Federal health IT modernization has reached an inflection point. The strategy is defined, but the work now is disciplined execution. Artificial intelligence, interoperability, automation, and analytics remain central to modernization strategies across agencies.
At the AFCEA Bethesda Health IT Summit Preview, however, the emphasis was not on emerging tools. It was on implementation.
Leaders from across the federal health ecosystem, including CMS and NIH, reinforced a reality we see consistently in practice. The strategic direction is largely defined. The challenge now is disciplined execution within statutory mandates, governance frameworks, and acquisition structures.
Modernization in federal health care succeeds when policy, architecture, and operations align.
Prior Authorization and Interoperability: Mandate Meets Operational Reality
Beginning January 1, 2027, certain CMS regulated payers, including Medicare Advantage organizations, state Medicaid and CHIP programs, and Qualified Health Plan issuers on the Federally Facilitated Exchanges, must implement Prior Authorization application programming interfaces to support electronic prior authorization workflows under the CMS Interoperability and Prior Authorization Final Rule. The mandate is clear. The complexity lies in operationalizing it across heterogeneous clinical environments.
Execution requires more than interface development. It demands:
- Governance-aligned architecture from the outset
- Embedded compliance controls, auditability, and role-based access
- Coordination among EHR vendors, payers, and providers
- Real-world workflow validation before broad deployment
- Incremental delivery with measurable checkpoints
Interoperability at scale is not a technical milestone. It is coordinated execution across policy, architecture, and clinical workflow.
Connecting Operational and Research Data with Oversight Intact
The divide between operational clinical data and research data was another central theme. These environments operate under distinct statutory and ethical guardrails. Modernization does not erase those boundaries. It connects them responsibly.
That connection requires clear policy interpretation before technical integration begins. It requires structured data governance models that define stewardship, ownership, and access. It requires enterprise architecture discipline so that data pipelines are sustainable rather than point solutions
At REI, we approach this integration by aligning governance frameworks and architectural design in parallel, ensuring connectivity expands insight without compromising oversight.
Technology enables connectivity. Governance sustains it.
Policy as a Design Input
Frameworks such as HIPAA remain foundational to federal health IT modernization. Even as regulatory structures evolve, privacy, integrity, and oversight remain nonnegotiable.
Speakers referenced modernization efforts within regulatory environments of significant scope. But structural evolution does not eliminate the need for deliberate implementation. Agencies emphasized real-world validation, coordination among standards bodies and vendors, and readiness before scale.
Policy is not a constraint to work around. It is a design input that shapes architecture, sequencing, and delivery.
Governance Aligned Execution in Practice
Disciplined modernization integrates policy interpretation, security requirements, user workflows, and phased delivery from the beginning.
In our work with the U.S. Food and Drug Administration Office of Criminal Investigations, REI modernized a decades-old investigative platform that had reached the limits of its legacy architecture. Replacing a 30-year Oracle Forms system required more than a technical migration. It required aligning new capabilities with strict evidence-handling standards, data-integrity controls, and oversight requirements, while maintaining operational continuity for Special Agents in the field.
Through governance-aligned architecture, incremental deployment, and structured stakeholder engagement, the resulting Case Management and Regulatory System (CMARS) platform modernized case management without disrupting mission operations.
This work reflects a broader principle reinforced at AFCEA: modernization succeeds when policy, security, workflow, and delivery are integrated from the outset. It is the same disciplined methodology we apply across federal modernization efforts to align governance, operational reality, and procurement from day one.
Aligning Technology with Acquisition Reality
Federal modernization does not happen in a vacuum. It unfolds within procurement pathways, budget cycles, and oversight structures.
Agencies are aligning technical strategies with available contract vehicles and funding realities to accelerate responsible delivery. Execution must align policy, architecture, funding, procurement, and oversight simultaneously.
In our experience delivering federal health programs, the acquisition strategy must be integrated from the outset, ensuring technical ambition remains grounded in procurement of feasibility and fiscal reality.
Solutions that ignore any one of these dimensions often stall at the pilot stage. Sustainable modernization depends on alignment across all five.
Delivering Measurable Progress
A consistent signal from federal health leaders was that disruption is not the objective. Agencies are focused on reducing administrative burden, strengthening data stewardship, improving secure connectivity, and effectively implementing statutory requirements.
Proposals centered on artificial intelligence and interoperability will continue. The differentiator is the ability to operationalize defined requirements within governance and acquisition structures and deliver measurable operational improvement.
As REI Systems prepares to sponsor the broader AFCEA Health IT Summit in May, these themes reinforce what we have seen across federal health modernization efforts.
In 2026, progress will not be defined by novelty. It will be defined by execution discipline that aligns policy, architecture, procurement, and mission outcomes.
Modernization endures when delivery is as rigorous as the mission it supports.
