ONC's HTI-5 Rule Cuts Health-IT Compliance Costs by $1.5 Billion

ONC eliminates $1.5 billion in regulatory costs starting December 2026

The U.S. Office of the National Coordinator for Health IT finalized the HTI-5 rule on October 26, cutting projected industry compliance costs by more than $1.5 billion. The rule takes effect December 28, 2026, with additional provisions starting January 1, 2027.

The rule reduces certification requirements for ONC-certified health IT, interoperability APIs, and electronic health information exchange. It lowers compliance overhead for established vendors including Epic, Oracle Health, and MEDITECH, while reducing entry costs for smaller FHIR and API vendors.

Health systems and payers should revisit 2027 compliance budgets and vendor roadmaps now. Lower certification costs will likely increase vendor competition, but buyers will need stronger contractual language for API conformance, security, version support, and data portability. Regulatory certification will provide less of a proxy for product maturity after the rule takes effect.

The phased effective dates create near-term procurement risk. Buyers need to map which purchasing requirements depend on current certification rules and which change after January 2027. Organizations with vendor selections scheduled for mid-2026 should clarify how HTI-5 affects roadmap commitments and compliance timelines.

Humana embeds prior authorization in athenaOne for 180,000 clinicians

Humana and athenahealth expanded electronic prior authorization through athenaOne, reaching more than 180,000 physicians and clinicians nationwide. The deployment uses HL7 Da Vinci interoperability standards: Coverage Requirements Discovery (CRD), Documentation Templates and Rules (DTR), and Prior Authorization Support (PAS).

The workflow handles eligibility discovery, documentation, electronic submission, and payer decisions inside the EHR rather than through separate portals. The deployment competes with stand-alone prior-authorization platforms from Cohere Health, Waystar, Availity, and Oracle Health.

Provider organizations using athenaOne can potentially reduce portal switching and custom integration work. Payers evaluating interoperability platforms should treat CRD, DTR, and PAS support as selection criteria, not optional features.

The announcement disclosed no price, denial-reduction percentage, processing-time benchmark, or quantified savings. Buyers should demand transaction volumes, automation rates, turnaround times, and implementation costs before assuming ROI. A single payer-EHR deployment does not prove broad interoperability works. Verify support for multiple payer endpoints, fallback workflows, auditability, and handling of non-FHIR legacy transactions before committing budget.

InterSystems waives FHIR licensing fees for NHS customers

InterSystems will provide FHIR systems-integration tools at no additional cost to NHS customers using its Health Connect platform. NHS organizations will receive access to FHIR profiles as they become available.

The move pressures integration competitors including MuleSoft, Rhapsody, Lyniate, and Microsoft, particularly where buyers compare platform license costs for FHIR enablement. It may shift purchasing decisions toward broader integration-platform capabilities—workflow, governance, monitoring, and legacy HL7 support—rather than FHIR tooling alone.

Existing Health Connect customers can lower incremental FHIR enablement costs and may accelerate interface modernization. New buyers should not treat "free" FHIR tooling as zero total cost. Implementation, testing, terminology mapping, monitoring, support, and migration remain budget items.

InterSystems did not disclose the monetary value of the waived licenses, eligible customer count, implementation timeline, or measurable adoption target. The pricing change is concrete, but its market effect remains difficult to quantify.

What to watch

Reassess certification and interoperability requirements against HTI-5's December 2026 and January 2027 effective dates. Organizations with RFPs closing in 2025 or early 2026 should clarify how vendors will adjust roadmaps and pricing in response to lower certification costs.

Require Da Vinci CRD, DTR, and PAS support in prior-authorization procurements, but insist on independently measured automation and turnaround results. A vendor claiming "FHIR-based prior authorization" without transaction volumes, approval rates, and median processing times is making an incomplete case.

Existing InterSystems customers in the NHS may have a lower-cost path to FHIR adoption. Competing vendors will need to justify integration-platform premiums with measurable workflow, governance, or monitoring advantages.

Across all three developments, the strongest verifiable numbers are the $1.5 billion projected regulatory savings, 180,000-plus clinicians in the Humana-athenahealth deployment, and zero additional FHIR-tool licensing cost for eligible NHS Health Connect customers. Pricing, performance, and adoption data remain insufficient for full ROI comparison. Demand those numbers before signing.