By: Ali Modaressi
When healthcare leaders talk about the future of data exchange, the conversation often turns quickly to technology: better standards, modern APIs, artificial intelligence and new ways to move information. At the second meeting of California’s Data Exchange Framework (DxF) Stakeholder Advisory Committee, another overarching theme surfaced throughout the discussion: the role of trust among California’s healthcare community.
If you’re not already familiar, the committee’s role is to provide information and advice to HCAI on information technology issues and to make recommendations for updates to the DxF and its policies and procedures, including the (Qualified Health Information Organization) QHIO program. The committee will also serve as an advisory body and forum for stakeholders and public engagement on policy decisions, while fostering accountability and transparency. Here’s the link to our summary of the first meeting.
The second meeting covered several critical components of interoperability that are important to our participants and the entire data sharing community through the lens of trust, including: Fast Healthcare Interoperability Resources, (FHIR), admission, discharge and transfer (ADT) notifications, and data sharing.
Here are some of the most important takeaways.
- Trust Begins With Reliability
California’s QHIOs already move a significant amount of information. Together, they receive more than 90 million admission, discharge and transfer messages each quarter and generate approximately 20 million event notifications. (Learn more about LANES Smart Alerts here.)
These notifications can let a care team know when a patient enters or leaves a hospital, creating opportunities to coordinate follow-up care, reconcile medications or offer support after a transition. For providers caring for people with complex medical, behavioral health and social needs, that visibility can be especially valuable.
The discussion also highlighted areas where the system is still developing. About one-third of the connections needed to exchange rosters and events between QHIOs are currently active. Among surveyed participants, 45% receive event notifications, while another 40% are interested but do not yet have the capability. Of those already receiving notifications, 55% reported being satisfied with them.
These findings suggest that trust may depend, in part, on consistent performance. Participants are more likely to rely on statewide exchange when they have confidence that information will remain available, interruptions will be addressed and organizations are working from clear expectations.
- Trust Also Depends on Usefulness
One key finding? More data does not necessarily lead to better care. QHIOs and hospitals alone may process millions of messages, but care teams still need information that is timely, relevant and easy to use. Large rosters, duplicate notifications or alerts without enough context can add to workloads without always improving decision-making. Instead of dozens of pages shared through fax, dozens of pages of a PDF are being sifted through. The outcome is the same.
This finding creates an opportunity to consider the next phase of the DxF not only in terms of connectivity, but also in terms of use. Measures of progress could look at whether information helps providers reach patients sooner, support safer transitions or reduce avoidable utilization.
To improve connectivity, members unanimously supported convening a standards workgroup to develop a statewide FHIR roadmap for review in 2027. FHIR offers the potential for more precise, flexible and modern exchange. This roadmap could also help prioritize practical use cases, align California’s approach with federal timelines and explore ways to measure meaningful use. It may also provide an opportunity to account for the different starting points of health plans, hospitals, physician groups, skilled nursing facilities, counties and community-based organizations.
- New Capabilities Bring New Questions
The committee also looked further ahead, including at the possibility of AI agents accessing and using health information through established exchange networks. These tools could potentially help people find services, identify care gaps or navigate complex health and social service systems. At the same time, they introduce questions about privacy, data leakage, appropriate use and protections for particularly sensitive information.
This emerging area may benefit from early discussion about who can access data, for what purposes and under what safeguards. Participant-verification processes, consent practices and accountability mechanisms could all play a role in shaping how these capabilities develop.
Similar questions are likely to arise as California expands exchange beyond traditional healthcare. Better connections between healthcare and social services could support whole-person care, but they also require careful consideration of consent, identity matching and the exchange of information among organizations governed by different privacy requirements.
Rather than trying to address every possible scenario at once, California may find value in beginning with focused, practical applications and learning from them over time.
Next Steps
QHIOs have become an important part of California’s data-sharing infrastructure, yet the opportunity to improve remains. Continued refinement to reciprocity, oversight, sustainability, service consistency are key, along with support for organizations with fewer resources.
As we prepare for the next meeting, QHIOs and healthcare communities leave with critical standards for defining success and contributing to trust-earning priorities: Did it help a care team take action? Did it support a safer transition? Did it make it easier for a patient to receive coordinated care?
Read more details about the second meeting and future meetings on the DxF Website: https://dxf.chhs.ca.gov/2026/04/stakeholder-advisory-committee-meeting-2-june-18-2026-1000-am-400-pm-pt/