Health Information Exchange (HIE)

Key facts

Common forms

Directed, query-based and consumer-mediated exchange

Operators

State and regional HIEs, national networks and EHR developer networks

National framework

TEFCA, required by the 21st Century Cures Act

Privacy rules

HIPAA plus state consent and sensitive-data laws

What is health information exchange?

HIE lets clinical data follow a patient. When a patient arrives at an emergency department, an exchange can supply recent discharge summaries, medication lists and lab results from other facilities, reducing repeat tests and gaps in history.

As an organization, an HIE (sometimes called a health information organization or regional health information organization) connects participants in a state or region, runs the technical infrastructure and sets participation rules. Many state HIEs received federal startup funding under the HITECH Act of 2009.

The term also covers national networks and frameworks that connect organizations across state lines, including the Trusted Exchange Framework and Common Agreement (TEFCA).

Types of health information exchange

Exchange generally takes one of these forms:

• Directed exchange: a provider sends information to a known recipient, such as a referral summary sent by Direct secure messaging.
• Query-based exchange: a provider searches for and retrieves a patient's records from other participants, often during unplanned care.
• Consumer-mediated exchange: patients gather and share their own records, for example through apps connected by FHIR APIs.
• Event notifications: hospitals send admission, discharge and transfer (ADT) alerts, which Medicare Conditions of Participation have required since 2021 for hospitals with capable EHRs.

Why health information exchange matters

Exchange connectivity has practical value for several groups:

• Hospitals: exchange supports the Health Information Exchange objective of the Medicare Promoting Interoperability Program.
• Public health: HIEs often route immunization, lab and case reports to state health departments.
• Value-based care: accountable care organizations and payers use HIE feeds to track admissions and close care gaps.
• Health IT developers: connectivity to state HIEs and national networks is a common requirement in hospital and payer contracts.

Health information exchange vs health insurance exchange

The abbreviation HIE is sometimes confused with health insurance exchanges, the Affordable Care Act marketplaces where people shop for coverage. A health information exchange moves clinical data, while a health insurance exchange sells health plans. The two are unrelated.