Civitas Networks for Health is proud to support the nationwide survey of Health Information Organizations (HIOs) in collaboration with Dr. Julia Adler-Milstein and team at the University of California, San Francisco, and the Office of the National Coordinator for Health IT (ONC).
The survey, which has been conducted several times starting in 2006, provides valuable insights into the current state of health information exchange (HIE) in the U.S. as well as the evolution of the role of HIOs in advancing regional, state, and national interoperability. The 2023 National HIO Survey revealed key findings about HIOs’ operations, including their role in promoting data exchange across health care systems, the challenges faced in standardizing data, and the integration of HIOs with public health agencies. These findings are shaping policy, informing stakeholders, and influencing the next phase of interoperability and data-sharing initiatives nationwide.
Health Information Organizations continue to play a foundational role in nationwide health data exchange—connecting providers, public health agencies, and community organizations.
Here are some highlights from what the latest 2023 survey tells us about how HIOs are evolving, where they’re excelling, and what challenges remain:
76 HIOs from 47 states responded to the survey and reported that they are actively supporting operational data exchange—offering a strong representation of the national landscape. However, only 34% reported that participant fees alone cover operating expenses, highlighting the ongoing need for public or diversified support.
63% of HIOs reported plans to participate in the Trusted Exchange Framework and Common Agreement (TEFCA), and over 90% are already participating in national or regional data-sharing networks. These efforts are critical for advancing interoperability and seamless information exchange.
HIOs deliver essential services such as event notifications, community health records, and Clinical Document Architecture (CDA) parsing—capabilities that help reduce duplication, close care gaps, and improve coordination.
86% of HIOs are electronically connected to public health agencies in 45 states. Among these:
Despite progress, 30% of HIOs reported routinely observing information blocking by EHR vendors, and 61% said such practices significantly hinder their services. 45% also reported similar challenges with information blocking by health systems.
Civitas Networks for Health is committed to the advancement of interoperability and health information exchange. By partnering with ONC and UCSF, Civitas ensures that HIOs’ voices are heard and that survey results inform local and national decision makers and health IT policy
Civitas believes in local health data infrastructure and in increasing the capacity within states for more interconnected health data ecosystems. The national HIO survey results reinforce the critical services and capabilities of HIOs throughout the country.
Looking for more information on the HIO Survey? Browse peer reviewed papers and related resources.
Public Health Data Exchange Through Health Information Exchange Organizations: National Survey Study
The State of Health Information Organizations and Plans to Participate in the Federal Exchange Framework
The 2025 round of the National HIO Survey is already underway, continuing to track the role HIOs play in advancing interoperability and promoting health information sharing. Civitas continues to provide guidance and ensure that the survey remains relevant and timely in capturing the challenges and achievements within the health information exchange and data interoperability landscape.
As HIOs across the country complete this year’s survey, Civitas remains committed to ensuring that data collected will be used to influence policy decisions that recognize HIOs role in enhancing health care delivery and in helping communities achieve better health outcomes.
To learn more, please email contact [at] civitasforhealth.org.
