BIONEWS
A year in, the agency's most honest progress report is a coffin labeled 'RIP CLIPBOARD,' and eight new voluntary pledge categories extend the same regime that has not yet moved the form out of the waiting room.
At HHS (the Department of Health and Human Services) headquarters in late July, federal health officials staged a funeral for the medical clipboard. The props were a cardboard coffin labeled "RIP CLIPBOARD," a brass-band rendition of "When the Saints Go Marching In," and a "whodunit" segment hosted by Medicare official Zac Jiwa, who walked onstage and asked, "So who killed the clipboard?" Health IT officials in turn read from cue cards denying responsibility for various data initiatives. The skit was the kickoff for Medicare's one-year stock-taking of its Health Technology Ecosystem initiative.
The Health Technology Ecosystem is the federal Medicare push to make digital health records follow patients between doctors, hospitals, and apps. In July 2025, the Centers for Medicare and Medicaid Services (CMS) gathered White House tech leaders and major industry players for a set of voluntary pledges on interoperability standards, health information exchange networks, electronic health records, and patient-facing apps. A year later, the agency is now adding eight new pledge categories to that same voluntary regime.
The original July 2025 commitments were not regulations. They were voluntary promises by hospitals, electronic health record (EHR) vendors, payers, and app developers to make their systems talk to each other so that a primary care doctor, a specialist, and a hospital could all see the same patient record. The point was to end the routine of a patient filling out the same intake form at three different offices, or of an MRI taken at one hospital not being visible to a specialist down the street.
CMS's categories page now lists the working taxonomy for the next phase. The eight new categories extend the voluntary model into more specific domains: app functionality, identity and patient matching, data usability, and similar sub-areas. Trade publication NextGov covered the same event as adding seven new industry pledges, a number that may reflect a count of distinct signers versus category types. Either way, the structure is the same: more rows on the pledge form, not new enforcement authority.
Federal officials, in costume, admitted in front of an audience that a year of voluntary pledges has not yet killed the clipboard. Patients still know the routine the skit was mocking: handing over insurance cards and filling out the same medical history at every new provider. Hospital systems still export records in formats the next provider's system cannot always read.
This is what makes the eight new categories worth reading as policy rather than press release filler. Legal analysis from Hogan Lovells describes the Health Technology Ecosystem as a move "from vision to deployment," but the deployment is still contractual, not regulatory. There are no CMS penalties for failing to deliver on a pledge. There is no compliance audit. There is no public scoreboard of which signers have shipped interoperability and which have not. The eight new categories add rows to the spreadsheet, not teeth to the rule.
For a patient, the stakes are concrete. If the regime works, the next visit to a new doctor starts with the provider already holding the records from the last one. Lab results, imaging, medication lists, and allergies follow the patient rather than living in siloed portals. If the regime does not work, the form stays. The clipboard is the visible marker of an information system that still does not treat the patient as the unit of data.
The next twelve months will be the test. CMS has two options when the year-two stock-taking arrives. It can name the companies that did not deliver, publish the measurable gaps, and move the regime from voluntary pledges to enforceable interoperability requirements. Or it can extend the same voluntary model with another round of categories. The agency's first-wave ecosystem plans suggest both paths are still on the table. The clipboard's funeral was a press conference. Year two is the moment the agency either buries the form for real, or buries another cardboard coffin.