{"id":7714982,"date":"2026-02-17T20:55:14","date_gmt":"2026-02-17T20:55:14","guid":{"rendered":"https:\/\/orionhealth.com\/?p=7714982"},"modified":"2026-02-18T00:43:45","modified_gmt":"2026-02-18T00:43:45","slug":"astp-2026-operationalizing-interoperability-ai","status":"publish","type":"post","link":"https:\/\/orionhealth.com\/global\/blog\/astp-2026-operationalizing-interoperability-ai\/","title":{"rendered":"From Policy to\u00a0Performance: The Hard Work of Operationalizing Interoperability\u00a0\u00a0\u00a0"},"content":{"rendered":"\n<p><em>By <a href=\"\/author-james-henderson\/\">James Henderson<\/a>, SVP &amp; GM, U.S., Orion Health<\/em>.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><em>Insights&nbsp;following&nbsp;the 2026 ASTP Annual Meeting<\/em>&nbsp;<\/h2>\n\n\n\n<p>Prior to&nbsp;the 2026 ASTP Annual Meeting, we&nbsp;published a perspective on&nbsp;<a href=\"\/blog\/astp-2026-from-interoperability-policy-to-practice\/\" target=\"_blank\" rel=\"noreferrer noopener\">the evolving state of&nbsp;U.S. health IT&nbsp;interoperability<\/a>&nbsp;and the shift from regulatory alignment to operational execution.&nbsp;After my time in D.C.,&nbsp;this shift is no longer theoretical. It is now the central challenge facing health systems, states, and technology partners.&nbsp;<\/p>\n\n\n\n<p>Across sessions&nbsp;and&nbsp;conversations, leaders kept&nbsp;coming back&nbsp;to the same&nbsp;issue:&nbsp;how to operationalize interoperability, data governance, and emerging AI expectations at scale&nbsp;within&nbsp;real&nbsp;funding, workforce, and accountability.&nbsp;<\/p>\n\n\n\n<p>The policy scaffolding is&nbsp;largely in&nbsp;place. The pressure&nbsp;now is&nbsp;on execution.&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Policy to Practice Gaps: Examples<\/strong>&nbsp;<\/h3>\n\n\n\n<p>If there was one phrase that kept surfacing throughout the meeting, it was this:<strong>&nbsp;compliance&nbsp;doesn\u2019t&nbsp;equal usability.<\/strong>&nbsp;&nbsp;<\/p>\n\n\n\n<p>Interoperability, price transparency, and AI acceleration are not new&nbsp;concepts.&nbsp;What\u2019s&nbsp;changed is&nbsp;scrutiny.&nbsp;Regulators, providers, and patients are asking a simpler question:&nbsp;does it&nbsp;actually work in everyday care?&nbsp;<\/p>\n\n\n\n<p>One&nbsp;example that&nbsp;stuck&nbsp;with me:&nbsp;patient-facing apps&nbsp;may&nbsp;technically connect&nbsp;via&nbsp;APIs, but&nbsp;response times can stretch to 20 minutes.&nbsp;From a&nbsp;standards&nbsp;perspective, that may count as interoperability.&nbsp;&nbsp;From a patient perspective,&nbsp;it\u2019s&nbsp;a failure.&nbsp;If&nbsp;data&nbsp;isn\u2019t&nbsp;available when&nbsp;it\u2019s&nbsp;needed, it might&nbsp;as well not exist.&nbsp;<\/p>\n\n\n\n<p>Another example discussed was the lack of clean workflows for basic care coordination. An urgent care visit still does not reliably notify a patient\u2019s primary care physician automatically. Parents who want to share a controlled and permissioned summary of a child\u2019s allergy history with a caregiver&nbsp;encounter&nbsp;friction. These are not rare edge cases.&nbsp;They\u2019re&nbsp;everyday&nbsp;workflow&nbsp;realities.&nbsp;<\/p>\n\n\n\n<p>We have electronic systems&nbsp;and&nbsp;standards.&nbsp;What we&nbsp;don\u2019t&nbsp;consistently have is&nbsp;performance, workflow&nbsp;alignment,&nbsp;and accountability for real-world usability.&nbsp;That\u2019s&nbsp;the gap the industry now&nbsp;needs to&nbsp;close.&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Governance in the Real World: Models and Risk Realities<\/strong>&nbsp;<\/h3>\n\n\n\n<p>AI&nbsp;was&nbsp;a central theme, but not in the way many expect. The debate&nbsp;wasn\u2019t&nbsp;about model&nbsp;capability.&nbsp;The constraint lies in system readiness.&nbsp;<\/p>\n\n\n\n<p>Panelists repeatedly highlighted four blockers&nbsp;for&nbsp;clinical AI adoption. These included:&nbsp;<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Fragmented and incomplete data access.&nbsp;<\/li>\n\n\n\n<li>Regulatory uncertainty for patient-facing or clinical-decision&nbsp;AI.<\/li>\n\n\n\n<li>Reimbursement models that&nbsp;don\u2019t&nbsp;reward&nbsp;prevention and avoided events.<\/li>\n\n\n\n<li>Trust across patients, providers, and institutions.<\/li>\n<\/ul>\n\n\n\n<p>Several panels&nbsp;moved&nbsp;beyond&nbsp;one-time model validation&nbsp;toward lifecycle monitoring that detects bias, drift, and&nbsp;real-world&nbsp;performance issues after deployment.&nbsp;Risk-based&nbsp;oversight was emphasized, with a focus on regulating where clinical risk is real while avoiding unnecessary slowdowns&nbsp;in use&nbsp;cases&nbsp;where it&nbsp;isn\u2019t.&nbsp;<\/p>\n\n\n\n<p>One concept introduced was&nbsp;a&nbsp;\u201csupervisory agent\u201d,&nbsp;an&nbsp;additional&nbsp;AI layer&nbsp;designed to&nbsp;continuously audit&nbsp;and&nbsp;monitor&nbsp;clinical AI&nbsp;models. Whether that specific&nbsp;construct&nbsp;becomes&nbsp;a reality&nbsp;remains to be seen.&nbsp;The barrier&nbsp;won\u2019t&nbsp;be&nbsp;the&nbsp;model\u2019s&nbsp;capability,&nbsp;but the system\u2019s inability to&nbsp;create durable&nbsp;trust at scale.&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Where&nbsp;Momentum&nbsp;Is&nbsp;Real&nbsp;and Where It Isn\u2019t<\/strong>&nbsp;<\/h3>\n\n\n\n<p>Not everything discussed was theoretical.&nbsp;There&nbsp;are&nbsp;areas where&nbsp;operational traction is visible.&nbsp;<\/p>\n\n\n\n<p>TEFCA was described as moving from aspiration to backbone, with exchange volumes accelerating. The&nbsp;expectation from&nbsp;leadership&nbsp;is shifting as well:&nbsp;interoperability must be fast and patient-centered, not just technically compliant.&nbsp;As TEFCA participation expands, performance and transparency expectations will increase.&nbsp;<\/p>\n\n\n\n<p>CMS\u2019s voluntary accelerator&nbsp;model&nbsp;reflects an iterative approach:&nbsp;test, learn, and refine in&nbsp;the open. That&nbsp;approach&nbsp;differs&nbsp;from&nbsp;the more structured governance&nbsp;model&nbsp;of TEFCA, but the two were presented as complementary&nbsp;levers within the same ecosystem.&nbsp;<\/p>\n\n\n\n<p>At the same time, foundational gaps&nbsp;remain.&nbsp;<\/p>\n\n\n\n<p>Provider directories&nbsp;are still&nbsp;inconsistent, expensive&nbsp;to&nbsp;maintain,&nbsp;and often unreliable.&nbsp;API performance expectations, like&nbsp;latency,&nbsp;are not yet&nbsp;consistently&nbsp;enforced. Reimbursement&nbsp;structures&nbsp;continue to&nbsp;lag in&nbsp;prevention-oriented&nbsp;innovation.&nbsp;<\/p>\n\n\n\n<p>The direction of travel is clearer than it has been in years. Execution at the operational layer&nbsp;remains&nbsp;uneven.&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>What This Means for&nbsp;States and&nbsp;Ecosystem&nbsp;Partners<\/strong>&nbsp;<\/h3>\n\n\n\n<p>For organizations that have already built statewide exchange infrastructure or scaled national interoperability programs, the next phase is&nbsp;less&nbsp;about adding&nbsp;new&nbsp;interfaces and more about ensuring that existing infrastructure preforms reliably at scale.&nbsp;&nbsp;<\/p>\n\n\n\n<p>As participation grows, expectations around latency, governance, and transparency increase. Sustaining trust depends on whether those systems continue to&nbsp;operate&nbsp;consistently under real-world pressure.&nbsp;From my perspective, three&nbsp;implications&nbsp;stand out:&nbsp;<\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>First, participation shapes outcomes.&nbsp;<\/strong>&nbsp;<\/h4>\n\n\n\n<p>It was&nbsp;emphasized that&nbsp;engaging&nbsp;early&nbsp;through&nbsp;pilots, workgroups, and comment processes&nbsp;is&nbsp;materially&nbsp;influencing&nbsp;how these frameworks get&nbsp;operationalized. If&nbsp;you\u2019re&nbsp;not&nbsp;at the table,&nbsp;you\u2019re&nbsp;accepting someone else\u2019s definition of \u201cgood enough.\u201d&nbsp;<\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>Second, interoperability must evolve from connectivity to performance.<\/strong>&nbsp;&nbsp;<\/h4>\n\n\n\n<p>Exchange volume alone is no longer the success metric. Latency, onboarding burden, pricing fairness, and operational transparency are becoming part of how interoperability is defined.&nbsp;It\u2019s&nbsp;more demanding, but&nbsp;it\u2019s&nbsp;the right one.&nbsp;<\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>Third,&nbsp;AI&nbsp;scalability&nbsp;requires incentive alignment.&nbsp;<\/strong>&nbsp;<\/h4>\n\n\n\n<p>We can demonstrate&nbsp;predictive&nbsp;accuracy all day long.&nbsp;If reimbursement models do not reward avoided events or upstream&nbsp;prevention,&nbsp;those tools remain stuck in pilots.&nbsp;Technology&nbsp;advancement&nbsp;and payment reform&nbsp;have to&nbsp;move together.&nbsp;<\/p>\n\n\n\n<p>Across&nbsp;all of this, one&nbsp;reality&nbsp;persists:&nbsp;aligning policy goals with&nbsp;real-world implementation requires coordination across states, vendors, regulators, and payers. No single entity can operationalize this shift alone.&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Moving&nbsp;From&nbsp;Direction&nbsp;to Delivery<\/strong>&nbsp;<\/h3>\n\n\n\n<p>What stood out most at&nbsp;ASTP&nbsp;wasn\u2019t&nbsp;a single announcement or&nbsp;rule&nbsp;change. It was the consistency of the message across panels and discussions.&nbsp;&nbsp;<\/p>\n\n\n\n<p>We are past the digitization&nbsp;phase. The next phase is operationalization.&nbsp;<\/p>\n\n\n\n<p>Policy has created&nbsp;direction.&nbsp;Standards have created&nbsp;structure. But unless those expectations translate into fast APIs, reliable directories,&nbsp;transparent&nbsp;governance, aligned incentives, and workflows&nbsp;that&nbsp;don\u2019t&nbsp;add friction, clinicians and patients will continue bridging&nbsp;system&nbsp;gaps manually.&nbsp;<\/p>\n\n\n\n<p>The destination is&nbsp;broadly agreed&nbsp;upon. The harder question, and the one now squarely in front of us, is&nbsp;whether we can make it work at scale in real systems, for real people, in real time.&nbsp;<\/p>\n\n\n\n<p>That\u2019s&nbsp;the shift underway. And&nbsp;it\u2019s&nbsp;where&nbsp;real&nbsp;work begins.&nbsp;<\/p>\n\n\n\n<div class=\"wp-block-media-text\" style=\"grid-template-columns:24% auto\"><figure class=\"wp-block-media-text__media\"><img loading=\"lazy\" decoding=\"async\" width=\"800\" height=\"533\" src=\"https:\/\/orionhealth.com\/wp-content\/uploads\/James-Henderson.jpg\" alt=\"\" class=\"wp-image-7715021 size-full\" srcset=\"https:\/\/orionhealth.com\/wp-content\/uploads\/James-Henderson.jpg 800w, https:\/\/orionhealth.com\/wp-content\/uploads\/James-Henderson-300x200.jpg 300w, https:\/\/orionhealth.com\/wp-content\/uploads\/James-Henderson-768x512.jpg 768w, https:\/\/orionhealth.com\/wp-content\/uploads\/James-Henderson-18x12.jpg 18w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\" \/><\/figure><div class=\"wp-block-media-text__content\">\n<p><strong>James Henderson<\/strong><br>SVP &amp; General Manager, U.S. at Orion Health<br><a href=\"https:\/\/orionhealth.com\/global\/author-james-henderson\/\">Read more from James Henderson<\/a><\/p>\n\n\n\n<ul class=\"wp-block-social-links has-normal-icon-size has-icon-color is-style-logos-only is-nowrap is-layout-flex wp-container-core-social-links-is-layout-ad2f72ca wp-block-social-links-is-layout-flex\"><li style=\"color:#abb8c3;\" class=\"wp-social-link wp-social-link-linkedin has-cyan-bluish-gray-color wp-block-social-link\"><a rel=\"noopener nofollow\" target=\"_blank\" href=\"https:\/\/www.linkedin.com\/in\/james-henderson-mha-5171296\/\" class=\"wp-block-social-link-anchor\"><svg width=\"24\" height=\"24\" viewBox=\"0 0 24 24\" version=\"1.1\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" aria-hidden=\"true\" focusable=\"false\"><path d=\"M19.7,3H4.3C3.582,3,3,3.582,3,4.3v15.4C3,20.418,3.582,21,4.3,21h15.4c0.718,0,1.3-0.582,1.3-1.3V4.3 C21,3.582,20.418,3,19.7,3z M8.339,18.338H5.667v-8.59h2.672V18.338z M7.004,8.574c-0.857,0-1.549-0.694-1.549-1.548 c0-0.855,0.691-1.548,1.549-1.548c0.854,0,1.547,0.694,1.547,1.548C8.551,7.881,7.858,8.574,7.004,8.574z M18.339,18.338h-2.669 v-4.177c0-0.996-0.017-2.278-1.387-2.278c-1.389,0-1.601,1.086-1.601,2.206v4.249h-2.667v-8.59h2.559v1.174h0.037 c0.356-0.675,1.227-1.387,2.526-1.387c2.703,0,3.203,1.779,3.203,4.092V18.338z\"><\/path><\/svg><span class=\"wp-block-social-link-label screen-reader-text\">LinkedIn<\/span><\/a><\/li><\/ul>\n<\/div><\/div>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>By James Henderson, SVP &amp; GM, U.S., Orion Health. Insights&nbsp;following&nbsp;the 2026 ASTP Annual Meeting&nbsp; Prior to&nbsp;the 2026 ASTP Annual Meeting, we&nbsp;published a perspective on&nbsp;the evolving state of&nbsp;U.S. health IT&nbsp;interoperability&nbsp;and the shift from regulatory alignment to operational execution.&nbsp;After my time in D.C.,&nbsp;this shift is no longer theoretical. It is now the central challenge facing health systems, [&hellip;]<\/p>\n","protected":false},"author":51,"featured_media":7715018,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"content-type":"","footnotes":""},"categories":[1],"tags":[96],"region":[23,28],"class_list":["post-7714982","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-blog","tag-interoperability","region-global","region-us"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.1.1 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ASTP 2026: Operationalizing Interoperability &amp; AI - Orion Health<\/title>\n<meta name=\"description\" content=\"Insights from the 2026 ASTP Annual Meeting on TEFCA, CMS, clinical AI governance, and scaling U.S. health IT interoperability.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/orionhealth.com\/global\/blog\/astp-2026-operationalizing-interoperability-ai\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"ASTP 2026: Operationalizing Interoperability &amp; AI - 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