SME: Tone Southerland, Chief Strategy Officer
Healthcare interoperability is fragmented. It has been for many years, and while we are seeing pockets of improvement, and certainly more connectivity than existed 20+ years ago, we are also in a position of having more data exchange happening due to general advancement of technology and programs like Meaningful Use, but this data exchange is not always happening in a semantically meaningful way.
The Meaningful Use Program advanced healthcare interoperability in an unprecedented way, and led to the adoption of EHR technology very broadly across the industry. However, health plans did not benefit in this same way as they have always operated under separate federal directives from CMS.
Compliance is king in the payer world, and there are limited standardized certifications that health plan apps and platforms can test against. This results in a strong focus on meeting CMS requirements while navigating an environment of ongoing federal and state oversight and compliance reviews—all without the assurance that comes from pre-validated certification processes.
It’s time to change the state of operation in the complex health plan ecosystem, don’t you think? That’s exactly our goal with CoCo – we are democratizing the health plan interoperability ecosystem with a vendor-neutral, standards-aligned, community-maintained schema. We aim to level the playing field and ensure health plan and healthcare organizations of all sizes can achieve compliance and semantic interoperability without reinventing the wheel.
The Challenge Today
Data fragmentation exists today across the board, and for many reasons. This could be due to a series of mergers and acquisitions for a particular health plan vendor, or could be because of a homegrown system that evolved over time. Fragmentation can also exist due to poor data egress interface solutions plugged into health plan ecosystems.
Even when data management is well-handled, there is no unified, field-level canonical model that industry partners can rely upon. The many Implementation Guides and Profiles being produced by HL7 through accelerators like Da Vinci FHIR are aiming for this, but these are extremely complicated undertakings, and they are still changing.
Dealing with fragmentation means higher costs, whether immediately during an implementation, or down the line when health care is negatively impacted because of fragmented data availability. In addition, the opportunity for out-of-compliance issues also tends to increase. Incomplete data availability in CMS mandated API such as Patient Access or Prior Authorization means audit challenges.
We need an interim and intermediary solution to bridge the gap.
What is CoCo and How does it help?
What is CoCo?
CoCo stands for Compliance Open Source Canonical Offering. It is an open source canonical solution designed to bridge the gap between health plan capabilities and CMS compliance requirements for CMS-9115-F and CMS-0057-F. Under an Apache 2.0 license, CoCo will be freely available for anyone to use, aligning with other HL7 tooling and the broader healthcare IT open source ecosystem. This open source project includes our production-used canonical schema models that power our own HealthLX Custos CMS compliance product.
Key Benefits
CoCo delivers value to the healthcare ecosystem by accelerating compliance, reducing fragmentation, enabling innovation, and fostering community are all value adds to the larger healthcare ecosystem.
Accelerate compliance – Health plan organizations face continued pressure to CMS regulatory deadlines while managing limited resources and competing priorities. CoCo’s ready-to-use canonical schemas can shorten implementation time for CMS rules, allowing organizations to meet regulatory requirements faster and with greater confidence.
Reduce fragmentation – The healthcare data landscape is plagued by fragmentation, with each vendor, payer, and provider creating their own proprietary, one-off mappings that do not communicate with each other. This ultimately leads to increased implementation complexity and higher costs. CoCo provides a unified, community-governed schema that serves as a convergence point with other healthcare data standards. By aligning with complementary models used by other major industry players and mapping to FHIR, CoCo helps create interoperability bridges that reduce redundant work and enable more efficient data exchange across the healthcare ecosystem.
Enable innovation – CoCo establishes a stable foundation for new use cases that extend far beyond basic regulatory requirements. Organizations can build on this foundation to tackle emerging challenges like Prior Authorization automation, Provider Access APIs, and Payer-to-Payer data exchanges. While the ever-changing nature of healthcare means the data transformation problem will never be fully solved, getting 80%+ of the way there allows innovators to focus on creating new solutions rather than wrestling with data plumbing. This means each new use case becomes easier to implement, accelerating innovation across the healthcare industry.
Foster community – Healthcare interoperability is not a problem any single organization can solve alone—it requires collective intelligence and continuous evolution. CoCo builds a contributor ecosystem where healthcare data practitioners, vendors, payers, and providers can share knowledge, contribute improvements, and shape the future of healthcare data standards. This community-driven approach ensures the schema evolves dynamically with changing regulations and emerging standards like HL7 FHIR. By gathering around this focused problem space and aligning our efforts, we amplify our collective voice in the HL7 community, driving effective change when and where it’s needed most.
So.. What’s Next?
The path to truly interoperable healthcare data has been long and challenging, but CoCo represents a practical step forward. By open-sourcing production-tested canonical schemas and fostering a collaborative community, we can finally move beyond the costly cycle of proprietary, one-off implementations that have held our industry back. Whether you’re a health plan struggling with compliance timelines, a vendor looking to reduce integration complexity, or a healthcare data practitioner tired of reinventing the same solutions, CoCo offers a foundation we can build on together.
The work ahead is significant, but by aligning our efforts around shared standards and pooling our collective expertise, we can accelerate progress for everyone. We invite you to explore the project at cocodata.org, join the conversation, and help shape the future of healthcare interoperability. Together, we can transform fragmentation into collaboration and compliance into innovation. Stay tuned for updates to our projected roadmap and a deeper dive into features that will be shipped with CoCo.