Following up on discussion about CMS Interop Framework and “CMS-Aligned Networks”… it’s clear that true national-scale interoperability needs more than just federated identity. The vision of “no per-site interactions” highlights a deeper architectural gap.

For years, networks have gestured at a more patient-centric model but have largely left robust patient-mediated authorization out of scope. There hasn’t been a strong forcing function to compel the industry to build it.

That’s changed. The CMS Aligned Network definition, with its requirement for seamless exchange, is that forcing function. It essentially requires better authorization primitives than what we have today.

Now is the time to embrace this challenge. We need to describe, prototype, build, and learn from new models.

We should be investing in what I’m calling “Patient Trust Authorities” (PTAs) — neutral public utilities that provide:

• A single, portable digital identity for patients to use across the entire ecosystem.
• A unified place to set durable consent preferences that are enforced automatically by the network.

This creates the trust layer needed for secure, patient-directed data flow without constant logins and approvals.

I’ve put together a paper outlining this approach. I believe it’s a concrete path forward to meet the new requirements and build the infrastructure we’ve needed for years. Eager to hear your feedback.

“#HealthIT #Interoperability #TEFCA #PatientData #DigitalIdentity #Authorization #CMS #FHIR