Every day, tens of thousands of patients in seek care for treatment of new or existing conditions. Behind the scenes, a complex net of information about health records, benefits, coverage, eligibility, authorization and other aspects play a crucial role in the type of medical treatment patients will receive and how much they will have to spend on prescription drugs. This means large amounts of data being produced, stored, and exchanged every second, which is also subject of inefficiencies and gaps in its access between patients, providers, and payers given the inconsistencies in how healthcare data interoperability standards are implemented. In the US, these inefficiencies contribute to an increasing healthcare system waste and challenges delivering cost-effective quality care. For over 20 years, the discussion of how to address this challenge has permeated the industry without a clear resolution. Just in 2020, the Centers for Medicare and Medicaid Services (CMS) published a rule for healthcare systems whereby patients, providers, and payers must be able to easily exchange information. The rule laid out an interoperability journey that supports seamless data exchange between payers and providers alike — enabling future functionalities and technically incremental use cases. Since 2021, healthcare insurance companies also known as payers, that set service rates, collect payments, process claims, and pay healthcare provider claims, have the obligation to comply with the interoperability requirements set in 2020. These requirements enable the exchange of important data between healthcare payers and providers. Establishing a clear interoperability framework is foundational to enabling administrative simplification, one of the five provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). This provision intends to reduce paperwork and streamline business processes across the health care system, leveraging technology to save time and money. With 63% of physicians reporting signs of burnout, and 47% of clinicians planning to leave their jobs in the next two to three years, this provision could not be more timely and relevant as it is right now. When combined with artificial intelligence (AI), an interoperable healthcare data platform has the potential to bring about one of the most transformational changes in history to US healthcare, moving from a system in which events are currently understood and measured in days, weeks, or months into a real-time inter-connected ecosystem. Why is data interoperability an imperative? Simply put, a healthcare ecosystem where all stakeholders can easily exchange information, enables payers and providers to better partner together to deliver high quality and cost-effective care. The return on investment (ROI) as a result of efficiencies gained, reduction of unnecessary medical spend, and improved member experience scores, can be in the hundreds of millions for mid-sized payer with 3 million members. Realizing the benefits of the business case, however, can be a daunting task for stakeholders in the healthcare ecosystem, especially considering the number of requirements and standards that need to be assessed and complied with, including the implementation of the Fast Healthcare Interoperability Resources (FHIR) standard for exchanging health care information. CMS recognizes the importance of FHIR in advancing interoperability and national standards to reduce administrative burden. As healthcare providers and payers are independently assessing the capabilities, maturity, and architectural patterns necessary for FHIR adoption along with the cost of implementation and the impact of adoption on current business processes and analytics, IBM is witnessing different rates of adoption and vastly different enterprise architecture implementation patterns across the industry. Ring 1 provides the capabilities necessary to ingest, standardize and integrate data from disparate sources to create the initial Longitudinal Patient Record (LPR). This “ring” of the solution includes key components for data acquisition, terminology standardization, patient matching (master data management), and persistence of the data in FHIR format. Ring 2 expands the capabilities of the FHIR data platform to perform calculation of Data Exchange for Quality Measures (DEQM). These capabilities are needed to establish patient attribution, identify individual patients with gaps in care, and update the patient care plan with the necessary actions to address the patient risks and care gaps. This also supports the capabilities to … (text truncated)