad stakeholder input through public calls and is actively incorporating lessons from pilot participants. Janice highlights that many organizations don’t even know where to start—some have APIs, patient portals, or identity systems in place, but lack a cohesive strategy for managing consent. That’s where FAST can help, not just with standards but with education and architectural guidance.

The discussion also tackles the elephant in the room: policy fragmentation. With states having vastly different rules—sometimes even conflicting ones within the same region—scaling consent can feel impossible. But rather than trying to standardize policy, FAST is focused on standardizing structure. That means creating frameworks flexible enough to accommodate policy differences without hardcoding for each new rule change. Mohammad notes this kind of flexibility is key to making systems resilient and future-proof.

Both guests agree that the time to act is now. Technology has matured, regulators are engaged, and public expectations for privacy and control over personal data are higher than ever. As Janice puts it, the stars are aligning. With CMS showing growing interest in digital identity and consent, and with FAST’s security IG set to be required for FHIR under TEFCA in 2026, organizations can’t afford to sit this one out.

Whether you’re a health plan, HIE, health tech vendor, or public health department, this episode makes one thing clear: scalable, patient-centered consent management isn’t just possible—it’s already underway. And FAST is laying the groundwork.

To get involved, attend a public call (2nd & 4th Fridays at 1:00 Central/2:00 Eastern), reach out to Janice directly at [email protected], or contact the team at [email protected]. Now’s the time to shape the future of consent—before it shapes you.

In this episode of The Dish on Health IT, host Tony Schueth and payer interoperability expert Kendra Obrist sit down with Rob Alger, SVP of Health Plan Technology at Kaiser Permanente, for a candid and sweeping conversation about payer interoperability, AI, FHIR, and the realities of health IT innovation at scale.

Rob kicks things off by discussing Kaiser Permanente’s unique care and coverage model, highlighting how it streamlines internal coordination and shapes investment priorities. He notes that, unlike many other health plans, Kaiser’s vertically integrated structure allows for fewer administrative hurdles, particularly in areas like prior authorization.

The conversation then turns to CMS-0057. While Rob acknowledges Kaiser must comply like everyone else, the regulation presents less of a lift for them due to their internal alignment. That said, both he and Kendra agree: the success of any interoperability initiative hinges on provider adoption, and that remains uncertain.

Looking ahead to 2025, Rob shares Kaiser’s strategic focus on simplifying healthcare experiences, especially by leveraging AI to remove friction from both clinical and administrative processes. One standout example is their ambient listening tool from Abridge, now rolled out across 40 hospitals and 600 medical offices, which is allowing clinicians to focus more on patients than keyboards. It’s one of the fastest clinical tech adoptions Rob’s ever seen.

Naturally, the discussion shifts to FHIR. Rob puts it plainly: “FHIR is non-negotiable.” Regulatory mandates have solidified its role, but he wonders whether the industry will eventually want to use FHIR or continue reacting to policy. Kendra and Tony weigh in, noting signs of growing pull once organizations recognize the potential. They agree that multi-stakeholder efforts like Da Vinci Project and FHIR at Scale Taskforce (FAST) are helping to build real-world traction by solving for shared use cases.

When asked why Kaiser stays engaged in these initiatives, Rob makes it clear it's about shaping standards early, staying ahead of the curve, and making smarter, future-proof decisions, especially when it comes to vendor selection.

The episode then revisits AI, with Rob outlining Kaiser’s guiding principles: human in the loop, bias mitigation, and responsible governance. He explains that while Kaiser isn’t trying to build every tool themselves, they aim to be excellent adopters, using AI to free up clinicians and call center reps to operate at the top of their license. It's less about chatbots and more about smarter workflows, ambient data capture, and preserving session context across modalities.

Data quality surfaces as a recurring theme. Kendra highlights increasing payer interest in tackling inconsistency and fragmentation. Rob acknowledges Kaiser has an edge due to its standardized EHR system, but insists no one is immune to the challenges, especially when AI is in the mix. As he puts it, “If your data’s not clean, you’re not going anywhere.”

As a member of the Council for Affordable Quality Healthcare (CAQH) board, Rob brings a unique perspective on industry-wide infrastructure and collaboration. He explains that CAQH, originally formed by major health plans to tackle non-competitive operational challenges, has evolved into a key player in both standards development and practical solutions like coordination of benefits and provider directories. That dual focus—advocacy and action—resonates throughout the conversation, especially as Rob underscores the importance of shared investments in foundational infrastructure that lift the entire industry.

The discussion then touches more specifically on directories and the potential of shared infrastructure for non-competitive areas of healthcare. Rob emphasizes that while payers care deeply about directory accuracy, the solution likely involves more human accountability than tech alone.

In closing, the trio shares their perspectives on under-discussed industry challenges. Rob flags cybersecurity as a growing threat, especially in light of recent ransomware attacks. Kendra and Tony shine a light on consent and pharmacy interoperability, two areas that, while not headline-grabbing, could unlock major gains in care coordination and equity.

Rob’s parting call to action? It’s time for the industry to align on clinical policy. Competing on utilization rules isn’t sustainable, and getting consensus on what’s appropriate care could help streamline prior auth and improve patient trust.

Kendra wraps by urging payers to suspend disbelief and start planning for a world where APIs and data exchange work as intended. Dream a little, and then build accordingly.

In this special HIMSS25 recap episode of The Dish on Health IT, host Tony Schueth, CEO of Point-of-Care Partners (POCP), is joined by co-hosts Brian Bamberger, POCP’s Life Sciences Lead, and Vanessa Candelora, Senior Consultant and Program Manager of the HL7 Gravity Project. Together, they break down the biggest themes from the conference, covering interoperability, artificial intelligence (AI), FHIR adoption, and the growing focus on improving data quality in healthcare innovation.

HIMSS25 once again proved to be a crucial gathering of healthcare leaders, vendors, and policymakers, drawing nearly 28,000 attendees. Vanessa notes the continued focus on interoperability and trust, with a clear divide between experienced stakeholders refining their strategies and newcomers trying to grasp the fundamentals of FHIR. Brian, a HIMSS veteran, points out that first-time attendees often struggle with the complexity of both the conference itself and the discussions around health IT’s latest advancements, particularly AI and its real-world applications.

To add perspectives from the conference floor, Tony introduces a series of interviews with HIMSS25 attendees and industry leaders, including Anna Taylor, Associate Vice President, Population Health and Value-Based Care of MultiCare, Erin Weber, Chief Policy & Research Officer, CAQH, Mariann Yeager, CEO, The Sequoia Project, Matthew Holt, Founder/Writer of The Health Care Blog, and Lynne Nowak, Chief Data and Analytics Officer. Each interview provides insights into the real-world implementation of interoperability and FHIR, the evolving use of AI, and how data privacy and governance are shaping health IT strategy.

FHIR adoption was one of the topics covered in the interviews. Some, like Mariann Yeager and Erin Weber, expressed optimism about FHIR’s expanding role in clinical data exchange, while others, such as Anna Taylor, highlighted persistent scalability challenges and limited adoption for administrative functions like prior authorization. Matthew Holt offered a broader view on data exchange, arguing that while data mobility has improved, the real challenge is how organizations actually use and integrate that information. Vanessa underscores that while FHIR is gaining traction globally, large-scale implementation remains a work in progress. The panel agrees that translating theoretical frameworks into real-world adoption is the next crucial step.

AI was another dominant topic, with a mix of enthusiasm and skepticism surrounding its potential. The HIMSS interviewees discuss AI’s growing role in streamlining administrative workflows, summarizing patient records, and enabling ambient listening for clinical documentation. However, as Brian bluntly puts it, the “magic” of AI is still far from reality—many tools promise seamless EHR integration but lack the ability to write back into clinical systems, requiring manual intervention. Lynne Nowak and others emphasized that AI’s effectiveness is directly tied to data quality—bad inputs will only lead to bad outputs. The consensus? AI has real potential to enhance workflows but cannot replace clinicians, and health IT leaders must focus on governance, usability, and ensuring AI supports, rather than replaces, human decision-making.

As the conversation wraps up, Vanessa highlights the critical role of policy and strategic innovation in shaping the next wave of health IT progress. With new regulatory shifts and uncertainty around TEFCA, organizations must stay agile while ensuring that patient privacy, data integrity, and consent management remain top priorities. Brian brings the discussion back to life sciences, stressing the importance of leveraging patient insights and real-world data to drive treatment adherence and improve outcomes.

HIMSS25 reinforced that while FHIR, AI, and interoperability remain hot topics, the industry is now at a critical inflection point—shifting from theory to execution. Organizations must filter out hype, focus on data quality, and build scalable solutions that improve both clinical and administrative functions.

For those who couldn’t attend HIMSS25 or want a deeper dive into what’s next for health IT, this episode provides a comprehensive breakdown of the major takeaways. Subscribe to The Dish on Health IT on Apple Podcasts, Spotify, or your preferred platform. The podcast is also available on HealthcareNOW Radio. Full video versions are also available on POCP’s YouTube channel. As always, health IT is a dish best served hot.

In this episode of The Dish on Health IT, host Tony Schueth leads an engaging discussion on pharmacy interoperability, a topic at the center of a recently published POCP white paper funded by the NCPDP Foundation and supported by Surescripts. Joining Tony as guests are, John Hill, Executive Director of the NCPDP Foundation, and Larry King, Director of Intelligent Prescribing at Surescripts, to unpack the white paper’s findings and explore the future of pharmacy’s role in patient care.

The conversation begins with Tony laying the foundation for the discussion by defining pharmacy interoperability as the seamless, bi-directional exchange of health information between pharmacy care settings and the broader healthcare ecosystem. This connectivity ensures that data flows effortlessly without adding complexity to the workflows of pharmacists or other providers. Tony highlights the POCP white paper, which outlines critical opportunities and challenges in achieving this vision. The document calls for leveraging standards and technology to integrate pharmacists as key contributors to care teams, addressing  medication management and broader clinical services.

John Hill and Larry King bring their unique perspectives to the conversation. John shares insights into how the NCPDP Foundation is focused on grants that expand the pharmacist's role, improve patient safety, and enhance access to care. He emphasizes that the white paper marks a pivotal step toward identifying gaps in interoperability and opportunities to engage pharmacists more fully in patient care. Larry draws from his experiences as a pharmacist and industry leader, highlighting the complexity of patient needs and the roadblocks that prevent pharmacists from working to the highest and best purpose of their license. Both guests underscore the need for workflow-friendly solutions to reduce administrative burdens and allow pharmacists to spend more time on meaningful, patient-centered work.

The discussion delves into the growing role of pharmacists, who are increasingly stepping beyond dispensing medications to provide direct patient care services, including immunizations, chronic disease management, and comprehensive medication reviews. Tony and his guests agree that pharmacies are uniquely positioned to fill gaps in care, especially in underserved areas, and to offload basic services from overburdened primary care practices. However, for pharmacies to step into this larger role, significant progress is needed in interoperability, reimbursement models, and technology adoption.

A key focus of the conversation is the critical role of standards in enabling interoperability. John elaborates on how NCPDP works to ensure data can be exchanged seamlessly, highlighting their collaboration with HL7 on standards like the eCare Plan. He explains that standards not only ensure data consistency across systems but also reduce the burden on users by integrating into existing workflows. Larry adds that Surescripts’ efforts to implement interoperable solutions, such as Qualified Health Information Networks (QHINs) under TEFCA, demonstrate the potential of standards to create a nationwide framework for secure data exchange.

The guests also discussed the importance of using sustainable financial models to incentivize investment in interoperability. Larry points out that while there are some reimbursement programs for clinical services, inconsistencies remain a significant barrier. Both guests stress that the industry must develop scalable payment models that align with pharmacists’ expanded roles and address the technology investments required to connect pharmacy systems with the broader care continuum.

Emerging technologies like AI are also prominently featured in the discussion. Larry shares how Surescripts is leveraging AI for tasks like parsing patient instructions and monitoring network activity for compliance issues. John highlights NCPDP’s efforts to explore how AI can support standards adoption and governance. Both agree that while AI offers enormous potential to optimize pharmacy workflows and enhance clinical insights, it must be implemented cautiously, with safety and security as top priorities.

As the episode nears its conclusion, the guests reflect on the ideal future state of pharmacy interoperability. Larry envisions a world where patients experience seamless care, with providers and pharmacists having immediate access to comprehensive, accurate health information. This would eliminate redundant data collection, reduce errors, and enable faster, more informed decision-making. John echoes this vision, emphasizing that interoperability can empower pharmacists to operate at the top of their licenses, improving patient outcomes and addressing provider shortages.

Tony closes the discussion by encouraging listeners to take actionable steps, such as engaging with workgroups like NCPDP’s Work Group 20, reviewing the POCP white paper, and participating in industry initiatives that drive interoperability forward. John and Larry emphasize the urgency of acting now, describing this as a once-in-a-generation opportunity to create lasting change in healthcare delivery.

For more insights and resources, including links to the white paper and details on key industry initiatives, check the episode summary. Subscribe to The Dish on Health IT on Apple Podcasts, Spotify, or Healthcare Now Radio to stay informed. Let’s continue the journey toward a more connected and efficient healthcare system—because health IT is a dish best served hot!

Reference Links: 

POCP Pharmacy Interoperability Whitepaper: https://info.pocp.com/pharmacy-interoperability-whitepaper 

NCPDP Foundation abridged results report: https://ncpdpfoundation.org/pdf/PharmacyInteroperability_AbridgedResults.pdf  

NCPDP Foundation website (for grant proposals in connection with the CTA of future opportunities for grants): https://ncpdpfoundation.org/home.aspx  

NCPDP Standards website (for encouraging involvement/collaboration in WGs in connection with the CTA of getting involved/supporting the mission): https://standards.ncpdp.org/  

Surescripts Blog, "Ready for Action: Advancing Pharmacy Interoperability": Preparing Pharmacy with Technology to Participate in Healthcare Interoperability | Surescripts