Health Information Exchange (HIE) refers both to the process of securely sharing health-related data and the organizations that facilitate this exchange. By improving access to critical health information, HIEs enhance clinical decision-making, support care coordination, and contribute to better patient health outcomes.
Health Information Exchange (HIE) enables the secure, electronic sharing of health information between the various, sometimes competing, stakeholders in diverse health care systems, promoting interoperability and the seamless exchange of data. The goal of HIE is to ensure that a patient’s health data is available when and where it is needed, helping providers make more informed decisions, improving care coordination, and reducing duplication.
HIEs operate in accordance with all applicable federal and state data privacy laws, including the Health Insurance Portability and Accountability Act (HIPAA). These laws allow the exchange of health data for specific purposes such as treatment, payment, and health care operations—while ensuring that patient privacy and data security are protected.
In practice, HIEs connect to electronic health records (EHRs), health systems, and national networks to help deliver accurate, real-time information at the point of care. When implemented and governed responsibly, HIE supports a more connected, efficient, and equitable health system.
Here is an easy-to-understand breakdown of how Health Information Exchange works in health care settings.
Health Information Exchange is necessary for better care coordination and outcomes.
Health Information Exchange plays a critical role in transforming health care delivery by:
Supporting the quality, safety, and cost efficiency of health care.
Reducing duplicate testing and associated costs.
Supporting care coordination for patients who visit multiple providers.
Providing real-time encounter alerts from the hospital to primary and specialty care, supporting transitions of care.
Driving public health initiatives with aggregated and real-time data.
Assisting payors and providers in the shift to value-based care.
A core goal of a Health Information Exchange is to make sure your health information is available whenever and wherever a patient needs care. Whether they’re receiving treatment in their home state or across the country, their care team should have timely access to the information they need to make the best decisions for their health.
To support this, many HIEs are connected to National Networks. These networks link HIEs and Health Information Networks (HINs) nationwide, using shared technology standards and robust privacy and security safeguards. This ensures health data flows securely to the right place—without going where it doesn’t belong.
This is also where the Trusted Exchange Framework and Common Agreement (TEFCA) comes into play.
The Trusted Exchange Framework and Common Agreement (TEFCA) is a federally supported initiative designed to streamline the secure, nationwide exchange of health information. Its goal is to unify existing National Networks, so organizations only need to connect once—instead of maintaining multiple connections across different networks.
TEFCA supports several types of data exchange known as “Exchange Purposes,” including Treatment, Payment, Health Care Operations, Public Health, Government Benefits Determination, and Individual Access Services. Initially, only Treatment and Individual Access Services are required, but more purposes will be phased in over time.
Please note that HIEs are not required to participate in TEFCA – it is entirely voluntary. However, HIEs may choose to participate in TEFCA directly or by partnering with a QHIN, depending on their structure, goals, and services.
Unlike existing networks like eHealth Exchange, Carequality, or CommonWell, TEFCA is backed by the federal government and mandated by the 21st Century Cures Act. While all networks aim to enhance interoperability, TEFCA is intended to be a common, scalable foundation that connects multiple networks under one agreement—reducing fragmentation across the national ecosystem.
Health Information Exchange is instrumental in:
Providers have timely access to comprehensive patient data. Patients gain access to their health data so they can actively participate in their care journey.
HIEs connect disparate systems and data sources to improve efficiency and de-duplication, and they navigate trusted relationships across multiple stakeholders
Aggregated data supports disease surveillance, case reporting, and prevention/crisis response.
HIEs bridge gaps across sectors, including social care, community-based organizations, and public health.
Care providers, payors, researchers, and policy makers can better understand and respond to real time population health trends through deidentified aggregate health data.
HIEs enable proactive, data-driven care by providing a comprehensive view of a patient’s health history, supporting early interventions, reducing hospital readmissions, and enhancing the management of chronic diseases.
Health Information Exchanges facilitate the seamless and secure transfer of health information among various stakeholders in the health ecosystem. Depending on the needs of providers and patients in a given state or market, HIEs can operate in distinct ways to enhance care coordination, ensure interoperability, and empower patient participation.
The 2023 National HIO Survey, spearheaded by the University of California at San Francisco and Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology and supported by Civitas, highlights the impressive reach and bi-directional connectivity of HIEs across a wide range of health care organizations and entities. This connectivity underscores the transformative potential of HIEs in enabling data exchange across the continuum of care.
Direct Health Information Exchange involves the secure, point-to-point transmission of patient information between providers, akin to encrypted email but designed to comply with stringent health care regulations. It is particularly effective for:
Key User Stats from the 2023 HIO Survey:
Query-based Health Information Exchange allows providers to search for and retrieve patient data on demand. This model supports real-time access to a patient’s medical history, improving decision-making at the point of care. Applications include:
Key User Stats from the 2023 HIO Survey:
Consumer-mediated HIE empowers patients to control and share their own health information. Patients can aggregate data from various providers and ensure that their care team has access to a unified health record. Applications include:
Key User Insights from the 2023 HIO Survey:
While consumer-mediated exchange adoption is still growing, it is a critical component for patient engagement, particularly in empowering underserved populations to manage their health records and facilitating transparency and patient-centric care.
With hundreds of use cases across the country, HIEs meet the needs of diverse stakeholders and power better health outcomes for all.
The 2023 National HIO Survey revealed the expansive connectivity of HIEs, enabling bi-directional data flow with diverse health care organizations – but there is room to improve interconnectivity:
While HIEs have robust connections with clinical care providers, some areas like tribal governments (23%), social service agencies (30%), and life insurance companies (20%) represent growth opportunities.
70% of HIEs exchange data with state public health agencies, crucial for modernizing disease surveillance and public health reporting.
Connectivity with FEMA or state disaster relief agencies remains limited (5%), indicating a critical area for development.
While Health Information Exchanges (HIEs) were originally established to support the secure sharing of clinical data for individual patient care, today’s health data needs extend far beyond the exam room. States increasingly require real-time, comprehensive data to support public health, health equity, population health analytics, and social care coordination.
A Health Data Utility (HDU) is a concept that describes a trusted, neutral entity responsible for meeting these expanded data needs across both the public and private sectors. Many HIEs are uniquely positioned to serve as HDUs because of their infrastructure, governance, and experience facilitating secure, interoperable data exchange.
Rather than “becoming” HDUs, HIEs are striving to broaden their capabilities to serve these growing state-level priorities—offering actionable, longitudinal data to drive better decision-making across care delivery, public health, and policy.
To learn more about the difference between HIE and HDU, check out Civitas’ HDU Guide to Implementation (page 7).
Civitas and its members offer a wealth of resources to help you navigate the world of Health Information Exchange. Visit our blog to learn about our member’s work or attend an upcoming event.
CRISP, HSCRC, and Medisolv
Learn how these Maryland-based organizations are empowering health care organizations to collect and submit digital quality measures via HDU.
Arkansas SHARE
Read more about the work being done in Arkansas to enable interoperability via Health Data Utility.
North Carolina Department of Health Information Technology
Discover how North Carolina's HIE – NC HealthConnex – is supporting Black mothers with secure health data exchange.
Chesapeake Regional Information System for Our Patients (CRISP)
Learn how CRISP worked with Civitas Networks for Health to develop an HDU framework.
Despite its many advantages, Health Information Exchange implementation faces obstacles and criticisms including the ability to protect data sensitivity and privacy, and to overcome technical barriers, regulatory variations, provider adoption, and more. Another challenge HIEs face is sustainability; they are working to evolve their revenue diversification but rely on a mix of state funds, provider fees, and federal grant programs.
HIEs offer a wide range of benefits for health care systems, providers, and patients alike:
HIEs also address critical gaps in care delivery and access:
Health Information Exchanges bring together a diverse range of stakeholders in the health ecosystem within the geography that they serve, all of whom benefit from the secure exchange of data. Participants include hospitals, health systems, independent physician practices, long-term care facilities, outpatient behavioral health providers, social service providers, community-based organizations, academic researchers, and policy makers. Public and private hospitals, federally qualified health centers (FQHCs), and community health centers (CHCs) also rely heavily on HIEs to streamline care coordination. Beyond traditional care providers, HIEs engage state Medicaid agencies, state public health departments, and emergency medical services (EMS) to facilitate population health management and public health reporting.
Additionally, private payers and other entities like imaging centers, social service agencies, and tribal governments increasingly participate to enhance multi–sector collaboration.
Health Information Exchanges prioritize data security through stringent protocols and compliance with federal and state regulations, such as HIPAA. They employ advanced encryption methods to protect data in transit and, they ensure that patient information is inaccessible to unauthorized parties. Role-based access controls are implemented to grant appropriate permissions based on user roles, limiting unnecessary access to sensitive information. Regular audits and security assessments help identify vulnerabilities and maintain high-security standards. They also must adhere to their individual state’s privacy and security regulations and have governance structures to support careful oversight.
Many HIEs also adhere to industry-leading interoperability standards like HL7 and FHIR, which include built-in security measures. By integrating robust monitoring systems and maintaining compliance with data-sharing frameworks such as TEFCA, HIEs create a secure environment for the exchange of health information.
Many Health Information Exchanges empower patients to access their health information through secure portals or apps. These tools provide individuals with a consolidated view of their medical history, lab results, and treatment plans, aggregated from various participating providers. By enabling patients to review their own health records, HIEs foster transparency and allow individuals to play a more active role in managing their care. Some HIEs also allow patients to directly share their health data with new providers or caregivers, ensuring continuity of care and minimizing delays. This patient-centered approach not only enhances health outcomes but also aligns with the broader goal of creating a more transparent and accessible health care system.
Patients have the right to opt out of a Health Information Exchange (HIE), depending on the policies of the specific exchange and the regulatory environment in their state or region. Opting out typically means that a patient’s health data will not be shared through the HIE, though it may still be accessible to their individual care providers through other means, such as direct record requests, fax, or secure email exchanges between providers. The opt-out process varies but often involves completing a formal request through the HIE or the patient’s health care provider. It is important to note that while opting out prevents data sharing across the network, it may also limit the benefits of care coordination, such as reducing duplicate tests and ensuring providers have a complete view of a patient’s medical history. Patients should carefully weigh these considerations when deciding whether to participate in an HIE.
If you want to opt out, contact your local HIE directly to ask about data sharing policies and opt-out options. Keep in mind, opting out may limit your providers’ ability to access timely, complete information when you seek care.
Regional HIEs cover a region within a state or in some cases may serve stakeholders across state lines. State-led Health Information Exchanges are entities within state government. National networks like CommonWell or eHealth Exchange serve complementary but distinct roles in the health care ecosystem. State-led and regional HIEs are established to meet the specific health data needs of a defined geography of. These exchanges focus on local interoperability, ensuring seamless communication between hospitals, providers, and public health agencies within their jurisdiction. Such HIEs have fostered trusted relationships with their stakeholders and have inclusive governance structures in place. They often play a key role in state-specific initiatives like Medicaid reporting, public health monitoring, and disaster preparedness.
In contrast, national networks like CommonWell operate on a broader scale, connecting providers and HIEs across state lines to create a more unified, nationwide data exchange system. These networks focus on enabling interoperability between electronic health record (EHR) systems and other health IT platforms regardless of geographic location. While state-led HIEs may provide highly tailored solutions for their regions, national networks prioritize scalability and standardization, helping to bridge gaps between disparate systems and support patients who receive care across multiple states. Together, they create a complementary framework for improving care coordination at both local and national levels.
The Trusted Exchange Framework and Common Agreement (TEFCA) establishes another national framework for interoperability, and Health Information Exchanges can play a vital role in advancing this federal initiative’s goals. HIEs can act as Qualified Health Information Networks (QHINs) or participants within QHINs under TEFCA, facilitating the seamless exchange of health data across state and organizational boundaries. By adhering to TEFCA’s technical and legal standards, HIEs ensure secure, standardized data sharing that supports a wide range of use cases, from care coordination to public health reporting.
HIEs contribute to TEFCA’s interoperability mission by implementing advanced data-sharing protocols, such as HL7’s FHIR and existing IHE profiles, to enable real-time access to patient data. This ensures that providers, payers, and public health entities can easily retrieve and share information, regardless of the systems or networks they use. By participating in TEFCA, HIEs enhance the overall health IT infrastructure, reducing data silos and enabling a more connected, patient-centered health care system. Due to the local trusted relationships that HIEs have throughout the country within their states and regions they enrich the national interoperability potential by connecting rural practices, federally qualified health centers, and other smaller health systems and providers that could otherwise be missed by national network exchange.
HIEs operate within a complex regulatory framework designed to ensure secure, standardized, and efficient health data exchange. Key policies and regulations include:
Emerging trends and innovations are shaping the future of HIEs, including:
Under federal privacy law (HIPAA), your data can be exchanged for specific purposes—treatment, payment, and health care operations—without your explicit consent. Examples include:
Some types of data—such as substance use treatment records, mental health information, or reproductive health—may require additional protections under state or federal law. These are exceptions to the general HIPAA rule.
Learn more about 42 CFP Part 2 and how sensitive data is protected under law.
National Networks like eHealth Exchange, CommonWell, and Carequality connect local HIEs and providers nationwide. They standardize how data is exchanged and ensure privacy and security compliance. These networks reduce delays and prevent data gaps when care occurs outside a patient’s typical health system.
Yes. All participants in HIEs and National Networks must adhere to strict privacy and security standards under HIPAA. Requests for data must have a legitimate, legal purpose, and systems are audited to prevent misuse.
Generally, you can’t stop legally allowed data sharing under HIPAA for treatment, payment, and operations. However, patients can request that specific data be withheld, and in many HIEs, patients can opt out of having their data shared entirely—except where legally required.
HIPAA only applies to covered entities (like doctors and insurers) and their business associates. Data shared via personal apps, texts, or devices may not be protected under HIPAA. Be cautious when entering health information into non-clinical platforms.
QHIN stands for Qualified Health Information Network. These are designated organizations approved by the Recognized Coordinating Entity (RCE) to serve as trusted data exchange hubs under TEFCA. QHINs facilitate connectivity between a wide range of participants, including HIEs, providers, payers, and other health data stewards.
A special thank you to Civitas members, Contexture, Connie, East Tennessee Health Information Network (etHIN), HI-BRIDGE HIE, SYNCRONYS, Arkansas SHARE, MyHealth Access Network, PelEX, Indian Health Information Exchange (IHIE), and CRISP Shared Services for your support in bringing this page to life.
