By Mark Scrimshire, Chief Interoperability Officer, Onyx
There’s been lively discussion on LinkedIn lately about whether healthcare standards like FHIR and SMART-on-FHIR do more harm than good inside a single organization. Brendan Keeler raised a fair question: if standards are meant to connect systems between organizations, do they actually slow down innovation within them?
As he put it, “Standards are good for cross-organization exchange, but at best a nice-to-have for intra-enterprise, and often detrimental.” His argument resonates with many developers who have battled with sluggish SMART launches, lagging ETL data, and standards that sometimes feel more like compliance checkboxes than enablers of real-world workflows.
But when it comes to payers, the definition of “intra-enterprise” gets complicated — and that changes the equation entirely.
The Payer Reality: One Enterprise, Many Systems
Inside most payer organizations, “intra-enterprise” doesn’t mean one unified platform. It means a complex ecosystem of systems — claims, member management, care coordination, utilization management — often from different vendors, each with their own APIs and data models.
As payers work to comply with CMS-0057, these silos are being forced to interact in ways they never had to before. Consider prior authorization: to meet the Da Vinci standards, a payer must support a series of FHIR-based APIs spanning multiple implementation guides (CRD, DTR, PAS, and CDex).
The challenge? Each function may live in a different internal or third-party system. Without shared standards, every connection between these systems becomes a one-off custom integration. Multiply that by hundreds of payers and vendors, and the problem scales exponentially.
That’s not efficiency — it’s entropy.
Why Standards Still Matter
When each vendor publishes proprietary APIs, payers are left maintaining dozens of brittle, vendor-specific integrations. Standards like the Da Vinci implementation guides don’t eliminate complexity, but they give the industry a common grammar for exchange.
For payers, this consistency is the difference between managing an ever-growing list of bespoke connections and being able to test, validate, and reuse integrations across lines of business and partners.
The key is to focus on API-level compliance, not just certification of entire platforms. Compliance ensures that systems speak the same FHIR dialect at defined hand-off points, enabling standards-based testing and reliable interoperability. Certification alone doesn’t guarantee that real-world integrations will actually work.
A Scalable Path Forward
At Onyx, we see this every day as we help payers implement CMS-0057 APIs. Our work with utilization-management vendors, clearinghouses, and core platforms shows that standards are the only viable path to scalability. Proprietary shortcuts may seem faster in the short term, but they lock organizations into costly maintenance and fragile dependencies later.
The better approach — and the one CMS-0057 is nudging the industry toward — is standards-based integration backed by rigorous testing. That’s how we turn compliance into capability.
Finding Balance: Standards + Usability
Brendan raises an important point — developer experience matters. Standards must evolve to be more usable, testable, and aligned with real-world data models. His perspective reflects the frustrations many implementers face when compliance feels disconnected from workflow reality.
At the same time, abandoning standards altogether isn’t the answer — especially for payers navigating multi-system architectures and regulatory deadlines.
The answer isn’t to choose between standards and speed, but to make interoperability practical for everyone involved — payers, vendors, and developers alike. When standards are implemented with usability and scale in mind, interoperability becomes more than compliance — it becomes a competitive advantage.
At Onyx, that’s the standard we’re building toward every day.
Interoperability is Evolving Fast, and We’re All Learning Together
If your organization is working through CMS-0057 implementation, we’d love to share what we’ve learned from helping payers of all sizes accelerate interoperability, without adding complexity.
Take our CMS-0057 Readiness Check to see where you stand and identify quick wins.
Or just reach to us info@onyxhealth.io out we’re always happy to compare notes and help you plan your next step.
Follow Onyx on LinkedIn for more real-world insights from our interoperability experts.