CMS looks to modernize the U.S. digital health infrastructure

Eight health systems have joined a Trump administration initiative to accelerate the implementation of integrated patient-facing technology in the healthcare ecosystem.

The agreement is a voluntary pledge by the health systems to be early adopters of forthcoming technology that will be designed, in part, to enhance interoperability and eliminate paper-based clinical encounters. Participants will be expected to make “complete, timely patient data available” to patients, other providers and, when appropriate, payers.

“Not just structured data, but real-world clinical documentation and encounter signals that improve care coordination,” stated CMS, which is overseeing the public-private partnership.

AtlantiCare, Bon Secours Mercy Health, Cleveland Clinic, Froedtert ThedaCare Health, Intermountain Health, Providence, Sanford Health and Tennessee Oncology accepted the terms of the pledge, as did three newer entrants to the provider space: Amazon, CVS Health and UnitedHealth Group (Optum).

They are among roughly 60 organizations spanning providers, payers, data networks, electronic health record (EHR) systems and health app developers that will “voluntarily align around a shared framework for data and access that empowers people, improves care and accelerates progress,” according to CMS. Plans are for this new ecosystem to be in place by the first half of 2026.

What’s envisioned

Among the goals for the reimagined ecosystem are making it easier for patients to access and share their health information and for providers to receive the data when interacting with patients. And outside of formal care encounters, patients will have enhanced access to apps and digital tools that provide customized support on demand. Mehmet Oz, MD, administrator of CMS, described the vision in broad terms during a talk at this year’s Not-for-Profit Healthcare Investor Conference, co-sponsored by HFMA.

In remarks Wednesday at the White House, HHS Secretary Robert F. Kennedy Jr. said part of the inspiration for the new ecosystem is the approach seen in Indonesia, which has achieved significant gains in life expectancy over the past three decades.

The country’s citizens have access to an app that “shows your height, your weight, your blood type, your BMI, your cardiac markers, your diabetes markers, your cholesterol and any kind of individualized treatment that you had,” Kennedy said. “So if you go to a doctor in another town, he doesn’t do what we have to do here, which is to sit there with a clipboard and a fax machine in order to get your health records. It’s available and it allows them to give better treatment. It also allows you to make better choices over your life.”

Kennedy also described a meeting with the prime minister of Australia, which similarly has made notable progress in population health.

“He said the single thing that he did that was most important to that transformation was the transparency that occurs when people control their own health records,” Kennedy said. “It gives them a sense of responsibility and allows them to measure the interventions if they change their diet, if they change their exercise.”

Issues to consider

If the new ecosystem develops according to plan, privacy experts warn of a potential trade-off to the improved levels of access and convenience. Health apps traditionally are not covered by HIPAA, for example.

CMS said one guardrail is that patients will have to opt in to the new system, while data security will be prioritized and there will be no centralized government repository for the data.

The ecosystem will “protect the data better than we could have imagined,” Oz said Wednesday.

Other points that remain to be seen include whether a voluntary initiative will be sufficient to encourage robust participation among healthcare stakeholders and whether the few providers that initially have signed up can make a widespread impact.

Participants are motivated by the opportunity to build an infrastructure that works better for all parties.

“We believe that seamless data exchange empowers both providers and patients, driving better healthcare outcomes across the country,” Cleveland Clinic said in a written statement. “By breaking down barriers to information sharing, we enable our teams to deliver coordinated, high-quality care at every stage of the patient’s journey.”

Some remote areas of the country may still lack extensive access to the level of Internet bandwidth needed to support widespread app utilization. Oz said rural infrastructure funding in the recently passed budget reconciliation bill can be put toward shoring up those gaps.

Expectations for participants

The idea is for the health systems and other stakeholders — including leading technology companies such as Apple, Google and OpenAI — to voluntarily adopt advanced approaches to creating a shared framework for digital health. Innovations are envisioned for data networks, EHRs and health apps.

The early adopters and subsequent participants will work to ensure the availability of real-time access to electronic health information (EHI) across systems for access by clinicians and patients. They’ll be expected to provide other CMS-aligned stakeholders with EHI upon request, including unstructured clinical documents (e.g., notes, PDFs, JPGs) that comprise a patient’s record.

The ecosystem will “help [clinicians] navigate the [healthcare] system better,” Oz said. “It’s giving you advice, decision support — which is becoming increasingly important as medicine gets more difficult.”

He also said the improved information flow will help the personal aspect of care encounters: “We will, within the workflow of doctors, allow physicians to take care of patients,” rather than being focused on EHR data entry.

He indicated the improved IT infrastructure and workflows will tamp down fraud, waste and abuse and make coding and billing more accurate: “We will destroy the upcoding that has hurt Medicare Advantage and other programs in a similar fashion.”

In June, the Trump administration announced plans to use a FHIR-based application programming interface to build “a dynamic, interoperable national provider directory” that will be navigable via health apps. Establishing accurate, accessible lists of which providers are in which health plans long has bedeviled the industry.

A new line of tools

As part of the initiative, healthcare apps for beneficiaries initially will fall into one of three categories:

• Digitization of healthcare information that allows patients to share their verified health and identity information directly with providers via a single click and instantaneously see a record of their completed visit (CMS refers to this as a “kill the clipboard” effort)
• Implementation of conversational AI technology that can deliver personalized, context-aware guidance to patients by securely accessing and interpreting their medical history in real time
• Tailored, data-driven support for individuals who have diabetes or obesity or are at elevated risk

“Today we [already] have all these apps that want to provide these services, but they can’t get the data because it is so hard for patients to access their records,” said Amy Gleason, acting administrator of the Trump administration’s Department of Government Efficiency (DOGE).

Next year, a patient arriving at a doctor’s office will be able to “just pull out her phone and tap or scan a QR code and seamlessly transfer her digital insurance card, her verified medical record and a digital summary that could help her provider get up to speed faster,” Gleason said.

After the visit, the patient can open an AI assistant that she has authorized to access her records and get plain-language insights on what the doctor said, what the test results mean and what the care plan is, along with booking follow-up visits.

There are other opportunities beyond healthcare episodes, Oz said: “We’ll have beneficiaries be able to get [Make America Healthy Again] advice and prevention tips and even be able to nudge them and reward them, perhaps, for that.”