HIEs

Health information exchanges (HIEs) are organizations, networks, or coalitions that enable the secure electronic sharing of patient health information among participating healthcare providers, organizations, and sometimes patients themselves. The goal is to improve care coordination, patient safety, and efficiency by giving clinicians access to a consolidated view of a patient’s health history across different care settings, including hospitals, primary care, laboratories, and pharmacies.

HIEs use standards such as HL7, FHIR, CCDs, and DICOM for imaging; employ exchange models including query-based, push/direct messaging, or hub-and-spoke; rely on identity and consent management; and incorporate privacy and security controls to align with HIPAA. Governance structures define participation, data access, and business rules.

Benefits include reduced duplicative tests, better medication reconciliation, faster access during emergencies, and support for public health reporting and population health management. HIEs can also contribute to care transitions and quality measurement by providing timely data across care settings.

Challenges involve interoperability across vendors and systems, data quality and consistency, patient matching, incomplete historical data, and sustainable funding. Privacy, consent models, and patient rights remain central considerations, as do workflow integration and user adoption.

In the United States, there are numerous regional and statewide HIEs, with major interoperability frameworks such as Carequality and CommonWell, and federal-level eHealth Exchange connecting federal and civilian participants. The landscape also includes state initiatives and private-sector efforts that aim to broaden participation and standardization.

Overall, HIEs are a core component of efforts to modernize health information exchange, though their success depends on broad participation, robust governance, and alignment with privacy laws.