From national exchange frameworks to patient access and AI readiness, conversations at HIMSS26 highlighted the infrastructure needed to support the future of trusted health data exchange.
Last week at HIMSS26, I had the opportunity to spend several days connecting with colleagues, partners, and members across the healthcare interoperability community. I was joined by Kelly Gwynn and Scott Stuewe, and we enjoyed many conversations with DirectTrust members, accredited organizations, and peers across the health technology ecosystem.
There was a noticeable shift in tone this year. Conversations felt less focused on where interoperability might go next and more focused on the work underway to make it real. If last year felt like a moment to pause and assess direction, this year felt like rolling up our sleeves and moving forward.
Several themes stood out across the Interoperability Preconference, HIMSS sessions, and discussions throughout the week.
Clean Data Is Becoming Healthcare’s Critical Infrastructure
The Interoperability Preconference opened with a keynote from Dan Liljenquist of Intermountain Health, who delivered a clear message about one of healthcare’s biggest challenges.
Administrative complexity costs the U.S. healthcare system roughly $750 billion annually, and a significant portion of that burden stems from fragmented, inconsistent data.
Liljenquist emphasized that if healthcare wants to take advantage of artificial intelligence and advanced analytics, the industry must first solve its data problem. Clean, structured, and consistent data models are essential.
“If you have a bespoke data model, you will get bespoke results.”
The conversation also highlighted the changing expectations of patients and consumers. When asked how many people in the room had used an AI tool to ask health-related questions, many hands went up. The implication was clear. Patients are already interacting with new sources of information, and healthcare organizations must ensure that the data behind those tools is reliable and accessible.
A key takeaway was that data must become infrastructure. The pipes that move information remain important, but the usability and quality of the data flowing through those pipes will determine whether new technologies deliver real value.
Interoperability Progress Is Real, but Implementation Still Matters
Across several sessions, speakers highlighted meaningful progress in national exchange efforts, particularly through TEFCA.
Mariann Yeager shared updates on areas where the framework is already showing impact. Discussions also explored upcoming developments such as dynamic registration for FHIR-based exchange expected in 2027, and the role of directories as a trusted source of information for exchange.
Panels discussing interoperability policy and implementation emphasized a shared goal: reducing reliance on fragmented or proprietary exchange networks in favor of national frameworks and shared infrastructure.
During one discussion, Scott Rossignol shared a personal story about navigating a prior authorization challenge for a family member. When the originally ordered imaging was not approved and no alternative pathway was provided, the situation ultimately resulted in an emergency department visit. The experience illustrated a broader point raised repeatedly during the conference.
Friction in the healthcare system directly translates to cost.
As one speaker summarized, every friction point increases cost for patients, providers, and the healthcare system as a whole. Addressing those challenges requires shared standards, coordination across organizations, and infrastructure that allows data to move where it is needed.
Data Quality and Trust Are Strategic Priorities
Another theme that surfaced repeatedly was the importance of measuring and improving data quality.
During a session focused on objective measurement of data quality, Charlie Mead captured the issue succinctly:
“If we don’t have good data quality, we’re really pushing data, we’re not really sharing data.”
As artificial intelligence becomes more integrated into healthcare workflows, the need for trustworthy data becomes even more critical. Organizations increasingly recognize that analytics, automation, and AI tools are only as reliable as the data they rely on.
This focus on trust is also central to the work happening across the interoperability ecosystem. Standards development, accreditation programs, and implementation frameworks all play a role in creating the confidence organizations need to rely on shared data.
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Digital Identity Is Emerging as a Foundational Challenge
Digital identity was another recurring topic throughout the week.
A panel focused on the NIST Digital Identity Guidelines (800-63 Revision 4) highlighted the growing momentum behind reusable digital credentials that can be trusted across multiple systems.
Recent developments include CMS enabling individuals to authenticate using ID.me, CLEAR, or Login.gov, while phasing out legacy login approaches. Early data shows that more than 90 percent of users already have an existing credential, which helps reduce friction for access.
Reusable identity credentials also provide operational benefits. One state agency saw identity-related support calls drop below one percent after implementing reusable credentials, allowing staff to focus on other priorities.
The discussion also reinforced a broader point. Identity is not simply about logging in. It is about ensuring healthcare systems know which data belongs to which patient and which provider, a foundational requirement for trusted data exchange.
Organizations across the ecosystem, including DirectTrust through its identity and trust frameworks, are helping advance these capabilities.
The Patient Experience Still Reveals Real-World Gaps
While national frameworks and technical capabilities continue to evolve, several sessions reminded attendees that implementation realities still matter.
During a patient experience panel, Jamie Bland shared a story about attempting to send medical records to a specialty hospital. Despite the availability of electronic exchange through Direct and health information exchanges, the receiving organization would only accept fax.
Faxing the records would have cost more than $400, so the records were ultimately mailed and scanned on arrival.
Stories like this highlight the frustrating gap between what is technically possible and what is consistently implemented across healthcare organizations. As Amy Gleason noted during another session, solving these challenges requires seeing all the puzzle pieces together, including technology, policy, operations, and incentives.
Collaboration Is Accelerating the Ecosystem
One of the most encouraging discussions came during a session featuring Ryan Howells, Amy Gleason, and Dr. Tom Keane, which focused on the scale of collaboration required to move interoperability forward.
Amy described the work underway across federal and private-sector initiatives as something akin to a large innovation accelerator, bringing organizations together to test and implement solutions.
The long-term goals are ambitious but clear:
- Increasing data liquidity
- Improving affordability and administrative efficiency
- Supporting technology evolution that benefits patients
Amy summarized the broader mission simply:
“Make healthcare work. Give patients their damn data.”
A Highlight of the Week: Bridging Standards, Connecting Leaders
One of the highlights of HIMSS26 was the Bridging Standards, Connecting Leaders Reception, hosted by HL7, The Sequoia Project, NCPDP, and DirectTrust.
More than 300 volunteers, leaders, and friends of the interoperability community gathered for the event, with sponsorship support from Lantana, Point of Care Partners, and Surescripts.
For many attendees, the reception offered a rare opportunity to connect with peers across organizations and initiatives in one place. I heard several people remark that it felt like the one space during HIMSS where they could see so many of their colleagues and collaborators together.
And yes, the cocktails and mocktails were appropriately themed for the interoperability crowd.
Demonstrating What Is Possible
Another highlight was the Interop + SMART Experience, where organizations demonstrated real-world interoperability scenarios.
A few demonstrations that stood out showed how patients could request medical information from multiple healthcare organizations, bring those records together into a single location, and use tools to help interpret the data.
Seeing these capabilities demonstrated in a practical environment reinforces that many of the technical building blocks already exist. The challenge now is scaling adoption and making these capabilities widely available across the healthcare ecosystem.
What This Means for DirectTrust and the Ecosystem
Many of the themes discussed at HIMSS align closely with the work happening across the DirectTrust community.
The industry’s growing focus on trusted exchange, identity assurance, data quality, and shared infrastructure reflects the same priorities that have guided DirectTrust’s programs and partnerships for years.
Efforts like TEFCA, CMS Aligned Networks, FHIR-based exchange, and Direct Secure Messaging each play complementary roles in the ecosystem. Together they create multiple pathways for trusted information sharing, allowing organizations with different technical capabilities and use cases to participate in nationwide interoperability.
At its core, the goal is the same: building trust in health technology and enabling secure, reliable exchange of health information.
The Role of Trust Infrastructure
As these conversations continue across the industry, it is clear that progress will depend not only on new technology, but also on trusted infrastructure that organizations can rely on across the ecosystem.
Frameworks like TEFCA, CMS Aligned Networks, FHIR-based exchange, and Direct Secure Messaging each support different use cases and technical capabilities. Together, they create complementary pathways that allow healthcare organizations to participate in nationwide exchange while continuing to advance toward greater interoperability.
For the DirectTrust community, the themes discussed at HIMSS26 reinforce the importance of the work underway across identity, accreditation, trusted exchange frameworks, and implementation collaboration. These efforts help establish the trust, accountability, and technical alignment needed to support secure and reliable health data exchange at scale.
As the industry continues to focus on reducing friction, improving data quality, and enabling trusted digital identity, the role of shared governance, standards, and accreditation will only become more important.
Leaving HIMSS26 Optimistic
After several days of panels, hallway conversations, and collaboration sessions, I left HIMSS26 feeling optimistic.
There is significant momentum building toward key milestones across the health technology ecosystem, including upcoming initiatives tied to the broader federal health technology roadmap.
More importantly, there is growing alignment around several foundational ideas:
- Patients must ultimately benefit from the technology we build
- Clean, structured data is essential for the future of healthcare
- Digital identity is a core enabler of trusted exchange
- Collaboration across organizations is necessary to reduce friction and cost
The energy throughout the conference reflected an industry ready to move forward together, and that momentum matters.