As we head into 2026, we anticipate the interoperability landscape will continue to evolve and mature, requiring that stakeholders be adaptable and flexible to changing directives and opportunities to succeed. In the short term, this period of time could feel like a lot of thrashing around, jumping from idea to idea and back again. This isn’t necessarily a bad thing; new market entrants, interest, and innovation are giving national interoperability a boost. Plus, some of that thrashing will end up being productive. In the long term, we all stand to benefit from the resulting rapid iteration and a separation between leaders and followers, impactful solutions, and one-hit wonders in quick order.
With this backdrop in mind, here are the trends we’re betting on in 2026.
Patient access will take off. The market will see continued entrants, both big and small, offering solutions that build on the standards introduced into Trusted Exchange Framework and Common Agreement™ (TEFCA™), including Individual Access Services (or IAS). Expect a variety of business models with clinical functionality from general access to specialty focused health coaching and support for administrative uses such as clinical data for insurance and disability. That said, we’re closely watching how providers will respond to changes. Easy access is both a tool for disruption and evolution, and it may spark previously unproven concerns about the patient-provider relationship when the patient has more access to their information (such as getting test results before a doctor’s appointment). No matter what the focus, the best solutions will be connected across the ecosystem to advance true interoperability.
Key takeaway: Expect a lot more patient solutions in 2026 — but not all offerings will be the same.
AI in healthcare will evolve. Based on recent surveys, we’re starting to see a shift in satisfaction and value among AI tools, such as AI Scribe. As AI conquers the back office so to speak, we’ll likely see AI creep into more patient-facing applications as trust grows. The CMS Interoperability Framework is pushing for patient-facing AI tools. So far, I’ve seen mixed results with some great advice, some marginal, and even some directly against generally accepted medical advice. That said, it would be wise to keep an eye on the regulatory environment; just as we saw a backswing on AI-powered clinical tools requiring disclosure, similar responses ahead will affect future leaps.
Key takeaway: AI will continue to gain ground, with a likely two steps forward, one step back approach as innovation and regulation move forward.
Business models will become a bigger priority for the interoperability networks. We’ll see a shift from community developed use cases built on reciprocity, like treatment, to new transactional and partnership models. Arbitrage is great for the one who finds the way to exploit a market gap, but the one being exploited tends to fight back eventually. Investors will want to see return on investment, and the nonprofits know there is no mission without margin. While we anticipate TEFCA will continue to be a part of these processes, less attention will be paid to the framework, and more attention will be paid to practical advancement across partners.
Key takeaway: As the interoperability market matures, expect value systems to focus even more on ROI.
It will likely be another crazy year — from the outside looking in. CMS entering the ring has shaken out some cobwebs, and I think there is some more dry powder here. I believe much of the movement is centered around newer entrants finding a friendly podium to show off their toys. But this does not mean that the entrenched, successful participants should dismiss it as all noise and no signal. In this environment, EHRs have an advantage as control over the administrative flows between the provider and the patient remain important to healthcare and to their own EHR market share aspirations. Don’t be surprised to see even more companies enter the market in 2026 — and loudly. In contrast, I think it’s likely some of the biggest changemakers will keep their heads down and then cheer from the stands when their backend tech fuels the data flows into these new apps.
Key takeaway: With disruption comes eventual advancement. We should get excited but not lose the plot.
My final thoughts? New ideas are fun to work on, but we are also still building up adoption and have a lot more EHRs and providers to hook up. TEFCA will continue quietly serving as the foundation of trust underpinning this work to achieve critical mass in data exchange. As we head into the new year, we do so clear-eyed and optimistic: Big change takes persistent work and trust in this community, and we must continue to work together through the coming ebbs and flows to advance a more effective and efficient healthcare system.