Interoperability’s Next Act: AI, TEFCA, and the Strategic Stakes of the eHealth Exchange Gathering

When the eHealth Exchange convenes its 2025 Annual Meeting in Nashville this November, it won’t just be another interoperability summit. The event will serve as a barometer for how U.S. health data infrastructure is evolving under new pressures, technical, political, and economic. Anchored by keynote remarks from CMS Deputy Administrator Kim Brandt, the gathering arrives at a pivotal moment, with federal modernization efforts accelerating and the commercial sector recalibrating its approach to data exchange, AI integration, and real-world outcomes.

More than a showcase of capability, the meeting’s agenda reflects a shift in posture: interoperability is no longer a compliance burden or an aspirational goal. It is an operational expectation. And its success now hinges less on policy consensus and more on strategic execution.

From Compliance Milestone to Competitive Asset

eHealth Exchange, the nation’s oldest and most expansive health information network, has long been the backbone of federal and interagency data exchange. With Trusted Exchange Framework and Common Agreement (TEFCA) entering its implementation phase, and eHealth Exchange itself recently designated as a Qualified Health Information Network (QHIN), the 2025 meeting is less about convincing stakeholders of interoperability’s value and more about defining what strategic leverage it will offer in the years ahead.

TEFCA’s rollout now intersects with fast-maturing FHIR adoption and expanding real-world use cases for AI in care coordination, payer workflows, and public health surveillance. Sessions like Federal Modernization and AI Action Plan and It Worked for ‘All of Us’ point to a new interoperability narrative, one centered not on access alone, but on applied intelligence, decision support, and research acceleration.

CMS’s Brandt is expected to frame these efforts within the broader Health Technology Ecosystem initiative, signaling that interoperability is no longer confined to HIEs and EHRs. It is foundational to digital modernization across Medicare, Medicaid, and value-based care platforms.

The Real-World Edge: Demonstrations Over Declarations

The agenda’s structure prioritizes demonstrations and applied perspectives over high-level overviews. The session Beyond the Hype: AI in Action will show how artificial intelligence can function inside payer environments, managing unstructured data and augmenting clinical reasoning in real time. This approach reflects a strategic shift: decision-makers are no longer satisfied with theoretical AI models or pilot outcomes. They want proof that systems can operate under live conditions—inside claims platforms, eligibility checks, and clinical authorization pipelines.

Similarly, Meet Public Health TEFCA Innovators will spotlight how the TEFCA framework is being operationalized to support electronic case reporting and early threat detection. The lesson: interoperability is becoming a core function of public health infrastructure, not an external overlay.

These sessions illustrate the evolving expectation from stakeholders, particularly payers and public agencies—that interoperability investments must now yield functional performance, not just compliance metrics.

Messaging, Maturation, and a Changing Advocacy Landscape

The presence of speakers like Erica Olenski of FINN Partners and Kat McDavitt of Innsena points to another evolution: the recognition that interoperability’s success depends as much on persuasive communication and change management as it does on technical standardization.

Olenski’s Healing Healthcare session brings the patient and caregiver perspective to the center, reminding attendees that systems only matter if they serve. McDavitt’s How to Change Someone’s Mind draws from her “Redneck Public Health Series,” challenging assumptions about who the interoperability movement reaches, and how.

In both cases, the message is clear: technical fluency alone won’t win over skeptics or frontline adopters. Interoperability must be translated into relevance, and those leading the charge must become more skilled at storytelling, persuasion, and policy framing.

Strategic Leadership Over Tactical Coordination

Perhaps the most telling session title on the agenda is Stop Doing Stupid Stuff, led by Ryan Howells of Leavitt Partners. It reflects growing fatigue with performative interoperability, endless committee cycles, duplicative processes, and siloed pilots that fail to scale.

Howells and others are calling for a shift from tactical orchestration to strategic leadership: consolidating efforts, measuring impact, and abandoning redundant infrastructure that drains resources without improving care.

This theme mirrors recent critiques from industry groups and federal auditors. A GAO report published earlier this year found that many federal interoperability initiatives still operate without measurable outcomes, raising concerns about return on investment and long-term sustainability.

The Role of eHealth Exchange in a Crowded Connectivity Market

As interoperability matures, the competitive landscape is shifting. Networks like Carequality, CommonWell, and emerging TEFCA QHINs all offer overlapping services. But eHealth Exchange’s legacy position, facilitating over 25 billion exchanges annually across 75 percent of U.S. hospitals and five federal agencies, gives it a scale and credibility few others can match.

Its vendor-agnostic posture and nationwide presence make it a rare neutral convener, capable of aligning federal, commercial, and public health interests. The 2025 Annual Meeting reflects this unique position: part policy summit, part product showcase, and part cross-sector coalition-building forum.

The inclusion of sponsors like InterSystems, supporting the networking reception, also signals a broader alignment between infrastructure vendors and interoperability consortia, a trend likely to intensify as TEFCA participation becomes more operationally consequential.

Interoperability at a Turning Point

The 2025 eHealth Exchange meeting will not resolve all the tensions surrounding interoperability in healthcare. But it may mark the beginning of a new phase, one where connectivity is not treated as a policy compliance checkbox, but as a platform for real-world impact, patient-centered design, and AI-enabled care.

For CIOs, CMIOs, payer executives, and public health strategists, the key takeaway is that interoperability is no longer about “getting ready.” It’s about leading or lagging. And those who treat it as a technical project rather than a strategic differentiator will miss its most valuable outcomes.