< + > HTI-5: Less Red Tape, More AI Flexibility for HTI-4’s Complex Requirements – Regulatory Talk Series

The following is a guest article by Nick Barger, PharmD, Vice President, Product at DrFirst.  This article is the next in the Healthcare Regulatory Talk series.

On December 22, the Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology (ASTP/ONC) dropped the Health Data, Technology, and Interoperability (HTI-5) proposed rule.

And while the timing lived up to the ONC’s nickname as the “Office of No Christmas” (for its history of announcing regulatory changes toward the end of the year), the rule isn’t the “bah humbug” that EHR and health IT vendors have come to expect. Instead of adding compliance requirements, it takes some away.

With HTI-5, the ASTP/ONC seeks to “reduce burden, offer flexibility to both developers and providers, and support innovation through the removal and revisions of certain certification criteria and regulatory provisions.” If finalized, it would eliminate 34 of 60 criteria in the Certified Health IT Program, relax requirements around AI systems, and make it easier for patients to access their own health data.

The public comment period runs until February 27, 2026, with the final rule expected to match up with existing compliance timelines.

HTI-4 Deadlines Still in Place

Mandates for real-time prescription benefit (RTPB) checks, electronic prior authorization (ePA), and National Council for Prescription Drug Programs (NCPDP) SCRIPT Standards remain in place.

A reduction in administrative overhead from HTI-5 means vendors can increase their focus on improving e-prescribing workflows, benefiting prescribers, pharmacies, payers, and, most importantly, patients.

The goals of HTI-4 are unchanged, so it’s full speed ahead for the timeline and deadlines:

• Now through 2027. Complete RTPB and ePA development, certify all required features, and begin the testing phase.
• From 2026-2027. E-prescribing systems can still use SCRIPT 2017071 or 2023011.
• January 1, 2028. SCRIPT 2023011 required.
• January 1, 2028. RTPB becomes mandatory for Base EHR certification.

Beyond Checking the Box

As a vendor, you have a great deal of work to do in the next two years but also some intriguing opportunities for innovation. Now is the time to make thoughtful decisions — will you meet minimum requirements or will you aim to improve real-world clinical workflows in a way that goes above and beyond?

Despite advances, physicians and pharmacists continue to grapple with interruptions and rework. Without key information readily available in the prescribing workflow, patients encounter delays that prevent timely access to therapy. This leads to the time-consuming ping pong of back-and-forth communications: phone calls to verify prescription information, faxes requesting prior authorization, and messages about formulary alternatives. Each exchange delays fulfillment and adds more friction for providers and patients.

Prescription orchestration capabilities from DrFirst address the needs of pharmacies, pharmacy benefit managers (PBMs), electronic health records (EHRs), providers, and patients.

Real-time workflow alignment ensures that all healthcare stakeholders automatically access necessary information—resolving issues pre-emptively so prescriptions reach the pharmacy ready to fill.  Simply passing data between doctor and pharmacy doesn’t cut it anymore, and recognizing that a new approach is needed is where the real opportunity lies.

The Bottom Line

HTI-4’s medication management requirements remain unchanged and urgent, and whether you decide to build or buy, the clock is ticking. RTPB and ePA will enable fundamental changes in how medications are prescribed, approved, and managed across healthcare systems.

Consider the significant resources it will take to build complex RTPB and ePA capabilities mandated by HTI-4 from scratch. You might decide to work with a trusted partner like DrFirst so you don’t have to sacrifice product differentiation in favor of compliance. Either way, look at this as an opportunity to level up your e-prescribing game.

If you’re looking to shift your strategy in the face of HTI-5 and learn about intelligent workflow innovations that go above and beyond the regulatory mandates of HTI-4, reach out to speak to one of our experts.

About Nick Barger, PharmD 

Nick is Vice President of Product at DrFirst, where he leads design and development of intelligent medication management solutions for the e-prescribing pioneer and the 270 EHRs and health information systems they partner with, providing clinical, regulatory, and digital workflow solutions that make healthcare more efficient and effective. Check out all the articles in the Healthcare Regulatory Talk series.

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