A Nurse’s Seat at the Table: Reflections on One Year Inside the CMS Health Tech Ecosystem

If this is the first time you’re reading something I’ve written for Nurse.org, an introduction is probably appropriate.

I’m an emergency department registered nurse, healthcare advocate, and the founder of Safe Staff, a nonprofit organization focused on healthcare workforce safety through transparency, secure documentation, and data. I still see healthcare very much through the eyes of a bedside nurse: the twelve-hour shifts, critically ill patients, staffing challenges, and constant workarounds required to deliver good care inside a system that often feels unnecessarily difficult to navigate.

Over the last several years, however, my work has increasingly taken me outside the walls of the hospital and into conversations about healthcare policy, technology, workforce safety, and what the future of our profession should look like.

One of the people who first introduced me to that much bigger world was Amy Gleason, the nurse who served as acting administrator of the Department of Government Efficiency (DOGE) and is a strategic advisor at CMS.

When I interviewed Amy, she introduced me to the CMS Health Tech Ecosystem and told me something that immediately caught my attention: they needed more nurses involved.

Amy’s interest in modernizing healthcare is also deeply personal. Her daughter required frequent interactions with the healthcare system, giving Amy a firsthand view of just how fragmented and technologically outdated the experience can be for patients and families. Her goal is ambitious but surprisingly simple: healthcare should function more like the modern world around it.

Patients shouldn’t repeatedly fill out the same clipboard. Their medical information shouldn’t become trapped inside individual health systems. Clinicians shouldn’t rely on faxes and disconnected portals to piece together a patient’s history. And accessing healthcare shouldn’t feel technologically decades behind nearly every other part of our lives.

That conversation ultimately led me to become involved with the CMS Health Tech Ecosystem myself. Safe Staff is one of the healthcare technology platforms participating in the CMS Health Tech Ecosystem, and I participate as both its founder and a frontline nursing voice, bringing the healthcare workforce perspective into conversations that have traditionally focused primarily on patients, providers, and health systems.

One year later, I’ve had the opportunity to watch an idea about modernizing healthcare begin turning into something much more tangible.

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For nurses who may be unfamiliar with it, the CMS Health Tech Ecosystem is an effort to bring together healthcare organizations, technology companies, clinicians, government agencies, payers, data networks, entrepreneurs, and innovators around a shared goal: creating a more connected, patient-centered healthcare system.

Instead of relying solely on new regulations, CMS is asking organizations to voluntarily align around common technical and interoperability standards and then build products that actually use them.

The distinction is important.

Healthcare doesn’t necessarily suffer from a shortage of technology. We have EHRs, patient portals, apps, data networks, artificial intelligence tools, scheduling systems, insurance platforms, and countless other technologies.

The problem is that many of them still don’t communicate particularly well with one another.

The Ecosystem is attempting to change that.

More than 700 organizations have now pledged to participate. CMS has established categories for data networks, EHR developers, health systems and providers, payers, government agencies, patients and caregivers, and several types of patient-facing applications.

But the most important development over the past year isn’t how many organizations signed up.

It’s that we’re beginning to see what they actually built.

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In April, CMS held its HealthTech Ecosystem Live! First Wave Launch, showcasing tools from more than 50 companies that were already available or approaching public availability.

One of the most recognizable initiatives is “Kill the Clipboard.”

The concept is exactly what it sounds like.

Instead of arriving at a new healthcare facility and attempting to remember your medication list, diagnoses, surgeries, allergies, and medical history yet again, patients could retrieve their health information and securely share it with a provider using technologies such as QR codes and SMART Health Cards or Links.

Under the CMS framework, that information can be exchanged using FHIR, a standardized method of allowing healthcare systems and applications to communicate with one another.

And importantly, this isn’t limited to small healthcare startups experimenting with new technology.

Major EHR companies and healthcare technology organizations have pledged to participate, including Epic, Oracle Health, athenahealth, eClinicalWorks, and others. Health systems and providers are also pledging to connect to CMS Aligned Networks and accept patient-provided health information through these new workflows.

CMS has also launched the Medicare App Library, creating a pathway for vetted health applications that connect to CMS Aligned Networks. Initial use cases include Kill the Clipboard, conversational AI assistants, and tools focused on diabetes and obesity prevention and management.

The larger vision is that a patient could choose trusted applications capable of accessing their healthcare information, with their permission, and then use that information to help manage their health.

That vision hasn’t been without questions. Privacy advocates have raised concerns about what patient data technology companies could access under this model, and CMS points to its vetting standards for security, privacy, and clinical evidence as the safeguard. I think those questions deserve continued attention, and they’re part of why clinicians need to stay involved rather than watch from the outside.

CMS has also developed an Interoperability Framework establishing common expectations for how participating networks exchange information. CMS Aligned Networks are intended to make health information available securely across organizations so that patients, providers, and approved applications can access the information they need without being limited by the particular health system where that information originated.

That infrastructure may not sound particularly exciting until you consider what it could mean clinically.

A patient arrives unconscious in an emergency department hundreds of miles from home.

Instead of depending entirely on family members, medication bottles, incomplete records, or phone calls to another hospital, imagine a healthcare system where authorized clinicians can rapidly retrieve the information necessary to care for that patient.

That is what interoperability looks like when you take it out of a policy document and put it at the bedside.

The Ecosystem has also expanded beyond patient-facing applications.

Electronic prior authorization was recently added as another major use case. Twenty-nine healthcare organizations, including health systems, EHR developers, physician practices, networks, and digital health companies, joined CMS as early adopters working to solve the technical and workflow problems that have made prior authorization so burdensome.

CMS estimates that requesting prior authorizations can consume approximately 13 hours of a provider’s time every week, representing roughly 700 hours annually that could otherwise be spent caring for patients.

The goal isn’t simply to turn a paper prior authorization into a digital prior authorization.

It’s to build an end-to-end process where the EHR, payer, provider, and underlying health information can communicate electronically.

For those of us who have worked clinically, this is where healthcare technology becomes much more interesting. Technology isn’t valuable because it’s new. It’s valuable when it removes something inefficient from the healthcare system.

As exciting as these advancements have been, participating in this work has reinforced something I’ve believed throughout my nursing career: we cannot transform the patient experience without also transforming the experience of the healthcare workforce responsible for delivering that care.

The Health Tech Ecosystem is intentionally patient-centered. It should be.

Patients should control their health information. Records should follow them. Technology should reduce administrative burden. Accessing healthcare shouldn’t require navigating disconnected systems or repeating the same information at every encounter.

But every one of those innovations eventually intersects with a healthcare professional.

And that’s why I believe there is an enormous opportunity for the Ecosystem’s next chapter: workforce-facing healthcare technology.

Nurses are still working inside systems where staffing and scheduling can require enormous amounts of manual work. Workplace violence incidents and safety concerns are documented across fragmented systems. Hospitals struggle with recruitment and retention while valuable information about why nurses leave often disappears with them. Nurses encounter inefficient workflows every day that technology could potentially solve.

There are already innovators building solutions to these problems. In full transparency, this is the space my own organization works in, so I have a stake in this argument as well as a belief in it.

What we don’t yet have is a clearly defined national lane that brings those innovators together with nurses, healthcare organizations, technology companies, and federal leaders in the same way CMS has begun doing around patient-facing technology.

And I think we should.

Because workforce technology is patient technology.

A nurse caring for an unsafe number of patients cannot provide the same care as one with an appropriate workload. A clinician spending unnecessary hours fighting technology has less time for patients. Scheduling inefficiencies, workplace violence, administrative burden, burnout, and turnover eventually become patient-care problems.

Improving the healthcare workforce isn’t separate from building a patient-centered healthcare system.

It’s one of the prerequisites for achieving one.

Perhaps the most encouraging thing Amy said to me during that first conversation wasn’t about AI, interoperability, or any particular technology.

It was that they needed nurses.

Nurses spend thousands of hours inside the workflows healthcare technology is supposed to improve. We know which processes waste time. We know where information gets lost. We know which “solutions” create three new problems. And we often recognize safety risks and inefficiencies long before they appear in an administrative report.

That experience is expertise.

Yet historically, nurses have often entered the healthcare technology process near the end: someone designs a product, someone purchases it, and then nurses are taught how to use it.

We need to reverse that order.

Bring nurses into the room when the problem is being defined.

Healthcare has never lacked passionate people or brilliant ideas. What it has often lacked is a place where those people can work together.

One year after Amy Gleason first introduced me to the CMS Health Tech Ecosystem, I understand why she was so excited about what they were trying to build.

And after watching what’s happened over the past year, I share some of that optimism.

Not because technology alone will fix healthcare. It won’t.

But bringing together the people who understand the problems with the people capable of building solutions is a very good place to start.

I’m grateful nurses have a seat at that table.

Now I want to make sure we bring more chairs.

Because the future of healthcare shouldn’t just be built for nurses.

It should be built with them.

Disclosure: The author is the founder of Safe Staff, a nonprofit focused on healthcare workforce safety through transparency, documentation, and data. Nurse.org received no compensation for this article.

🤔 Nurses: if a national health tech initiative took on one workforce problem first, what should it be? Tell us what you think in the comments below.