About 10 million records moved through TEFCA in January 2025. Thirteen months later the figure was closer to 500 million. Whatever you think of the pace, the exchange layer works.

The harder part starts now. Most organizations can move data. Far fewer can act on it in the moment that decides the outcome. That gap is what will separate the winners and losers over the next several years of the industry.

Standards alignment is table stakes

SMART on FHIR and FHIRcast belong in the infrastructure plan of any organization serious about the point of care. SMART on FHIR launches an application inside the clinician’s session with the patient already loaded. FHIRcast keeps every open application following that clinician as they move to the next patient. Together they are the difference between a workflow that helps and one that adds another login.

The clinician feels it as a cleaner workflow.  The organization sees it in outcomes and cost of care.

The patient is still the point of all this. That has not changed.

Exchange becomes Intelligence

What has changed is the speed at which AI is reshaping what interoperability can do.

The organizations moving fastest have gone from moving data to acting on it. AI search cuts the time a care team spends hunting through a chart for something the chart already contains. Terminology mapping takes most of the pain out of connecting a new source to a legacy one. NLP pulls usable facts out of clinical narrative, which is where the useful detail has been sitting for thirty years.

These changes are structural. They change how organizations coordinate across care settings and ensure patients are seen in the right venue at the right time.

Governance is the prerequisite. Identity and patient privacy becomes an afterthought

Clean exchange is worth exactly as much as the trust you place in the data underneath it. Most organizations still treat governance as a compliance function. It is closer to a load-bearing wall. Point an AI model at an ungoverned foundation and you get confident answers built on sand.

Identity resolution is the piece that gets starved. Matching a patient correctly across systems has no demo. The failure mode stays invisible until it is expensive.

Then it shows up everywhere at once. Duplicate records that split a medication history in half. Care gaps that never close because the closure landed on the other version of the patient. Claims denied for reasons nobody can reconstruct. Risk scores built on two thirds of a chart. An AI model that answers with total confidence because it never knew the other record existed.

A bad match is also a privacy event. Merge two patients and you have exposed one person’s record to another, which is a breach no consent language covers after the fact. Consent travels with identity as well. A patient’s sharing preferences are only enforceable if you know which patient made them, where the service was rendered and who is asking.

Every downstream capability inherits whatever your match rate got wrong. That is the whole argument. You cannot activate data you cannot correctly attribute to a human being.

Value-based care turned interoperability into a financial capability

Payers and providers both need a longitudinal record they can defend in front of an auditor. Closing gaps and demonstrating outcomes rest on completeness. When the record is thin, the money is wrong.

Policy is pushing the same direction. CMS-0057-F put payers on a FHIR path for prior authorization. The CMS Interoperability Framework turned voluntary pledges into CMS Aligned Networks with published criteria. CMS-0062-P extends the prior authorization work into drugs.

None of this is optional infrastructure anymore, and the compliance dates are close enough that architecture decisions made this year determine whether you meet them.

Bringing it all together

The industry has spent years building the pipes. Now the focus is on what flows through them.

That is precisely why we built CareIntelligence. Designed to make data truly actionable, CareIntelligence delivers high-integrity insights that help healthcare organizations reduce costs, improve care quality and optimize reimbursement. It builds on our robust data aggregation capabilities to drive better cohesion across the industry, regardless of system of record, and turns data into a genuine strategic asset.

CareIntelligence will not fix a broken source system. Nothing will. What it does is make the data coming out of those systems usable regardless of which vendor produced it.

That means resolved identity, governed lineage and mapped terminology underneath every insight, so a care team can trust what it sees and a CFO can defend what gets billed. It builds on our aggregation work and turns a pile of exchanged records into something a strategy can rest on.

Interoperability matters. Everyone agrees on that now. The open question is whether the data moving through your systems can carry the weight of the decisions you are relying on that data for.

For organizations navigating the complexity of 2026 and beyond, the question is no longer whether interoperability matters. It is whether the data flowing through your systems is clean enough, governed enough and connected enough to power the decisions that matter most.

With the right foundation, it can be.