The Pitt, the acclaimed 2025 television drama on HBO Max, feels chaotic because much of American healthcare is chaotic. The award-winning series follows a single day in a busy Pittsburgh emergency room and captures the pressure, uncertainty, and emotional weight of a fifteen-hour clinical shift.
Guided by input from real emergency clinicians, the show has earned praise for its realism and unfiltered portrayal of frontline care. Each episode highlights the constant push and pull between urgent medical decisions and the systemic barriers that make those decisions harder.
Overcrowded hallways, missing information, delays in payer communication, and the strain on care teams reflect a reality that clinicians know well. The drama resonates because it exposes a deeper issue that often remains unseen. The nation’s data infrastructure is fragmented, slow, and built on systems that were never designed to support real-time care.
The Hidden Systems Beneath Every Clinical Decision
What looks like emotional tension in each episode often stems from data that’s missing or can’t be retrieved quickly. An ED physician guesses at a medication history because external records won’t load. A nurse calls multiple pharmacies to confirm a chronic prescription. A trauma team repeats tests simply because a patient’s prior imaging is locked inside another provider’s system.
These situations feel dramatic on TV, but they represent everyday experience in US healthcare. Fragmentation is the norm. EHRs, labs, specialists, pharmacies, and payers operate in different data environments. Clinicians often cannot see what they need in real time. As 1upHealth Chief Strategy Officer Dr. Don Rucker has noted, the complexity of modern healthcare requires computerized communications that connect clinical and financial data with minimal human intervention. Yet this infrastructure is still taking hold nationwide.
The result is exactly what The Pitt shows. Delays. Guesswork. Risk.
The Technology That Changes Everything
Healthcare’s opportunity lies not in building more portals or isolated integrations. It lies in standardizing the way data moves across the entire ecosystem. CMS-0057 accelerates this shift by requiring payers to support four key API capabilities that strengthen care coordination and reduce administrative friction. Each component reflects a larger national move toward real-time interoperability.
FHIR APIs
FHIR is the foundational standard behind all CMS-0057 API requirements. It ensures that clinical and administrative data follow a consistent structure, which allows payers, providers, and digital applications to interpret information instantly. This standard is the backbone of every mandated Patient Access, Provider Access, Payer-to-Payer, and Prior Authorization API.
RESTful API Architecture
RESTful APIs define how data is requested and delivered. They give healthcare the same digital infrastructure used in retail, finance, and travel. REST allows systems to exchange information quickly and reliably through simple, standardized HTTP interactions. When paired with FHIR, RESTful APIs create a unified approach for delivering accurate, real-time data inside the clinical workflow.
Patient Access, Provider Access, and Payer-to-Payer Data Exchange APIs
CMS-0057 requires payers to expose clinical, claims, and encounter data through standardized FHIR-based APIs.
- Patient Access APIs give patients direct visibility into their own information through the applications they choose.
- Provider Access APIs allow clinicians to retrieve the data they need for care delivery without manual phone calls or faxed records.
- Payer-to-Payer APIs ensure that a member’s history follows them when coverage changes, preventing care delays and unnecessary repeat tests.
Prior Authorization API
The rule also mandates an API that streamlines the prior authorization process. This API provides automated status updates, standardized documentation requirements, and faster communication between payers and providers. It replaces manual workflows with predictable, electronic exchanges that support timely, informed decision-making.
Together, these technologies create the infrastructure required for a healthcare system where information moves as fast as the decisions that depend on it.
What CMS-0057 Will Change in 2026
CMS-0057 advances the government’s broader mission to eliminate information blocking and accelerate real-time interoperability. By 2026, payers will be required to support several FHIR-based API capabilities that strengthen clinical and operational decision-making.
Key expectations include:
- Automated prior authorization status and documentation via API
- Expanded clinical data exchange between payers and providers
- Standardized reporting on API performance
- Infrastructure that aligns with the 21st Century Cures Act interoperability vision
These requirements move the industry closer to a world where payers and providers can make decisions based on shared information instead of manual processes.
If The Pitt Had Better Interoperability
The show gives clear examples of how improved data access would reshape clinical care. Consider the following scenarios reimagined with modern APIs.
Scenario 1. A Patient Arrives With No Known History
In the show:
A patient is rushed through the ambulance bay doors, barely conscious. The team gathers around, ready to act, but they’re working blind. No medication list. No allergy record. No sense of the conditions this person has been fighting outside the hospital walls. A physician calls out for “anything in the chart,” but there is nothing. A nurse tries a family member’s number with no answer. Seconds feel like hours when the wrong decision could cost a life. The tension isn’t about capability. It’s about missing information at the moment it matters most.
With APIs:
- A few keystrokes surface a complete, unified picture of the patient’s medications, allergies, diagnoses, and recent imaging.
- The care team moves with certainty, not hesitation, because the right data meets them at the bedside.
- Treatment begins faster, risk drops, and the patient receives care shaped by insight rather than guesswork.
This is the power of real-time data access. It replaces fear with clarity and transforms chaos into coordinated care.
Scenario 2. A Medication Issue Creates Delays
In the show:
A woman stands at the counter of the emergency department pharmacy window, confused and embarrassed. The medication she depends on is suddenly marked “not covered,” and nobody can explain why. A nurse tries calling the pharmacy benefits manager (PBM), then the prescribing provider, then the health plan. Each call leads to another hold tone. Meanwhile, the woman’s symptoms worsen, and she wonders if she’ll have to go without essential treatment yet again. The problem isn’t clinical. It’s administrative friction overshadowing human need.
With APIs:
- Pharmacy records, prescribing history, and payer coverage details sync instantly.
- The clinical team sees the issue, resolves it, and dispenses the medication before the patient’s fear grows any larger.
- The entire interaction becomes what healthcare should always be: simple, clear, and compassionate.
When systems talk to each other, patients stop falling through the cracks between them.
Scenario 3. Discharge Slows Due to Payer Uncertainty
In the show:
A patient waits on a hallway gurney, gripping a thin blanket as fluorescent lights flicker overhead. She should be home by now, but the team cannot discharge her until they know whether her post-acute care will be covered. The nurses apologize, helpless, while trying to reach someone who has the authority to say “yes.” What she feels is not just discomfort. It’s the weight of an opaque system holding her in place without explanation.
With APIs:
- Eligibility details and prior authorization status appear instantly inside the clinical workflow.
- The care team confidently finalizes her discharge plan, grounded in accurate, real-time information.
- The patient leaves the hallway and returns to her life with dignity, supported by a system that finally communicates.
Throughput improves, outcomes improve, and most importantly, trust improves.
Why This Matters for the Future of Care Delivery
Every delay in The Pitt is rooted in data that clinicians cannot access. Every frustration is the downstream effect of a fragmented system. As healthcare shifts toward value-based care and real-time allocation of resources, the nation needs an infrastructure that acts as quickly as clinical practice demands.
APIs are the foundation. They allow payers and providers to share information consistently, securely, and at scale. They reduce administrative burden, support patient safety, and strengthen the collaboration required for modern care.
This is the future that CMS-0057 accelerates. It’s also the future 1upHealth is helping organizations build.
A Health System Ready for Prime Time
The Pitt portrays the visible breakdowns in US healthcare. APIs are the hidden mechanisms that can fix them. As the nation prepares for the next phase of interoperability, healthcare organizations have an opportunity to build systems that match the urgency and complexity of modern care.
FHIR APIs are no longer optional. They’re the infrastructure that will define the next decade of healthcare transformation. 1upHealth is ready to support payers and providers as they strengthen their data foundations for 2026 and beyond. Contact us to talk about your interoperability strategy.