LAS VEGAS—The Department of Health and Human Services (HHS) is ramping up major federal interoperability initiatives on several fronts.
As part of this interoperability work, the Trump administration unveiled in July a sweeping health tech initiative that aims to modernize Medicare and advance next-generation digital health for patients, including conversational artificial intelligence, digital IDs and easier ways to access health data.
The Centers for Medicare & Medicaid Services (CMS) is spearheading an API-focused data exchange framework to enable sharing of patient medical records through a new initiative called the CMS Aligned Network. This work is meant to accelerate data sharing at a faster pace than can be achieved through regulations alone, according to Amy Gleason, acting administrator, U.S. DOGE Service, and strategic advisor to the CMS.
"We tried to listen and say, 'Why isn't interoperability working? We have all these great rules, regulations, TEFCA [Trusted Exchange Framework and Common Agreement], but in the real world, there's just a lot of cases where it just doesn't work in the way we want. I have a daughter with a rare disease, so I live this every single day, and so I'm very passionate about this area," Gleason told an audience of provider, payer and health tech executives at the 2026 Healthcare Information and Management Systems Society (HIMSS) Global Health Conference & Exhibition. "We really just decided to lay out a vision and ask people to come along and just make things work with us in a short period; we did six-month and 12-month goals."
Since July, more than 700 healthcare organizations have joined the Health Tech Ecosystem pledge, which is completely voluntary, Gleason said. The goal is to have tangible results from these pledges go live by March 31.
The CMS also set another deadline, July 4, for organizations to demonstrate more advanced functionalities and workflows, she noted.
"We have about 12 work groups and a Slack channel with government and private sector to collaborate. It's kind of like a giant hackathon, and we're working together to make it work," she said.
The CMS Aligned Network is not meant to compete with TEFCA, Gleason said, referencing the government-backed health data sharing initiative that allows patients, providers and payers to share health records.
In a blog post in December, Steven Posnack, principal deputy national coordinator for health IT, described TEFCA as "a rising tide that lifts all boats," while networks that have pledged to be a CMS Aligned Network "are more like speedboats shooting out ahead to achieve specific milestones."
To spur the use of digital health tools, the CMS recently unveiled a Medicare App Library as a centralized directory so Medicare beneficiaries can access vetted digital health tools that are integrated with CMS Aligned Networks. Participating apps must sign the interoperability pledge and complete certain steps to participate, including partnering with ID.me or CLEAR to implement identity verification services. Companies also must complete an evaluation by the Digital Medicine Society or the CARIN Alliance before undergoing a CMS review.
The CMS also is participating in the Health Tech Ecosystem pledge and is committed to rolling out new innovations to support interoperability.
"CMS is eating their own dog food," Gleason quipped.
The agency added enhanced login options on Medicare.gov based on modern identity credentials—CLEAR, ID.me and Login.gov—to enable beneficiaries to log in using a digital identity credential and engage with their own health information on the site.
"Medicare patients can come in and use CLEAR, ID.me and Login.gov to authenticate using just their biometrics, just like they can in other parts of their life," Gleason said. "Already, just in the first five or six days, 25% of the people just automatically picked one of those new modern credentials. Sixty percent of new accounts that have been created have all been using one of these modern credentials, and 90% of those people that created a new account already had been identity-verified," she said.
Thomas Keane, M.D., assistant secretary for technology policy and national coordinator for health IT, said his office, the Assistant Secretary for Technology Policy (ASTP), and the CMS collaborate on interoperability efforts but take different approaches.
"All the innovations that Amy [Gleason] is able to come up with in her initiative, we can actually adopt in regulations. Subsequently, you know, the regulatory cycle is about 18 months to actually develop, release, process comments and then finalize a rule followed by, typically, a two-year implementation timeline. It is slow. What Amy is able to produce in under a year is pretty impressive," Keane said during the health policy panel at HIMSS.
"All of those innovations are things that we can adopt. I think the brilliance of what CMS is doing under her leadership is herding the cats. I think Amy's executing against [CMS Administrator] Dr. Oz's vision of using collaboration and convening as a means of advancing our goals," he said.
On the regulatory side, the HHS finalized a rule, HTI-4, last fall that advances electronic prior authorization and real-time prescription benefit checks. It also released in December a proposed rule, HTI-5, to update its health IT certification program requirements and amend the information blocking regulations the HHS' health IT arm issued under the 21st Century Cures Act. Under that proposal, the HHS plans to eliminate 34 out of 60 certification requirements for electronic health records and revise seven certification requirements.
Its rationale, the proposed rule states, is that the majority of the existing requirements are a hindrance to health IT developers, preventing them from innovating and erecting regulatory barriers to new entrants in the certified health IT market.
One of the goals of axing certification requirements is to promote the use of AI through FHIR APIs. The office said it aims to “establish a new foundation” for FHIR API requirements to “support creative AI-enabled interoperability solutions.”
"It is our hope that between this rulemaking and subsequent rulemaking in 2026 that we're able to actually drive interoperability," Keane said during the HIMSS panel.
The ASTP/ONC also is stepping up enforcement of information blocking. The HHS announced in September that has put more resources behind investigating and enforcing information blocking rules.
The ASTP/ONC has sent notices to developers of certified health IT about potential nonconformity under the ONC Health IT Certification Program, Keane confirmed.
"Those have gone out, and we're continuing to issue them," he said.
Those notices request information and explanations about nonconformity issues. Should information blocking be confirmed, health IT developers could face penalties of up to $1 million per violation, while providers could be prevented from receiving Medicare payments.
"The way that process works is folks then respond to us and tell us if they think they are non-conformant, then we come up with a correction corrective action plan. If we feel that they are non-conformant, and if they don't meet the strictures of the corrective action plan, we can pull their certification, and their customers lose the ability to access CMS payment incentives," he said.
Since the HHS launched its information blocking complaint portal, more than 1,500 complaints have been filed alleging information blocking, he noted.
Keane added, "Separately, the Office of Inspector General has the ability to level civil monetary penalties up to $1 million per instance for each instance of information blocking. What's great about the law is it doesn't say exactly what an instance constitutes. So in theory, the penalties could be quite large. The Office of Inspector General has to approach its cases very carefully, has to establish case law, has to make sure that if it goes to litigation, that they can win. They are actively looking at the cases that we have sent over to them."