Why HIEs will be essential to CMS' Health Tech Ecosystem

What are the goals of the Health Technology Ecosystem initiative?

Announced at the end of July, CMS secured voluntary commitments from major tech companies, health systems, patient-facing app developers and payers to support the Health Technology Ecosystem initiative. The initiative focuses on two goals: establishing an interoperability framework and increasing the availability of personalized health tools.

According to CMS, the interoperability framework will serve as a "voluntary blueprint" for data exchange across the healthcare industry, including among HIEs, EHRs and tech platforms. It outlines the criteria for data sharing and the various categories of participants.

For example, entities that voluntarily meet the CMS criteria will become "CMS aligned networks." By July 4, 2026, these networks will need to provide or facilitate access to:

• Data using FHIR APIs
• Chart notes and clinical documents as FHIR attachments
• Appointment and encounter notifications using FHIR subscriptions

"This is a movement, not a mandate. It is a call to action, not a regulation," CMS stated on its website.

In August, MiHIN expressed enthusiasm for the initiative, noting the need for a collaborative approach to interoperability.

Pacheco doubled down on this sentiment, stating, "We're encouraged by the national momentum towards patient-centric standards, standards-based interoperability and the CMS initiative. I think it really validates the work we've been doing in Michigan for years, and that's building a secure, trusted infrastructure that empowers patients and providers."

She also emphasized the importance of involving local healthcare providers in interoperability efforts to ensure they have the intended real-world impact.

Exploring HIEs' role in achieving federal interoperability goals

More than 60 entities have pledged their support for the federal initiative, including Amazon, Epic, Cleveland Clinic, Google, CVS Health, K Health and Oura. While these organizations have a national reach, they may lack the local relationships necessary to deliver on the promise of interoperability.

HIEs, such as MiHIN, link diverse healthcare stakeholders, including hospitals, public health agencies, behavioral health providers, Medicaid agencies and more, at the regional level.

"We see our role as the bridge, linking national capabilities with local governance and trust that makes interoperability work," Pacheco noted. "That's why it works today at MiHIN. It is because we have that local presence, and I really think we see our role as a bridge here."

The local context and trust that HIEs have will be essential to the initiative's goals, particularly in developing and adopting shared technical standards, including FHIR APIs, she added.

Not only that, but Pacheco stated that HIEs will play a critical role in ensuring that privacy protections extend to all entities and in preventing the fragmentation of the infrastructure needed for interoperability.

"We have to maintain equitable access for rural and underserved communities because they don't have the resources that are needed to be able to implement things like this," she said. "So, they really do rely on their local partners, which are the local regional HIEs."

"That's the piece that I want to make sure gets put out there: You can't bypass the local infrastructure that's already built and expect to build something on a national scale," she continued.

For instance, interoperability efforts will require access to various databases of health information and patient data, which HIEs can help provide. MiHIN's network includes 148 hospitals, 665 outpatient facilities, 298 skilled nursing facilities and 44 physician organizations across Michigan.

In addition to data access, HIEs can help the national entities involved in the Health Tech Ecosystem navigate complex consent processes across communities.

Achieving interoperability is a collaborative task that requires all stakeholders, regardless of their size, to come together. Pacheco emphasized the symbiotic relationship that is required to support the lofty interoperability goals of the CMS Health Tech Ecosystem initiative.

"National platforms and regional HIEs serve different but complementary roles," she said. "Big tech brings scale, while HIEs bring the trust, the relationships, the local governance that make data actionable in real communities."

Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.