By Jay Nakashima, President at eHealth Exchange
As we move beyond the first month of 2026, the start of the year feels less like a beginning and more like a moment to take stock. Looking back at 2025, I’m struck by how dynamic and consequential the past year has been for interoperability, public health, and trusted data exchange. It’s also a fitting time to reflect on leadership, continuity, and what it means to prepare an organization for what comes next. I’m looking ahead with optimism at what 2026 will bring for our network, our participants, and the broader healthcare ecosystem.
2025: A Defining Year for Interoperability
2025 was another intense year in our “little interoperability space.” We saw continued cyberattacks, ransomware events, and system downtime across the healthcare sector, luckily not involving eHealth Exchange—sobering reminders of how critical security, privacy and resilience are to patient care. At the same time, federal policy and enforcement evolved: information blocking enforcement gained momentum, TEFCA™ expanded to eleven designated QHINs™, and CMS introduced its Health Tech Ecosystem initiative, including CMS-Aligned Networks.
Against this backdrop, eHealth Exchange continued to do what it has done for nearly 20 years: facilitate trusted, secure, and high-quality exchange at national scale. Today, our participants exchange more than 25 billion transactions annually, supporting care for 300+ million patients, with 99.999% uptime—and we do it while storing zero patient data. That trust model is not incidental; it is foundational to who we are.
Expanding Beyond Treatment Exchange
While treatment remains the majority of exchange on our network, 2025 marked meaningful progress in expanding non-treatment use cases—particularly for public health and trusted payer-provider exchange. Electronic case reporting volumes more than doubled, helping public health agencies nationwide receive timely, actionable data. We also reached a long-anticipated milestone with Bulk FHIR, now in production, enabling authorized exchange for entire populations or rosters of members and supporting use cases like quality measurement and value-based care.
Another highlight was the successful go-live of the NIH “All of Us” Research Program, made possible through collaboration with OCHIN, Cedars-Sinai, Manifest MedEx, and the University of North Carolina Chapel Hill. All exchange occurs pursuant to patient authorizations, reinforcing that trust and consent remain at the center of everything we do.
Trust, Transparency, and Data Quality
Trust continues to serve as our differentiator. eHealth Exchange never stores data, never tracks patient movements, and never uses or sells data for secondary purposes. Our network is governed by providers, HIEs, and federal agencies—not vendors—and participants must pass rigorous content validation to ensure data is truly usable.
In 2025, we advanced real-world PHI conformance validation, supported USCDI v3, and laid the groundwork for expanded FHIR-based content validation. We also enhanced transparency, helping participants better understand who they are exchanging with, why data is requested, and how it is used.
Looking Ahead to 2026
As we look to 2026, our strategy is clear and consistent: modernize trusted exchange beyond treatment using scalable, standards-based APIs.
Key areas of focus include:
- Public Health Modernization: Transitioning electronic case reporting and case investigations to FHIR, expanding FDA adverse event exchange, and advancing immunization data exchange.
- Payer–Provider Exchange: Increasing adoption of Bulk FHIR, prior authorization and clinical data exchange (Da Vinci CDex/PDex) for quality improvement, and payer-to-payer data sharing.
- TEFCA and CMS-Aligned Networks: Supporting new TEFCA use cases, such as government benefits determinations, while also engaging as a CMS-Aligned Network.
- Data Quality and Transparency: Advancing USCDI v3 validation, FHIR content testing, and enhanced dashboard capabilities that clearly display purpose of use and transaction types.
The strategy we set several years ago is working, and the opportunity ahead is even greater —not just to expand interoperability, but to do so with intention. As new use cases emerge and policy expectations evolve, trusted governance, transparency, and data quality will matter more than ever. We are committed to leading in these areas while continuing to listen, adapt, and collaborate.
None of this progress happens in isolation. I encourage our participants and partners to engage with us as we move forward—whether that’s exploring new FHIR-based use cases, advancing public health exchange, or shaping how payer and provider data can be shared responsibly. Together, we can ensure interoperability continues to mature in ways that deliver real value to patients, clinicians, and communities.
A Personal Note
As I think about the future, I also want to share a personal update. As I announced in 2025, I will retire from my role as President of eHealth Exchange in July 2026. Leading this organization has been the privilege of my professional life. I am incredibly proud of what our staff, board, Coordinating Committee, and participants have built together—and I am deeply grateful for the trust you place in us every day.
With that in mind, eHealth Exchange has begun the search for its next President. We are looking for a leader who shares our commitment to trusted interoperability for the public good, trusted governance, and collaboration across the healthcare ecosystem. Details about the open role are available, and I encourage interested candidates—or those who know someone who would be a great fit—to learn more and engage with us.
Thank you for being part of this journey. I look forward to working alongside you throughout 2026 as we continue to strengthen the network—and as we prepare for the next chapter of leadership at eHealth Exchange.
