00;00;00;00 - 00;00;18;16 Unknown Have you ever shown up for, a new doctor's appointment? Maybe. And you spend 20 minutes filling out that same tedious form? You know, the one. All the information you've given a dozen other doctors before. Oh, definitely. Or maybe you needed a prescription refill, a critical one, but your specialist couldn't easily get the notes from your primary care doc. 00;00;18;16 - 00;00;42;28 Unknown Exactly. Leading to delays, frustration, maybe even the wrong medication. We've all been there, right? That feeling that your own health info is just scattered, locked away in these silos. Moving at the speed of a fax machine? Basically, yeah. In an age where everything else is instant. It's a huge problem. It really undermines care. We have these incredible medical advances, precision surgery, new therapies. 00;00;43;05 - 00;01;10;17 Unknown But our health data, it just lags way behind. It creates so many barriers for patients, for providers trying to actually deliver care efficiently. It's been this nagging long term challenge. And it seems the centers for Medicare and Medicaid Services CMS has finally said enough. They are apparently done waiting. That's the phrase they're using. So today we're going to do a deep dive into this pretty monumental effort by CMS to actually change all this. 00;01;10;18 - 00;01;31;07 Unknown It's called the Health Tech Ecosystem Initiative. That's right. And it's important to understand this isn't just, you know, another set of rules CMS is rolling out. It's actually a voluntary blueprint. Voluntary. Interesting. Yeah. Think of it more like a call to action for health data networks all across the country. The goal is to really speed up seamless, secure data exchange. 00;01;31;07 - 00;01;53;26 Unknown Okay. And the mission here, it's big. They're talking about creating a paradigm shift in health care. Really trying to tear down those digital walls we mentioned and unlocking innovation. Right. That seems key. Absolutely. Unlocking massive innovation for you as a patient and really for the whole health care industry. It's designed to be market friendly. And when you say monumental effort, you really mean it. 00;01;53;26 - 00;02;21;18 Unknown This isn't just CMS pushing something down. No, quite the opposite. Over 60 organizations have already pledged support. We're talking tech giants. Amazon. Apple. Google, OpenAI. Wow. The big names. Yeah. Alongside major health systems, the big EHR vendors, even drug companies. It's a really broad coalition that is significant. It suggests the industry is actually ready for this. It definitely signals a collective readiness for change, I think. 00;02;21;19 - 00;02;41;26 Unknown Okay, so on this deep dive, we'll explore the vision behind this framework. We'll get into the, the technical side to what actually makes it possible. Right. Nuts and bolts. Then we'll look at the exciting opportunities. This opens up especially for patients and developers, because that innovation piece is key for sure. Lots of potential there. And finally, we need to be realistic. 00;02;41;26 - 00;03;05;19 Unknown We'll look at some of the big challenges that still need to be tackled. Good plan. It's ambitious. So there will be hurdles. All right. Let's unpack this. We heard CMS is done waiting, but what exactly is this interoperability framework and why now? Why is it such a big deal? Okay, so at its heart, it's this voluntary blueprint for, let's say, modern health data exchange. 00;03;05;21 - 00;03;31;03 Unknown The whole design is meant to put patients and providers first right at the center. It's described as open standards based and as I mentioned, market friendly. The idea is really to get the industry past all the talk. The pilot programs and into real world solutions that can scale. So let's theory more action. Exactly. And what's kind of interesting is that it's not about imposing new regulations, new burdens. 00;03;31;05 - 00;03;55;25 Unknown CMS is looking for genuine buy in alignment, quick execution and just building momentum from the industry, leveraging the market itself. Then precisely, it's more collaboration than regulation this time around. You mentioned CMS being done waiting. And that really hits home. I think the frustration with faxes and fragmented records is real. We've heard about interoperability for years, decades really. 00;03;55;27 - 00;04;11;22 Unknown So what makes CMS think this time is different? Is it just this market friendly approach, or is there something else giving them confidence? That's a fair question. I think part of it is the approach, but it's also the sheer number and influence of the organizations that have signed on voluntarily. All right. The Googles and Apples of the world. 00;04;11;29 - 00;04;36;12 Unknown Yeah. When they step up alongside major hospitals and EHR vendors, it feels like a tipping point. And the goal itself, while ambitious, is clear make your health information easily, seamlessly shareable wherever you get care. And that's not just about convenience, is it? No, not at all. It ties directly to better health outcomes. Doctors having the full picture. It's about reducing that awful provider burden. 00;04;36;15 - 00;05;03;07 Unknown Less paperwork, less chasing down records, killing the fax machine. Finally, hopefully and crucially, empowering you, the consumer, with better, more complete information to make decisions about your own care. Imagine your doctor actually seeing everything in real time. So it's more than just sharing data points. It sounds like building what people call a learning health system. Exactly that. The idea is that every time data is exchanged, it should feed back into improving health care overall. 00;05;03;08 - 00;05;26;05 Unknown How so? Well, the data can be used for immediate treatment, obviously, but also for analyzing trends, developing really personalized care plans based on more complete info, and ultimately driving better health for whole populations over time, making the data work smarter, not just harder. Precisely, it's about creating that feedback loop for continuous improvement. And how does the framework picture this happening? 00;05;26;06 - 00;05;51;13 Unknown Who are the key players. Right. So the framework outlines specific roles. You've got CMS align networks. Think of these as the main data highways the hubs okay. Then providers and health systems the doctors the hospitals. They'll be able to query and get full patient records and also share their data easily. That's a big change for them. Huge. Then EHR vendors, the companies building the actual record systems, they're critical. 00;05;51;19 - 00;06;14;23 Unknown They have to implement the standards so data can flow in and out seamlessly. Like epic, Cerner those folks exactly. Payers insurance companies are involved to connecting claims and authorization data adds another layer of context, right? What was actually paid for? Yep. And finally, maybe most importantly for the listener patient facing apps, these are the tools that will let you manage and interact with your own health information. 00;06;14;26 - 00;06;35;28 Unknown Your key to the system essentially. So it really takes everyone working together like a network effect. Absolutely. Every piece needs to participate for it to reach its full potential. Okay, we've got the vision moving beyond the fax machine era building this interconnected system. But a vision needs, you know, a technical foundation. Yeah. How does this actually work? What's the plumbing underneath it? 00;06;35;28 - 00;07;01;06 Unknown All right, the technical backbone, the absolute cornerstone, the sort of universal language here is called for here, for here. It stands for Fast Health care Interoperability Resource. It's a modern standard. It defines a common language and structure for health data using web APIs RESTful APIs. For the tech folks listening. So like a common dictionary for health data, that's a great way to put it. 00;07;01;12 - 00;07;24;09 Unknown Instead of every system speaking its own dialect, Fhir provides that common tongue. It uses these modular data elements called resources like a patient resource, medication resource, and observation resource. Makes it flexible, I guess very flexible and easier to implement across different systems. And we're seeing this adopted pretty quickly, right? People call it the next generation standard. Incredibly rapid adoption. 00;07;24;12 - 00;07;47;12 Unknown It's already required by the ONC, the office the national coordinator for health it. And now it's central to this CMS framework. It really shows how fundamental it is. So it's not just a nice to have. It's becoming mandatory in many ways. Yes. And to give you a sense of the teeth behind this, by July 4th 2026, all these CMS align networks must provide access to data using APIs. 00;07;47;13 - 00;08;08;26 Unknown That's a hard deadline. It is, and it has to conform to specific implementation guides like the US Core Implementation Guide, supporting standard data elements, things like Loinc codes for labs, Rxnorm for meds. It ensures consistency. So my lab results from LabCorp should look the same digitally speaking, as those from Quest Diagnostics. If they're using FHA, that's the goal. 00;08;09;03 - 00;08;32;24 Unknown That consistency unlocks other powerful things too, like for bulk data. Bulk data. What's that for? It allows for secure transfer of large data sets like your entire health record if you switch doctors, or for population health studies. Okay, big transfers and also FHA are subscriptions. This allows for real time notifications. Imagine getting an alert on your phone when you were admitted to the hospital, or your doctor getting instantly notified about your discharge. 00;08;32;25 - 00;08;58;20 Unknown Wow. Okay. Real time updates. That's powerful. It really is. So here is the language. But our health care system is massive, fragmented. How do all these different networks, hospitals, clinics across the country actually talk to each other using FH here? Good question. That's where TEF Ka comes in. The Trusted Exchange Framework and Common Agreement, aka another acronym. 00;08;58;22 - 00;09;23;26 Unknown Yes, lots of acronyms here, but Topeka is basically a nationwide initiative to create a unified network of networks. A network of networks. Yeah, it provides common rules. That's the common agreement and technical specs, the shared technical framework. Think of it as the rulebook and the blueprints for connecting all these separate health networks together nationally. So instead of every hospital needing to connect to every other hospital individually, which would be impossible basically, right? 00;09;23;26 - 00;09;52;26 Unknown They connect to this telco framework somehow they connect through something called a QA in a qualified health information network. Cheyenne. These Cheyennes are the centerpiece of TVA, their high capacity data networks that have been vetted and approved under TVA. They act as the main hubs routing data requests nationally. So for me, the listener, it's like instead of my doctor needing a direct line to every lab and hospital I've ever visited, they just plug in to a Cheyenne, and the Cheyenne handles finding the data. 00;09;52;28 - 00;10;14;23 Unknown That's a great analogy. It drastically simplifies things. Connect wants to a Cheyenne and you get access to this nationwide network. It makes data flow across state lines, across different systems much, much easier. Like flipping a switch almost. That's the idea. And we're talking major players becoming Cheyenne's Commonwealth Health Alliance eHealth exchange. Epic has one called Epic Nexus Health gorilla. 00;10;14;25 - 00;10;37;14 Unknown These are big connectivity providers and CMS itself is getting involved. Yes. And this is huge. CMS plans to participate by sharing Medicare claims data through these Cheyennes by 2026. Wow. That puts a lot of valuable data into the system. It creates a ready made, high volume infrastructure. It really incentivizes everyone else to get on board and connect. It's a major catalyst. 00;10;37;14 - 00;10;58;24 Unknown Okay, this is where it starts to get really exciting I think for people listening. This whole interoperability push, it's not just about back end systems or making doctors lives easier though. That's important, right? It's fundamentally about what you can actually do with your health data. It sounds like it's lowering barriers, creating this fertile ground for digital health innovation that directly helps patients. 00;10;59;02 - 00;11;19;07 Unknown Absolutely. And one of the most, relatable goals is probably the mission to kill the clipboard. Yes, please. Finally, eliminate those awful manual check forms. The redundant data collection that happens every single time you see a doctor. We've all been there scribbling the same allergies for the 10th time. So how does this initiative actually kill the clipboard? 00;11;19;08 - 00;11;53;22 Unknown Imagine going to that news specialist instead of the clipboard. You pull out your phone, an app with your clear consent securely grabs your latest medication, list your allergies, recent labs all using Fhir from the network, and it just fills in the forms for you. Instantly pre-populated them. That's the vision. Seamless patient first. How would that work? Technically? Like with my phone, it involves using secure digital credentials, maybe similar to mobile driver's licenses, you could transmit the info using Fhir via, say, a QR code on your phone or something called a smart health card. 00;11;53;26 - 00;12;16;21 Unknown Okay, simple and secure. And on the flip side, after your visit, you could get a summary diagnosis treatment plan sent back to your app in that same standard Fhir format. That's useful. And big companies are backing the specific pledge. Yes, Apple, Samsung, CVS, health, Google, they're all involved in this kill the clipboard effort. Yeah, it shows real cross-industry commitment. 00;12;16;22 - 00;12;40;22 Unknown Okay. Moving from clipboards to something even more futuristic conversational AI assistants in health care. Yeah, this sounds like science fiction territory. What's the promise here? It is pretty cutting edge. The objective is to have AI assistants that can give you personalized, context aware guidance. And the key is they would do this by securely accessing and interpreting your medical history, potentially your whole history in real time. 00;12;40;26 - 00;13;06;22 Unknown So an AI that actually knows me and my health situation, that's the goal. Providing tailored support, maybe helping with symptom checking initially explaining complex medication instructions, helping coordinate appointments, even supporting chronic disease management over time. An AI health guide almost kind of. Imagine an AI that understands your specific conditions, your meds, your past treatments, and offers guidance relevant just to you. 00;13;06;22 - 00;13;29;24 Unknown What's really striking is who's involved in this pledge. It's not just health care companies. No. It's fascinating. You have the major AI players anthropic with Claude AI, OpenAI with ChatGPT. The names everyone knows now, right? But also health care focused AI startups like Hippocratic AI, which really emphasizes its do no harm approach to patient safety. That seems crucial. 00;13;29;24 - 00;13;55;04 Unknown Absolutely. And then consumer health companies, too, like aura, the smart ring maker, and Zoc doc for booking appointments. It's this powerful blend of general AI expertise and specific health care focus. So how might that actually work? Like the aura ring talking to my medical record? Potentially, yes. An app could securely connect your sleep and activity data with your clinical history, say your diabetes record to give you more holistic advice. 00;13;55;05 - 00;14;16;23 Unknown That's interesting. Or Zoc docs. I might not just book the appointment, but also help you securely pre share the relevant parts of your record with the new doctor before you even walk in, making the visit much more efficient. Exactly. And critically, these companies are explicitly promising to be very clear about the difference between general educational content and actual clinical advice. 00;14;16;24 - 00;14;39;07 Unknown Important distinction very and always guiding you back to a human professional when needed. Safety and trust are paramount. It's about augmenting care, empowering patients, not replacing doctors. Okay, so beyond these really cool patient facing tools, what other innovation does this unlock? Are there new business opportunities maybe. Oh, definitely a big area is what you could call interoperability middleware and services. 00;14;39;08 - 00;15;07;08 Unknown Middle up. Yeah. Companies basically offering interoperability as a service. Yeah. Maybe helping smaller clinics connect or building tools to translate all that old legacy data into Fhir. It's a complex technical job. So companies helping other companies connect, right. There's also huge potential for analytics and population health platforms with easier access to bulk Fhir data. They get much deeper insights, helping hospitals manage chronic diseases better across their whole patient population. 00;15;07;11 - 00;15;30;23 Unknown Identify risks earlier using the data for public health. Almost in a way, yes, and will likely see new value added network services from the Cheyennes themselves. Maybe specialized learning systems, dashboards for doctors, patient engagement tools built on top of the basic data exchange. A whole new layer of tech that makes sense. But are there still gaps areas where innovation is really needed? 00;15;30;23 - 00;15;57;05 Unknown Oh for sure. And these gaps are also opportunities. A persistent one is universal patient identity and consent solutions, matching the right John Smith across different hospitals. Exactly. Even with Fhir reliably linking your records from five different places while totally respecting your privacy and consent is still a major challenge. We need better tools for that. Maybe a single dashboard where you control who sees what and when giving patients control. 00;15;57;06 - 00;16;21;11 Unknown Definitely another big gap. Inclusion of small and under-resourced providers. Your small town clinic or rural health center doesn't have the IT budget of a major hospital system, right? How do they participate? We need lightweight, affordable, easy to use solution so everyone can connect, not just the big players. That's a market opportunity. Makes sense. What else? Expanded use cases, especially integrating social and behavioral health data. 00;16;21;18 - 00;16;45;01 Unknown Things like housing status, food security, mental health data. They massively impact health outcomes, but they're often stuck in totally separate silos. Bringing that social context into the medical record. Exactly. Bridging those silos could be revolutionary for truly holistic care. And finally, health care, consumer engagement and education. It's not enough just to give you access to your data. We need tools to help you understand it. 00;16;45;04 - 00;17;08;06 Unknown Explain lab results in plain language. Help you navigate treatment options. Make the data genuinely actionable for you. The patient turning data into knowledge. Precisely. That's a huge area for innovation. Okay, this all sounds incredibly promising. Potentially transformative. But you mentioned hurdles. No big shift like this happens smoothly. What are the main challenges we need to watch out for? 00;17;08;08 - 00;17;35;12 Unknown Well, a big one that comes up immediately is privacy. CMS is clear that nothing here overrides high copy. The main U.S. health privacy law. Right. But what happens when your health information gets shared with your consent to one of these new consumer apps that isn't covered by IPR? So, like a wellness app or something? Exactly. Once the data leaves the hyper bubble of your doctor or hospital, it might fall under different rules, maybe FTC regulations, which might not be as strict. 00;17;35;12 - 00;18;02;07 Unknown That sounds like a potential pitfall. Could that data be used for, say, advertising? That's the concern. It creates these potential frictions. How is consent really managed? Is it truly informed opt in, especially for things like beta sharing between insurance companies? How robust is identity verification across all these systems? Plus, you have different state privacy laws adding complexity. So maintaining trust is going to be absolutely critical Paramount. 00;18;02;14 - 00;18;27;27 Unknown We need consistent enforcement of privacy promises really transparent policies that patients can understand. Maybe even third party audits. Without trust, people won't use these tools. Okay, privacy is huge. What about the technical side? The actual implementation? Well, just the sheer work involved in data mapping and normalization is enormous. Taking decades of old data in different formats and translating it accurately into standard Fhir. 00;18;27;29 - 00;18;50;23 Unknown That's a heavy lift. Like translating ancient scrolls. Kind of. And during the transition, systems will have to handle multiple standards simultaneously. Old ones, new ones. That makes the technical plumbing very complicated. Sounds messy. It can be. Yeah. And then there's the overall security and privacy complexity. Just managing certifications like I try and dealing with those varying state laws, ensuring data integrity. 00;18;50;27 - 00;19;18;14 Unknown It's a constant, significant burden, especially for smaller tech teams or clinics. And what about the users? The patients. That brings up the digital literacy challenge. We can't assume everyone has the latest smartphone or reliable internet or feels comfortable using complex apps, right? The digital divide? Exactly. We need genuinely inclusive design. How do we make sure these tools work for people with limited English skills, or older adults, or those in rural areas? 00;19;18;19 - 00;19;39;08 Unknown It requires conscious effort and outreach. The tech alone isn't enough. And that deadline Q1 2026 for tangible results. That's ambitious. Very. It's a motivator, for sure, but there's a risk that progress could be uneven, maybe piecemeal. If some organizations lag behind. It's definitely a sprint. But despite all these challenges, it feels like the momentum is really there this time. 00;19;39;08 - 00;19;57;16 Unknown The voluntary by and cms's approach. It seems like there's a real commitment. I think so the vision is compelling. The coalition is broad. There seems to be a collective will to finally tackle this. Even with the difficulties. Okay, so let's wrap this up. We've covered a lot. What's the bottom line? What does all this mean for you, the listener? 00;19;57;16 - 00;20;26;11 Unknown The patient? Well, in a nutshell, this CMS interoperability framework built on things like Fhir, TEF and Cheyennes is really laying the foundation for a truly connected, patient first health system. Finally, it's this huge team effort tech giants, hospitals, innovators all working together to finally make your health information flow the way it always should have, easily and securely. And it's not just about efficiency behind the scenes, it's about putting you in control. 00;20;26;12 - 00;20;48;08 Unknown Exactly. Empowering you with your own health data. Less time repeating your history, potentially more personalized insights from tools like AI assistance and a system where information actually follows you. It gives you more agency in your own health journey and the long term potential. If this vision truly pans out, it could be massive. Think truly personalized medicine tailored to your genetics and history. 00;20;48;11 - 00;21;15;03 Unknown Much better preventive care because risks are spotted earlier. Precision medicine ensuring you get the right treatment at the right time. Unlocking whole new levels of care? Potentially, yes, the blueprint is there now. It's up to this whole community developers, organizations, policymakers to actually build it and make it work for everyone. So a final thought for our listeners. What possibilities do you imagine when your health data can finally flow freely, securely and actually work for you? 00;21;15;06 - 00;21;18;14 Unknown Something to think about as this new era really starts to unfold.