2025 Year in Review: HIEs, FHIR Accelerators Make Steady Progress on Data-Sharing Frameworks

At the federal level, 2025 began quietly on the policy front in terms of interoperability and data standards work. As the new administration came into office, there was a lull at the beginning of the year when initially no one was appointed to lead the Assistant Secretary for Technology Policy/Office of the National Coordinator for Health IT (ASTP/ONC). Thomas Keane, M.D., M.B.A., was appointed to the position in June.

Additionally, the ONC Health Information Technology Advisory Committee (HITAC) did not hold a meeting all year. 

Meanwhile, industry stakeholders spent several months reading the tea leaves trying to discern whether the new administration would support the Trusted Exchange Framework and Common Agreement (TEFCA) going forward. Midway through the year the ASTP/ONC did signal support for TEFCA by saying it is committed to scaling treatment exchange and individual access services via TEFCA, and will work on expanding participation and live use of the network for the other exchange purposes: payment, healthcare operations, government benefits determination, and public health. 

In July, CMS unveiled voluntary criteria for trusted, patient-centered, and practical data exchange that will be accessible for all network types—health information networks and exchanges, EHRs and tech platforms. According to CMS, more than 60 companies pledged to work collaboratively to deliver results in the first quarter of 2026. Twenty-one networks pledged to meet the CMS Interoperability Framework criteria to become CMS-Aligned Networks.

While this was going on in Washington, D.C., Healthcare Innovation continued to track data-sharing progress taking place through the HL7 FHIR accelerators such as Da Vinci and the Gravity Project, as well as at state and regional health information exchanges as they seek to position themselves as health data utilities supporting increasingly sophisticated use cases. 

Incremental progress is being made in New York State to unify the state’s health information networks, and we interviewed several key execs in the Empire State. In July we reported that HealtheConnections (HeC), a Syracuse, N.Y.-based HIE, was awarded a contract to provide statewide encounter alerts on behalf of the Statewide Health Information Network for New York (SHIN-NY) and is partnering with vendor PointClickCare to provide the service. The statewide encounter alert system aims to improve care coordination by providing real-time hospital visit notifications across regions.

HealtheConnections President and CEO Elizabeth Amato also said that HeC is “moving to a completely cloud-native FHIR-based HIE platform that's really going to open up a lot of doors for our participants to get some meaningful insights out of their own data, as well as the community data that we have access to.”

In another development this year, the New York eHealth Collaborative (NYeC) made an application developed by Hixny, one of the state’s six health information networks, available to all providers in New York. Hixny CEO Mark McKinney described to Healthcare Innovation the data access and workflow integration provided by the SMART-on-FHIR app called Snapshot NY.

McKinney said  that since 2020, its patient record Snapshot application has delivered insights and data points to connected healthcare providers in an easy-to-navigate format, surfacing actionable information within existing EHR workflows. In the past year, Hixny has introduced new capabilities, including direct access to the state’s prescription drug monitoring program query tool and a health-related social needs (HRSN) screening tool that meets all the requirements of the state’s 1115 Medicaid waiver amendment.

Progress in California

Meanwhile, on the other side of the country, progress continued in California on the state’s own data-sharing ecosystem. This fall, Gov. Gavin Newsom signed a bill into law that builds an accountability framework around the state’s ambitious Data Exchange Framework (DxF).

California is establishing the DxF to improve how health information is shared across the health and social services systems. Among the goals are protecting public health, improving care delivery, and guiding policies aimed at caring for the whole person, while maintaining patient privacy, data security, and promoting equity.

The framework includes a single data-sharing agreement and a common set of policies and procedures that required the exchange of health information among large healthcare entities and government agencies by Jan. 31, 2024. (Smaller provider organizations have until 2026 to comply.)

This year Healthcare Innovation reported that Los Angeles-based L.A. Care Health Plan, the nation’s largest publicly operated health plan, began using FHIR to connect with the Los Angeles Network for Enhanced Services (LANES), its Qualified Health Information Organization (QHIO) under the DxF. Another payer, Elevance Health, began using FHIR-based exchange to connect with Manifest MedEx (its QHIO), including sharing claims in FHIR format for the DxF,  in December 2024.

eHealth Exchange Building on Utah Pilot

CMS has issued new prior authorization interoperability rules, as well as requirements for payers to exchange data electronically using modern application programming interfaces (APIs) starting in 2027. To meet these goals, the nonprofit eHealth Exchange is at the center of an ambitious digital health pilot project in Utah to implement a statewide FHIR-based ecosystem. In August, its president and executive director, Jay Nakashima, spoke with Healthcare Innovation about how the Utah project can serve as a model for other states. 

Nakashima said the Utah work is forming a model for state-based connectivity in 12 other states, with Washington state being No. 2.  He added that “one of the big takeaways is that the payers and providers have learned that they really need this hub-and-spoke model. For instance, a health system like Intermountain Health’s first inclination might be to say we know who we exchange with. We're going to spend nine to 10 months negotiating a trust contract with them and then spend nine months negotiating how we're going to do this technically, and how we're going to interpret HL7 Da Vinci. They learned quickly that that's going to get them nowhere fast. So they've connected to our hub-and-spoke model, and it really accelerated that process. Intermountain already has the technical connection. They've already got the trust contract. All they have to do is electronically trust or consume an eHealth Exchange SMART-on-FHIR app that they can load that into their EHR —just like you trust loading a new app on your phone, right?”

In November, we wrote about how Providence and Humana are working together to improve interoperability using HL7 FHIR standards and Da Vinci Implementation Guides, moving beyond minimal compliance to industry-wide solutions. Their project aims to replace manual, fragmented data processes with automated, standards-based data exchange, increasing accuracy and efficiency in payer-provider interactions.

HIE in support of value-based care

In April we reported that the North Carolina Health Information Exchange Authority (NC HIEA) had unveiled a strategic document outlining how it plans to broaden exchange capabilities and support value-based care. One goal is to leverage the NC HealthConnex health information exchange infrastructure more broadly to support social services and community-based organizations.

NC HIEA also said it would work to establish, together with partners, a formalized state Health Data Utility model and provide requested statewide health data services. It will develop service-specific cost recovery models for state agencies, health plans and other users who do not submit data, but for whom receipt of clinical data for approved uses cases is of high value.

Another goal is to implement a quality measurement and reporting service to support providers and health plans.

New FHIR accelerators coming

Data-sharing standards progress continued in 2025 thought the work of HL7’s FHIR accelerator program. Accelerators include the Argonaut Project, Carin Alliance, Codex, Da Vinci, the Gravity Project, Helios and Vulcan. 

During an October webinar, Diego Kaminker, HL7’s deputy chief standards implementation officer, said that HL7 is working on another FHIR accelerator called Gizmo that involves medical device interoperability. “We will focus on creating exchange for any device. It is a broad definition. It could be something in the hospital, something in the lab — any device will be covered by this accelerator,” he said. “We also are starting to think about a new accelerator on quality measures for next year.”

Kaminker also brought up the vision of the CMS interoperability pledge to accelerate open standard-based data exchange and create what they call CMS Aligned Networks to put patients and providers first. A core requirement is that all networks must commit to support and implement FHIR APIs, and the compliance deadline is July 4, 2026. “Interesting times if they do all of it,” he said. “It’s a pledge.”