Collective Voice Insights
From EDI to APIs: Lessons from a Career Shaping Health care Interoperability
Michael McNutt, WEDI VP, Education & Events
July 21, 2026
Health care interoperability is often discussed in terms of today's innovations—FHIR APIs, digital health ecosystems, artificial intelligence, and real-time data exchange. Yet every advancement builds upon decades of policy development, industry collaboration, and lessons learned. Understanding where we've been is just as important as understanding where we're going.
On a recent episode of The Collective Voice of Health IT (episode 255), former CMS leader Lorraine Doo reflected on her career helping shape some of health care's most significant interoperability initiatives. From her first day at CMS working on the Attachments Rule to helping advance HIPAA Administrative Simplification standards, supporting the early implementation of Affordable Care Act enrollment standards, and participating in the evolution of the Blue Button initiative, Lorraine offered a unique perspective on how health care data exchange has transformed over the past two decades.
One of the most compelling themes from the conversation was the industry's gradual evolution from traditional EDI transactions to modern API-based interoperability. While administrative transactions remain a critical foundation for health care, today's environment requires a broader approach that supports richer clinical information exchange and greater patient access to health information. Lorraine described how her own thinking evolved as she collaborated with colleagues across CMS to better understand the role of emerging standards such as HL7 FHIR and how they could complement—not replace—the existing HIPAA transaction standards.
That transition required more than adopting new technology. It required changing perspectives.
Rather than viewing administrative standards and interoperability initiatives as separate efforts, organizations increasingly recognized that different standards serve different purposes, all contributing to a more connected health care ecosystem. Breaking down organizational silos and encouraging collaboration across policy, technology, and operational teams became just as important as the standards themselves.
The discussion also served as a reminder that successful policy extends well beyond regulation. Lorraine reflected on the Health Plan Identifier initiative as an example of how implementation can become challenging when operational realities, industry feedback, and education are not fully aligned. The lesson is one that remains highly relevant today: successful health care transformation depends not only on developing sound policy, but also on ensuring stakeholders understand how to implement it effectively.
As health care continues to embrace APIs, prior authorization modernization, TEFCA, artificial intelligence, and other digital initiatives, the conversation reinforced another important principle—technology alone is rarely the limiting factor. Progress depends on thoughtful implementation, high-quality data, operational readiness, and meaningful collaboration between government, standards organizations, payers, providers, vendors, and patients.
Perhaps the greatest takeaway from Lorraine's reflections is that interoperability is not a destination but an ongoing journey. Each generation of standards builds upon the work that came before it, while each new policy creates opportunities to improve how information moves throughout the health care system. Looking ahead, the industry's success will continue to depend on balancing innovation with practical implementation, learning from past experiences, and remaining focused on the ultimate goal: reducing burden and improving care for patients.
The conversation serves as a valuable reminder that while technologies evolve, the principles behind successful health care transformation remain remarkably consistent—collaboration, education, thoughtful policy, and a commitment to making health care work better for everyone.