Advisory committee OKs standards work group to draft state FHIR roadmap

The Data Exchange Framework Stakeholder Advisory Committee voted unanimously Wednesday to ask staff to convene a standards work group to draft a California roadmap for adoption of the Fast Healthcare Interoperability Resources standard, commonly known as FHIR.

Supporters said the work group can help the state align with federal momentum on modern interoperability while minimizing harm to under-resourced providers. “FHIR is the future of health data exchange,” Rim Catherine, a subject-matter consultant, told the committee during a technical briefing on federal activity and adoption roadmaps.

The committee’s vote followed a multi-hour discussion that balanced several trade-offs: push broad, early mandates that would accelerate technical alignment but risk overwhelming small providers and community-based organizations; or promote phased, use-case-driven adoption, giving priority to early wins such as event (ADT) notifications. Committee members repeatedly raised the cost and readiness problems for social-service organizations, skilled-nursing facilities and small ambulatory practices.

Under the motion adopted by the advisory panel, HAI (the state’s health information office) will convene a 10–15 person standards work group in 2026 made up of technical and operational experts. The work group will be charged with producing a draft FHIR roadmap that identifies prioritized use cases, recommended content standards, suggested timelines and staged milestones for different participant types. That draft will be returned to the full advisory committee for review in early 2027.

“Use cases matter,” said Lucy Sains, who represents community health centers. She urged the group to prioritize FHIR work that helps practices move from document exchange (PDFs/CCDs) toward data that supports value-based care and quality measurement.

Staff outlined federal activity that has increased urgency for state-level planning: ONC’s EHR certification now requires FHIR capability, and CMS rules are increasingly using FHIR for payer-provider exchanges, notably for prior authorization. FHIR adoption is uneven, however; the state’s presentation noted that while many payers are investing in FHIR to meet federal requirements, most provider systems and many regional intermediaries still rely on legacy HL7 messaging.

To bridge that gap, the work group will consider phased approaches and whether the state should recommend staged requirements (for example, making ADT/event notification the first required FHIR-enabled use case) or instead focus on incentives and technical support for smaller providers. The committee specifically directed staff to factor in federal timelines when building the state roadmap so California’s milestones align where possible with CMS and ONC requirements.

The motion was moved by Mark Savage and seconded by Scott McDonald. The committee recorded the motion as approved; members present said they would return to review the standards work group’s draft in early 2027. The work group convening and the July 16 jurisdictional webinar announced by staff are the immediate next steps.

The committee also heard public comment urging early, pragmatic steps: vendors and provider representatives proposed piloting FHIR for ADT exchange and using FHIR APIs to reduce the large roster transfers that currently burden intermediaries. HAI staff said the July webinar will highlight other states’ approaches and that the work group will be asked to incorporate those lessons.

The advisory committee did not set any immediate statewide mandates as part of the vote. Instead the approved next step is the technical work group to develop a draft, including milestones and a staged timeline, for full committee consideration in early 2027.