At HIMSS25, healthcare leaders and innovators gathered to tackle the industry’s most pressing challenges around interoperability, data sharing, and collaborative innovation. Among the standout sessions was Aneesh Chopra’s closing keynote at the Interop and HIE Forum, where the Chief Strategy Officer of Arcadia and first U.S. Chief Technology Officer under the Obama Administration shared valuable insights on breaking down barriers through strategic collaboration. As we reflect on these important conversations and look ahead to continuing them at HIMSS26, we’re pleased to share this Q&A with one of healthcare IT’s most influential voices.
This conversation, which we’ve lightly edited for length and clarity, occurred in May, 2025. In July, 2025, The Centers for Medicare & Medicaid Services released its Interoperability Framework, a significant development pertinent to many of the themes discussed below.
Quality improvement should be an evergreen responsibility, not tied to whether a patient is in front of you now.
What inspired your keynote on overcoming barriers and creating breakthroughs by working together?
Aneesh: The story that really catalyzed the session was the experience in the founding of the Argonaut project, which made consumer access to health information through an app of their choice a reality. It had three critical ingredients:
1. A clear role for public sector involvement through the government’s Meaningful Use program, which emphasized consumers’ right to their data through an app of their choice
2. A group of organizations (Epic, Cerner, McKesson, etc.) willing to collaborate at a faster pace than traditional standards development processes
3. The involvement of Apple Health Records, which offered a free app to consumers and served as a technical implementation partner
This collaboration led to what is now a ubiquitous capability we take for granted today—a low-to-no-cost mechanism for sharing data in a structured and standardized format across more than 10,000 clinics, with no marginal cost to consumers, doctors, or EHR vendors.
What do you see for the future of interoperability in HIE?
Aneesh: We’re applying that same philosophy to new challenges. The Centers for Medicare & Medicaid Services published an RFI that I’ve referred to as “making use meaningful again.” While we’ve addressed the consumer use case, we’re now in a gray area where payers are obligated to make data available to doctors in a FHIR format upon request, but there isn’t the same reciprocity for how providers respond to payers who need information for care coordination, quality improvement, or risk adjustment.
We lack explicit policy driving information flowing the other way and clarity around what constitutes “treatment” versus “operations” in value-based care. Quality improvement should be an evergreen responsibility, not tied to whether a patient is in front of you now. This is why much of my discussion focused on bulk FHIR—using it for quality improvement and other use cases where payers, providers, and consumers interact.
What was the main takeaway you hoped audiences had from your session?
Aneesh: It’s on us. There won’t be some big decree from Washington. Even with the RFI, we have the opportunity and obligation to work together given the signals we’re getting on where to focus.
Many organizations wait for rules and requirements before preparing, but here’s the chicken-and-egg problem: to have nice things, you need to raise your hand. We need early adopters to set requirements and develop technical standards that then get fed into regulatory processes that can be scaled.
If we can’t recruit early adopters to find the right mechanisms, we’ll end up with frustrating approaches that don’t work well. When I told the Argonaut story, I mentioned the critical first dozen or 18 health systems that told Apple they wanted to go first. It wasn’t just a vendor-to-vendor discussion—it was vendor-to-vendor technical consensus with early adopters providing real-world implementation feedback.
There’s a historical bias that writing an implementation guide equals success, but an implementation guide without real-world testing and feedback loops is like a tree falling in the forest with no one to hear it.
How can public-private partnerships be structured to drive innovation and address systemic barriers in healthcare data sharing?
Aneesh: It’s the Argonaut project formula: shared call to action, early adopters, real-world implementation, and feedback—all with the backdrop that the government will likely scale what works through regulation. This approach ensures your project isn’t just “pilotitis” where you’re wasting time on custom projects forever; you’re blazing a trail for everyone to follow.
In what ways does robust data governance contribute to minimizing disruptions and maintaining data integrity across healthcare systems?
Aneesh: There’s a trade-off between capital-G Governance and lowercase-g governance in the form of API management. With traditional trust frameworks where pipes are binary (on or off), you need capital-G Governance where everyone agrees to play by certain rules—only requesting data for treatment, using it only for specific use cases, etc. But anyone who subverts those rules can get away with it because the pipes are “dumb.”
In the world of FHIR APIs, we can move from a capital-G trust and legal framework to more of a lowercase-g technical implementation. When CMS shares data with doctors, they create a bulk FHIR key, develop the group associated with relevant patients, authorize the use case, and distribute the key—implementing a governance model through technology.
You’re not allowing everybody to query everything all at once; you’re technically enabling open access to a governed, filtered set of data elements subject to contract or legal structure. It’s less lawyerly and more engineered—”trust by engineering” through secure keys.
What strategies have proven effective in balancing proactive measures with reactive responses when unforeseen data issues arise?
Aneesh: The power of feedback loops. The DNA of a standards accelerator is that good people reach rough consensus, ship code, get feedback, and iterate. Implementation becomes an ongoing iterative science rather than deploying one standard protocol to rule them all.
When Apple first engaged in the FHIR API Argonaut work, they discovered lab results weren’t assigned to specific encounter dates—you just got lab results without knowing which visit they related to. The Argonaut community then iterated based on this real-world experience to address the issue. That’s the hallmark of an effective standards acceleration process.
Who should drive the economic model for data sharing?
Aneesh: There’s an implicit challenge: Should networks drive the economic model for data sharing, or should network participants set the guardrails?
This reminds me of the net neutrality debate during my time as US CTO. If you have a cable connection to your house, should the cable provider dictate whether you choose Netflix, Hulu, or NBC? Should they throttle speeds for some services but not others? The analogy in healthcare is that doctors and hospitals have one pipe—their EHR platform.
The net neutrality principle held that economics should flow to edge applications in a competitive marketplace rather than being controlled by networks. For your HIMSS audience, there’s an open debate: We may make commercial decisions about which EHR platform to use, but should those commercial decisions extend to how we interact with trading partners?
This tension is at the heart of TEFCA for operations and payment. We understand that doctors share data for treatment purposes at no charge and patients get access to data at no charge. But for things outside the mandatory requirements, what drives the economic model? Is it a cost-plus model that incentivizes infrastructure bloat, or will we drive utility prices down through innovation?
I’m inspired by the founding story of NEHEN (New England Healthcare EDI Network), where John Halamka, John Glasser, and others brought together payers and providers to reduce EDI transaction costs from $0.25 to $0.05 or less. That spirit of deflationary utility pricing may be key to deciding between Silicon Valley-backed networks that extract value or utility-grade deflationary models where value flows to trusted applications.
Looking Ahead to HIMSS26
The conversations sparked at HIMSS25 around interoperability, collaborative innovation, and the economic models that will drive healthcare data sharing are far from over. As Aneesh highlighted, we need early adopters and trailblazers willing to implement real solutions rather than just discussing theoretical frameworks.
These critical discussions will continue at HIMSS26, taking place March 9-12, 2026, in Las Vegas. Industry leaders, innovators, and healthcare professionals will once again gather to share insights, showcase solutions, and forge the partnerships needed to overcome healthcare’s most persistent barriers.
