Interoperability Mandates: Provider Compliance Lags – WEDI Survey
More than half of healthcare providers haven’t even begun working on the APIs required by CMS, signaling meaningful challenges for achieving healthcare interoperability. A WEDI survey reveals critical hurdles, including insufficient funding as the primary barrier to compliance with the CMS Final Rule on Advancing Interoperability. With mandates slated for implementation by january 1, 2027, many providers are struggling to define cohesive strategies and understand how emerging health facts networks, like TEFCA and qhins, will interact with their existing systems. The survey also highlights concerns about the total cost of compliance, impacting the goal of reducing administrative burdens.News Directory 3 can provide additional insights into this complicated transition. Discover what’s next as the industry tackles strategy, standards, and the sustainability of these crucial changes.
CMS Rule Compliance Lags Amid Funding, Strategy Gaps
Updated June 13, 2025
Many hospitals and health systems are struggling to meet upcoming data-sharing requirements from the Centers for Medicare & Medicaid Services (CMS). A recent survey by the Workgroup for Electronic Data Interchange (WEDI) revealed notable challenges in achieving healthcare interoperability.
The survey found that 52% of provider organizations have not yet begun work on the application programming interfaces (APIs) mandated by the CMS Final Rule on Advancing Interoperability and Improving Prior Authorization (CMS-0057-F). These mandates, aimed at improving data access and streamlining prior authorizations, must be implemented by Jan.1, 2027.
Financial constraints are a major hurdle. The survey indicated that insufficient funding is the most commonly cited barrier to implementation. Providers also reported difficulty in defining a cohesive enterprise strategy for achieving interoperability and improving the prior authorization process.
Robert tennant, executive director of WEDI, noted the complexity of the situation. “Many of our members are navigating a labyrinth of emerging interoperability frameworks and still lack a clear map,” Tennant said. “The complexity of aligning existing IT infrastructure with federal mandates is compounded by uncertainty about return on investment.”
Another challenge involves understanding the relationships between various national health information networks and exchanges. Providers are grappling with how systems like TEFCA, QHINs, and regional health information exchanges (HIEs) will interact with their existing data exchange mechanisms to improve data access.
Almost half, 44%, of surveyed providers expressed uncertainty about the total cost of complying with the new rule, including technology implementation and employee training. Despite these challenges, 79% of providers consider broad payer participation in prior authorization requirements “very significant” or “extremely important” for triumphant implementation of data sharing initiatives.
One anonymous health system CIO emphasized the need for coordination. “Without substantial coordination across payer and provider systems, we risk investing millions into fragmented solutions,” the CIO said.
The WEDI report highlights the strain on health systems already facing inflationary pressures, workforce shortages, and digital change initiatives. The Final Rule’s goal of reducing administrative burdens and improving patient access to care may depend on overcoming these structural and financial obstacles.
Tennant stressed the potential impact of the mandates. “These API mandates have the potential to be transformational, but success will depend on whether we can come together as an industry to solve for strategy, standards, and sustainability,” he said.
What’s next
Industry stakeholders will likely focus on collaborative efforts to address funding gaps, clarify interoperability strategies, and ensure effective implementation of the CMS Final Rule to improve data access and streamline prior authorization processes.