In 2026, CARIN focused on improving the standards and workflows that allow consumers to access, use, and share their health and coverage information. This work included updates to the CARIN Blue Button, Digital Insurance Card, and Consumer Real-Time Pharmacy Benefit Check (RTPBC) implementation guides, alongside continued work on digital identity, SMART digital check-in, and the Patient Information Quality Improvement Alliance (PIQI).
Together, these efforts are helping implementers connect standards across consumer and provider workflows and identify where additional guidance is needed.
CARIN Blue Button
CARIN Blue Button STU 2.2.0 was published in March 2026. The update aligned the implementation guide with US Core 7 and included technical corrections and other refinements. The community is now preparing STU 2.2.1 to address issues identified after the publication of 2.2.0.
Work has also begun on STU 3.0.0. Topics under discussion include terminology updates, a provider network identifier, and preparation for the transition to 12-digit National Drug Codes.
Digital Insurance Card and Real-Time Benefits
The CARIN Digital Insurance Card STU 2.0.0 completed the September 2026 HL7 ballot. The update includes guidance for authorization and distribution, integration with Patient Access APIs, support for multiple coverages, consumer exchange, RTPBC, and Summary of Benefits and Coverage information. It also supports newer versions of US Core and the use of the HL7 SMART Health Cards and Links Implementation Guide.
RTPBC STU 2.0.0 was also recently published, adding support for deductible accumulators, formulary status, coverage restrictions, and the next available fill date while maintaining alignment with NCPDP Version 13.0.
At the July 2026 CMS HL7 Connectathon, participants tested the CARIN Digital Insurance Card and RTPBC implementation guides together. Consumer applications used digital coverage information to discover payer endpoints, populate benefit requests, review medication coverage and estimated out-of-pocket costs, compare alternatives, and explore cash and discount pricing.
The testing showed how a digital insurance card can connect a consumer application to other payer services while reducing the information a consumer must enter manually.
CMS Health Tech Ecosystem: Digital Check-In and Real-Time Benefits
The CMS Health Tech Ecosystem is helping move CARIN-related standards and concepts from implementation guides into real-world use. Current work is testing how coverage discovery, benefits information, digital identity, intake, clinical data sharing, digital check-in, and real-time benefits can work together in consumer and provider workflows.
Trust and app evaluation are also becoming part of implementation. In February 2026, DirectTrust and the CARIN Alliance announced that CARIN-CFA accreditation, based on the CARIN Code of Conduct, had been recognized by CMS as an evaluation pathway for participation in the Medicare App Library.
Through the Kill the Clipboard workgroup, participants are testing digital check-in workflows that allow consumers to share relevant health, coverage, and intake information before a visit. Initial 2026 demonstrations showed patient summaries shared as both PDF and FHIR data using SMART Health Links. Some of these capabilities are now being used in real-world settings and are expected to scale over time.
Current testing is expanding to app-initiated and provider-initiated check-in workflows that include sharing USCDI data to pre-populate intake forms, using FHIR questionnaire responses, sharing coverage and benefits information, and using identity credentials instead of portals to log in. The work has also highlighted practical implementation issues that still need to be resolved, which are informing the next phase of testing as the group works toward the November 1, 2026, minimum viable product milestone.
The Real-Time Benefits workgroup is focused on giving consumers clearer coverage and cost information when they are making decisions about care or medications. The workgroup is building on existing standards, including the Digital Insurance Card, RTPBC, and NCPDP standards. Its initial scope includes access to member coverage information, pharmacy benefit details, coverage restrictions, and estimated out-of-pocket costs. The work is also exploring richer benefit information, including cost sharing, network differences, benefit limits, plan identification, and patient-specific pharmacy benefit checks. As the work moves toward broader availability after the first of the year, the workgroup is identifying where additional standards or implementation guidance may be needed to meet the pledge’s intent.
Digital Identity
The CARIN Alliance and the HL7 FAST community continue to coordinate consumer-facing trust and policy work with technical identity standards. The goal is to allow a consumer to use a trusted identity credential across health care instead of completing a separate identity-proofing process for each portal or organization. Current work includes federation, discovery, verified attribute exchange, trust across credential service providers, and caregiver and pediatric relationships.
Patient Information Quality Improvement
The PIQI (Patient Information Quality Improvement)Alliance also reached several milestones in 2026. The PIQI Informative Document 1.0.0 was published, the Framework Implementation Guide 2.0.0 completed the September ballot cycle, and the community tested PIQI at several HL7 FHIR Connectathons in addition to the July CMS Connectathon. Clinical and claims models are now part of the implementation guide work. The community is also developing a governance process to review, test, validate, version, and assess the maturity of new PIQI models.
At the September HL7 FHIR Connectathon, participants explored applying PIQI to aggregated patient information before it enters an EHR, including International Patient Summary content. This work could help identify completeness, conformity, plausibility, and other data quality issues for review before incorporating patient-shared information into clinical workflows.
Next Steps
The CARIN Alliance will continue ballot reconciliation and publication work, expand Connectathon testing, and support the CMS Health Tech Ecosystem workgroups. The Alliance will also continue coordinating work across coverage, benefits, identity, digital check-in, and data quality. For implementers, this work will provide additional opportunities to test how these standards operate together in real-world consumer and provider workflows. For developers, implementation experience and feedback will help identify technical gaps, refine implementation guidance, and inform future updates to the implementation guides.
We welcome continued participation from implementers, developers, patients, payers, providers, policymakers, and technology organizations through CARIN work groups, HL7 ballots, FHIR Connectathons, and implementation testing. This participation remains essential to understanding what works, what needs to change, and where additional standards or guidance are needed.
About the CARIN Alliance
The CARIN Alliance is a nonpartisan, multi-sector HL7 FHIR Accelerator working to advance consumer-directed exchange so individuals and their authorized caregivers can access, use, and share digital health information when, where, and how they choose. Learn more at carinalliance.com. To get involved, contact Ryan Howells at Ryan.Howells@leavittpartners.com or Mark Roberts at Mark.Roberts@leavittpartners.com.
Mark Roberts
Program Project Lead, CARIN Alliance
Ryan Howells
Program Manager, CARIN Alliance