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Health Information Exchange as a Complex and AdaptiveConstruct: Scoping Review
Citation for published version:Akhlaq, A, Sheikh, A & Pagliari, C 2017, 'Health Information Exchange as a Complex and AdaptiveConstruct: Scoping Review' Journal of Innovation in Health Informatics, vol 23, no. 4, pp. 633–683. DOI:10.14236/jhi.v23i4.889
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Journal of Innovation in Health Informatics Vol 23, No 4 (2016)
JOURNAL OF
INNOVATION IN HEALTH INFORMATICS
Health information exchange as a complex and adaptive construct: scoping review Ather Akhlaq
Department of Health and Hospital Management, Institute of Business Management, Korangi Creek, Pakistan Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, Medical School, University of Edinburgh, UK
Aziz SheikhCentre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, Medical School, University of Edinburgh, UK
Claudia PagliariEdinburgh Global Health Academy and Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, Medical School, University of Edinburgh, UK
ABSTRACT
Objective To understand how the concept of Health Information Exchange (HIE) has evolved over time.Methods Supplementary analysis of data from a systematic scoping review of definitions of HIE from 1900 to 2014, involving temporal analysis of underpinning themes.Results The search identified 268 unique definitions of HIE dating from 1957 onwards: 103 in scientific databases and 165 in Google. These contained con-sistent themes, representing the core concept of exchanging health information electronically, as well as fluid themes, reflecting the evolving policy, business, and organisational and technological context of HIE (including the emergence of HIE as an organisational ‘entity’). These are summarised graphically to show how the concept has evolved around the world with the passage of time. The term HIE emerged in 1957 with the establishment of occupational HIE, evolving through the 1990s with concepts such as electronic data interchange and mobile computing technology; then from 2006 to 2010, it largely aligned with the US government’s health information technology strategy and the creation of HIEs as organisational entities, alongside the broader interoperability imperative, and continues to evolve today as part of a broader international agenda for sustainable, information-driven health systems.Conclusions The concept of HIE is an evolving and adaptive one, reflecting the ongoing quest for integrated and interoperable information to improve the effi-ciency and effectiveness of health systems in a changing technological and policy environment.
Keywords: health information exchange, definition, scoping review, eHealth
Systematic review
Cite this article: Akhlaq A, Sheikh A, Pagliari C. Health information exchange as a complex and adaptive construct: scoping review. J Innov Health Inform. 2016;23(4):633–683.
http://dx.doi.org/10.14236/jhi.v23i4.889
Copyright © 2016 The Author(s). Published by BCS, The Chartered Institute for IT under Creative Commons license http://creativecommons.org/licenses/by/4.0/
Author address for correspondenceDr. Ather AkhlaqAssistant Professor of eHealth, Health and Hospital Management, Institute of Business Management, Karachi, Pakistan Email: [email protected]
Accepted November 2016
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Akhlaq et al. Health information exchange as a complex and adaptive construct 634
INTRODUCTION
Policymakers, health care professionals, industry groups and researchers recognise health information exchange (HIE) as a vital component of the solution to the current problems posed by disparate and fragmented health systems and non-interoperable technologies.1,2
HIE is not a new concept, but an evolving one, which to some extent ‘reinvents itself’ every 2.5 years due to the advancement in technology and changing of the regulatory environment.3,4
The report ‘Evolution of State Health Information Exchange’ prepared for The Agency for Healthcare Research and Quality yielded many significant findings about various HIE projects in terms of their designs and goals, stages of development and specific future barriers to deployment.3 The authors noted that no two HIE projects were similar, as the projects differ vastly with regard to stakeholders engaged, available finance, choice of technology, deployment strategy and community background.3 This variability makes it difficult to track the development of HIE due to variability of the HIE definitions and HIE models deployed.4 As described else-where in this issue (see Part 1 of the review), we undertook a detailed scoping review of existing definitions of HIE in order to develop an evidence-based concept map that may be help-ful for HIE stakeholders and for improving clarity and compa-rability in the published literature. This paper describes the components of the analysis oriented around time to assess and map the evolution of HIE concepts.
METHODS
In this part of the review, the included definitions were the-matically analysed to understand changing concepts and perspectives of HIE over time and in different global regions. First, definitions were sorted according to the year of publica-tion. Second, definitions were thematically analysed accord-ing to their changing contexts with the passage of time.
RESULTS
Corpus of DefinitionsAs noted in our Part 1 of the scoping review paper, the 268 unique definitions eligible for inclusion dated back to 1957.5 Many definitions used terms synonymous with, or closely equivalent to, HIE, such as ‘Electronic Data Interchange’.6–8 ‘Clinical Information Exchange’,9–14 ‘Healthcare Information Exchange’,15–20 ‘Clinical Health Information Exchange,21,22 ‘Clinical Document Exchange’,23 ‘Medical Data Exchange’24 and ‘Information Exchange’.25 Most of the definitions (n = 240) were from the United States. Other contributing countries were the United Kingdom (UK) (n = 5),10,26–29 Australia (n = 3),8,30,31 the Netherlands (n = 3),7,32,33 Canada (n = 2),34,35 Germany (n = 1),19 Denmark (n = 1),36 New Zealand (n = 1),37 Sweden/Finland (n = 1),38 Israel (n = 1),39 Switzerland (n = 1),40
Portugal (n = 1)41 and the European Union (n = 1).42 The origins of seven definitions were unclear.
Changing definitions over time and different national perspectives Figure 1 illustrates a timeline of the included definitions. The concept of HIE evolved with the rise in occupational health problems in the United States when Byers in 1957 recog-nised the need for a central coordinating organisation. Early ‘occupational HIE’ aimed to collect, collate and disseminate all types of information related to occupational health prob-lems.43 In the early 1990s, references to Electronic Data Interchange (EDI) systems for transferring data between General Practitioners (GPs), hospitals and various other stakeholders to enhance quality of care appeared in the lit-erature from Australia (1991),8 the Netherlands (1992)7 and the United States (1998).6 In 1996, the term mobile comput-ing technology (MCT) began to be used in the United States to describe clinical information exchange between older car-diac surgery patients at home and health care providers to give additional information of patients’ recovery to providers after surgery.44
Varying conceptual starting points: In 2006, a report from Australia defined HIE as the corporate network of data ware-houses of the health department that contains data on sur-gical procedures, international classification of diseases, diagnostic codes, record episodes, information and diagno-ses and some demographic items.30 Again in 2006, the first definition from the UK defined HIE as a process in terms of ‘information exchange’ between patients and health profes-sional to achieve shared decision making.26
HIE as an organisational entity. Between 2006 and 2007, the terms HIEs and regional health information organisa-tions (RHIOs) were being used interchangeably in the United States to facilitate the flow of clinical information45,46 in parallel with the concept of linking patients’ health records across organisations,47 including medical records,20 pro-vider health records48 and HER.49 Between 2008 and 2009, the concept of an HIE as an organisational entity was becoming common in the United States, using location-spe-cific names such as local health information organisations (LHIOs), RHIO and sub-network organisations (SNO) and ‘state-wide’, all serving the purpose of overseeing and gov-erning the exchange of health information among different health care stakeholders.50
Funding environment: The funding environment for enabling and sustaining HIE is emphasised in a number of definitions. In 2007, a US definition described HIE as a ‘mul-timillion dollar effort’ and insisted on establishing a reason to sustain the effort (HIE).51 In the same year, the business case for investment in HIE was argued in terms of its potential to create productive efficiencies for the provider community.45 Another US definition from 2009 defined it as ‘a business offering services to generate revenue that must exceed its expenses and should provide services according to the expectations of stakeholders’.52
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Akhlaq et al. Health information exchange as a complex and adaptive construct 635
Figu
re 1
. Cha
ngin
g de
finiti
ons
over
tim
e an
d di
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nt n
atio
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1955
1960
……
...19
9019
9520
00…
…20
0520
0620
0720
0820
0920
1020
1120
1220
1320
14
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Interoperability agenda. References to the term ‘interoper-ability’ became more common in 200953 in a US definition of HIE along with the term ‘standardised electronic exchange’, recognising the need to manage incompatibilities between systems and software.54
Influence of the US policy/incentives environment: 48 definitions appeared during 2009–2010, all from the United States, with the exception of two from Canada, illustrating the increasing importance of HIE in North America for the two con-secutive years after the enactment of the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009 and the associated attention from researchers, acade-micians and vendors in United States. Along with the general definitions of HIE, a number of HIE definitions are specifically associated with certain states’ and vendors’ names, for exam-ple, Nebraska Health Information Initiative (NeHII),55 Indiana HIE (IHIE),56 South Carolina HIE (SCHIEx),57 and New York Clinical Information Exchange (NYCLIX),12 whereas ven-dors involved were Accenx Exchange,58 Centricty HIE59 and Verizon HIE.60
Global dispersion of the concept: By 2011, the concept of HIE dispersed to the other parts of the world and the lit-erature included definitions from Germany, UK and Finland/ Sweden. We see slight modifications of the term HIE such as Healthcare Information Exchange Network in a definition from Germany,19 Clinical Information Exchange in defini-tions from the UK10 and United States12 and Clinical HIE in a definition from the United States.22 A definition from the UK stressed the accomplishment of HIE through policy, infrastructure and system of care. Moreover, it further says to acquire and build computing applications and make use of financial and clinical incentives to sustain clinical informa-tion exchange. Several definitions dating from 2011 focused on the use of HIE in emergency departments, for supporting access to patient records for the purposes of out-of-hours medical care.
As the topic of HIE gained momentum, more countries, states and vendors came out with definitions in 2012–2013. New Zealand referred to it as an ‘application-level communi-cation medium’ to exchange health information.37 Denmark, a global leader in software for connected care, has aligned the concept of HIE very much with the vendor system procured for national use, InterSystems HealthShare™.36 A definition from the Netherlands referred to HIE as national Electronic Health Records (EHR)32 while a definition from UK referred to it as ‘nationally accessible electronic records’.61 A definition from Switzerland aligns the concept of HIE with the benefits and challenges it generates, such as greater care coordina-tion through transparency, balanced by risks of greater dis-closure and the need to change the habits and practices of patients and health professionals.62 Finally, a definition from Israel identifies ‘Clalit Health Services’ as an HIE entity, which uses a single medical informatics system to exchange health information between a national network of hospitals and com-munity care.39
DISCUSSION
The analysis has revealed the emerging nature of the field and the changing relevance of HIE to different stakeholders and contexts.
The majority of the definitions originated in the United States, no doubt reflecting the considerable investments in HIE that have characterised the government’s HITECH Act,63,64 which aims to accelerate the adoption of interoperable health infor-mation systems and integrate the health care delivery systems for the benefit of patients. This has fuelled a growth in interest in HIE amongst health care professionals, providers, payers, technology companies, policy makers and researchers.
With respect to international variations, the related terms, HIE, Clinical Information Exchange, Healthcare Information Exchange, EDI and Clinical Health Information Exchange were used mostly in the United States, whereas in the UK only HIE and Clinical Information Exchange terms were typi-cally used when referring to the exchange of health informa-tion. HIE and EDI were preferred in publications emanating from the Netherlands, and our review found one definition on Healthcare Information Exchange Network from Germany.19
Although the term EDI was used more in the contexts of exchanging business information using a standard format, our review found two definitions of EDI, dating back to 19927 and 1998,6 that fit our inclusion criteria as describing HIE.
Organisations exchanging health information were also known by different names, such as LHIO, RHIO and SNO.50 In some cases, the terms HIE and RHIO were used inter-changeably13,34,45,65,66 although RHIO typically referred to an infrastructure that enabled HIE within the health care admin-istrative regions.39,67
The origins of various definitions lie in a range of con-texts, reflecting the importance of HIE for various purposes across the health industry, for example, occupational health HIE, community HIE and HIE for public health. Most of the definitions prioritise regional or national perspectives, although a few make reference to the value of HIE on a global level.55,68,69 At the macro level, natural disasters and viral outbreaks present requirements for global monitoring or coordinated international responses, for which effective HIE is essential. For example, this was demonstrated in the aftermath of Hurricane Katrina, where health care organisa-tions throughout the region and nationwide exchanged health information in order to take care of inhabitants displaced by the storm.70 The value of HIE in managing the recent Ebola crisis has also been described.71
Strengths and limitationsStrengths of the review include searching from 1900 to 2014, analysing a large corpus of HIE definitions and using academic databases and grey literature to find HIE defini-tions. Moreover, including reference of each source docu-ment and the given appendix (see Appendix A) ensured rigour of the findings.
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However, we recognise the considerable progress that many countries across Europe, New Zealand, Australia, Israel and elsewhere have made in implementing national and regional health information infrastructures to support HIE, which are not fully reflected in the corpus of HIE definitions. Extending the search to related terms such as ‘national health information infrastructure’ would no doubt uncover additional definitions, and authors in the future may wish to extend the review to capture broader aspects of health informatics.
Implications for research, practice and policyGovernments become more attuned to what other countries are doing, and with major eHealth technology businesses globalis-ing, we might expect the language of HIE to coalesce around a set of concepts. The priority according to different issues within HIE discussions may also change as more countries become involved in HIE; for example, personal health insurance and reimbursement are major issues in the United States, but in the UK and some other countries, health care is free to citizens at the point of care and funded through national taxation.
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HIE remains an evolving concept, which due to its complex-ity presents challenges for developing concrete and shared definitions. It will continue to evolve mainly due to change in technology, stakeholders engaged and different paradigms of health care in different countries. In addition, the growing health care challenges around the world, such as Zika, will trigger further research to develop effective HIEs with new designs and services.
Funding We would like to thank the Higher Education Commission,
Pakistan, and The University of Edinburgh for providing funds for this review.
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645
App
endi
x A
: Ext
ract
ed D
efin
ition
s
S.N
o.
Aut
hor
Sour
ce
Yea
r of
Publ
icat
ion
Cou
ntry
D
efin
ition
1.
1st P
C (7
3)
Web
pag
e: 1
st P
rovi
ders
C
hoic
e, S
olut
ion
Prov
ider
Unk
now
n U
S H
ealth
Info
rmat
ion
Exch
ange
(HIE
) ref
ers t
o th
e pr
oces
s of r
elia
ble
and
inte
rope
rabl
e el
ectro
nic
heal
th-r
elat
ed in
form
atio
n sh
arin
g co
nduc
ted
in a
m
anne
r tha
t pro
tect
s the
con
fiden
tialit
y, p
rivac
y, a
nd se
curit
y of
the
info
rmat
ion.
2.
4
Med
(74)
Web
pag
e: E
duca
tiona
l R
esou
rce
for H
ealth
care
In
form
atio
n Te
chno
logy
Unk
now
n U
S H
ealth
Info
rmat
ion
Exch
ange
(HIE
) rep
rese
nts t
he tr
ansm
issi
on o
f hea
lthca
re-
rela
ted
data
am
ong
faci
litie
s, he
alth
info
rmat
ion
orga
niza
tions
(HIO
) and
go
vern
men
t age
ncie
s acc
ordi
ng to
nat
iona
l sta
ndar
ds. H
IE is
an
inte
gral
co
mpo
nent
of t
he h
ealth
info
rmat
ion
tech
nolo
gy (H
IT) i
nfra
stru
ctur
e un
der
deve
lopm
ent i
n th
e U
nite
d St
ates
and
the
asso
ciat
ed N
atio
nal H
ealth
In
form
atio
n N
etw
ork
(NH
IN).
3.
A
bhya
nkar
et a
l (7
5)
Scie
ntifi
c 20
10
US
Som
e re
gion
al h
ealth
info
rmat
ion
exch
ange
s (H
IEs)
pro
vide
web
-bas
ed
deliv
ery
syst
ems t
hat a
ccep
t lab
resu
lts m
essa
ges f
rom
man
y so
urce
s (e.
g.
hosp
ital l
abor
ator
y, st
and-
alon
e ra
diol
ogy
serv
ices
) and
del
iver
them
in a
un
iform
form
at to
phy
sici
an o
ffic
es.
4.
Acc
enx
(58)
Web
pag
e: H
ealth
care
in
form
atio
n te
chno
logy
&
IT st
rate
gy n
ews
2009
U
S Th
e A
ccen
x Ex
chan
ge is
a h
ealth
info
rmat
ion
exch
ange
(HIE
) ser
vice
s pl
atfo
rm th
at b
rings
the
med
ical
reco
rds i
n an
y gi
ven
com
mun
ity m
uch
clos
er
toge
ther
by
actu
ally
ext
endi
ng th
e re
ach
out t
o th
e ph
ysic
ian
prac
tices
, ho
spita
ls a
nd o
ther
hea
lthca
re o
rgan
izat
ions
. It a
llow
s pub
lic o
r priv
ate
HIE
s to
imm
edia
tely
est
ablis
h a
tech
nolo
gy a
nd se
rvic
e pl
atfo
rm fo
r sha
ring
clin
ical
re
sults
, ord
ers a
nd o
ther
pat
ient
info
rmat
ion
amon
g pr
ovid
ers u
sing
virt
ually
an
y EM
R sy
stem
- or
no
EMR
at a
ll.
5.
Adl
er-M
ilste
in e
t al
(76
) Sc
ient
ific
2011
U
S C
entra
l goa
l of t
he le
gisl
atio
n w
as to
pro
mot
e br
oad-
base
d el
ectro
nic
HIE
, in
whi
ch k
ey c
linic
al d
ata
flow
am
ong
prov
ider
s and
bet
wee
n pr
ovid
ers a
nd
othe
r sta
keho
lder
s, su
ch a
s pub
lic h
ealth
dep
artm
ents
. 6.
A
dler
-Mils
tein
et
al (
77)
Scie
ntifi
c 20
11
US
Hea
lth in
form
atio
n ex
chan
ge e
nabl
es p
atie
nts’
hea
lth in
form
atio
n to
follo
w
them
bet
wee
n de
liver
y se
tting
s in
orde
r to
supp
ort c
are
coor
dina
tion
and
avoi
d du
plic
atio
n of
serv
ices
. The
re is
bro
ad c
onse
nsus
that
such
con
nect
ivity
is
criti
cal t
o im
prov
ing
care
and
redu
cing
hea
lthca
re c
osts
. 7.
A
dler
-Mils
tein
an
d Jh
a (7
8)
Scie
ntifi
c 20
12
US
Hea
lth in
form
atio
n ex
chan
ge (H
IE) i
s the
act
of s
harin
g cl
inic
al d
ata
amon
g he
alth
car
e pr
actit
ione
rs a
nd p
ract
ice
setti
ngs (
phys
icia
ns, h
ospi
tals
, nur
sing
ho
mes
, etc
) who
are
not
par
t of t
he sa
me
orga
niza
tiona
l ent
ity.
8.
Adl
er-M
ilste
in e
t Sc
ient
ific
2013
U
S H
ealth
info
rmat
ion
exch
ange
(HIE
) ref
ers t
o th
e pr
oces
s of e
lect
roni
cally
646
S.N
o.
Aut
hor
Sour
ce
Yea
r of
Publ
icat
ion
Cou
ntry
D
efin
ition
al (
79)
trans
ferr
ing,
or a
ggre
gatin
g an
d en
ablin
g ac
cess
to, p
atie
nt h
ealth
info
rmat
ion
and
data
acr
oss p
rovi
der o
rgan
izat
ions
. Exc
hang
e m
ay ta
ke p
lace
bet
wee
n di
ffer
ent t
ypes
of e
ntiti
es, f
or e
xam
ple,
e-tr
ansf
er o
f pat
ient
dat
a be
twee
n am
bula
tory
car
e pr
ovid
ers o
r e-tr
ansf
er o
f dat
a at
the
regi
onal
leve
l. 9.
A
eHN
(80)
Web
pag
e: A
lask
a eH
ealth
Net
wor
k U
nkno
wn
US
Hea
lth in
form
atio
n ex
chan
ge (H
IE) i
s the
ele
ctro
nic
shar
ing
of h
ealth
-rel
ated
in
form
atio
n.
10.
Afz
al (8
1)
Con
fere
nce:
Mar
ylan
d’s
Hea
lth In
form
atio
n Ex
chan
ge.
SOA
in H
ealth
care
C
onfe
renc
e.
The
Rol
e of
Hea
lth
Info
rmat
ion
Exch
ange
in
Driv
ing
To
war
d In
tero
pera
bilit
y
2011
U
S H
ealth
Info
rmat
ion
Exch
ange
, or H
IE, a
llow
s clin
ical
info
rmat
ion
to m
ove
elec
troni
cally
am
ong
disp
arat
e he
alth
info
rmat
ion
syst
ems.
The
goal
of H
IE is
to
del
iver
the
right
hea
lth in
form
atio
n to
the
right
pla
ce a
t the
righ
t tim
e—pr
ovid
ing
safe
r, m
ore
timel
y, e
ffic
ient
, eff
ectiv
e, e
quita
ble,
pat
ient
-cen
tere
d ca
re.
11.
AH
A (8
2)
Rep
ort:
Hea
lth
Info
rmat
ion
Ex
chan
ge P
roje
cts
Wha
t Hos
pita
ls a
nd
Hea
lth S
yste
ms
Nee
d to
Kno
w b
y A
mer
ican
Hea
lth
Ass
ocia
tion
Unk
now
n U
S H
ealth
info
rmat
ion
exch
ange
ena
bles
hos
pita
ls to
brin
g be
tter i
nfor
mat
ion
to
the
poin
t-of-
care
and
enh
ance
s opp
ortu
nitie
s for
clin
ical
dec
isio
n su
ppor
t.
12.
AH
IMA
(83)
Web
Pag
e: A
mer
ican
H
ealth
Info
rmat
ion
Man
agem
ent
Ass
ocia
tion
Unk
now
n U
S A
n H
IE is
the
elec
troni
c m
ovem
ent o
f hea
lth-r
elat
ed in
form
atio
n am
ong
orga
niza
tions
acc
ordi
ng to
nat
iona
lly re
cogn
ized
stan
dard
s. H
IE is
als
o so
met
imes
refe
rred
to a
s a h
ealth
info
rmat
ion
netw
ork
(HIN
)
13.
Ale
rt (4
1)
Web
pag
e: A
lert
HIE
, Pr
ovid
er
Po
rtuga
l (H
ead
Off
ice)
ALE
RT®
HIE
is a
n in
tegr
atio
n in
fras
truct
ure
that
pro
vide
s the
abi
lity
to
acce
ss p
atie
nt c
linic
al re
cord
s fro
m d
iffer
ent h
ealth
care
faci
litie
s loc
ated
in
diff
eren
t geo
grap
hica
l are
as.
14.
Altm
an e
t al (
84)
Scie
ntifi
c 20
12
US
HIE
ena
bles
dig
ital,
clin
ical
info
rmat
ion
shar
ing
amon
g di
spar
ate
inst
itutio
ns,
whi
ch a
llow
s for
a m
ore
seam
less
tran
sitio
n of
car
e be
twee
n pr
ovid
ers.
With
H
IE, p
atie
nts c
an h
ave
thei
r exi
stin
g cl
inic
al in
form
atio
n vi
ewed
by
prov
ider
s ac
ross
diff
eren
t hea
lthca
re o
rgan
isat
ions
, kee
ping
all
of th
eir p
rovi
ders
in
form
ed. U
sing
HIE
, com
mun
ity c
linic
ians
can
als
o fo
llow
thei
r pat
ient
s’
inte
ract
ions
with
par
ticip
atin
g ho
spita
ls in
real
tim
e.
647
S.N
o.
Aut
hor
Sour
ce
Yea
r of
Publ
icat
ion
Cou
ntry
D
efin
ition
15.
AM
A (8
5)
Web
pag
e: A
mer
ican
M
edic
al A
ssoc
iatio
n U
nkno
wn
US
Hea
lth In
form
atio
n Ex
chan
ges (
HIE
s) a
re e
ntiti
es th
at b
ring
toge
ther
hea
lth
care
stak
ehol
ders
with
in a
def
ined
geo
grap
hic
area
and
gov
ern
the
elec
troni
c sh
arin
g of
hea
lth in
form
atio
n am
ong
them
for t
he p
urpo
se o
f im
prov
ing
heal
th
and
care
in th
at c
omm
unity
. The
fund
amen
tal c
once
pt b
ehin
d cr
eatin
g H
IEs i
s th
at th
e ab
ility
to e
xcha
nge
heal
th in
form
atio
n el
ectro
nica
lly is
crit
ical
to th
e ef
forts
to im
prov
e th
e U
S he
alth
car
e sy
stem
. 16
. A
mat
ayak
ul (5
0)
Web
pag
e: H
ealth
care
Fi
nanc
ial M
anag
emen
t bu
sine
ss jo
urna
l
2008
U
S H
IE o
rgan
izat
ions
go
by d
iffer
ent n
ames
-loca
l hea
lth in
form
atio
n or
gani
zatio
ns (L
HIO
), re
gion
al h
ealth
info
rmat
ion
orga
niza
tions
(RH
IO),
sub-
netw
ork
orga
niza
tions
(SN
O)-
-they
serv
e th
e sa
me
purp
ose:
to o
vers
ee a
nd
gove
rn th
e ex
chan
ge o
f hea
lth-r
elat
ed in
form
atio
n am
ong
disp
arat
e st
akeh
olde
rs fo
r the
pur
pose
of i
mpr
ovin
g he
alth
and
hea
lth c
are.
17
. A
ncke
r et a
l (8
6)
Scie
ntifi
c 20
12
US
Hea
lth in
form
atio
n ex
chan
ge (H
IE),
the
exch
ange
of e
lect
roni
c pa
tient
dat
a am
ong
heal
thca
re p
rovi
ders
and
inst
itutio
ns, i
s bei
ng p
rom
oted
by
natio
nal
polic
y be
caus
e of
its p
oten
tial t
o im
prov
e he
alth
care
qua
lity
and
effic
ienc
y,
enga
ge c
onsu
mer
s, an
d pr
omot
e po
pula
tion
heal
th.
18.
Ark
ansa
s OH
IT
(87)
Web
pag
e: A
rkan
sas
Off
ice
of H
ealth
In
form
atio
n Te
chno
logy
Unk
now
n U
S Th
e A
rkan
sas S
tate
Hea
lth A
llian
ce fo
r Rec
ords
Exc
hang
e (S
HA
RE)
is a
st
atew
ide
heal
th in
form
atio
n ex
chan
ge (H
IE) t
hat s
olve
s thi
s pro
blem
. SH
AR
E al
low
s prim
ary
heal
th c
are
prov
ider
s, re
late
d he
alth
serv
ices
pr
ofes
sion
als,
and
publ
ic h
ealth
aut
horit
ies t
o ac
cess
and
exc
hang
e w
ith e
ach
othe
r rea
l-tim
e, e
lect
roni
c pa
tient
info
rmat
ion
that
is se
cure
and
pro
tect
ed b
y cu
rren
t fed
eral
and
stat
e pr
ivac
y an
d se
curit
y la
ws.
Thro
ugh
its
impl
emen
tatio
n an
d us
e, S
HA
RE
will
redu
ce m
edic
al e
rror
s and
dup
licat
e te
stin
g, p
rom
ote
impr
oved
man
agem
ent o
f chr
onic
dis
ease
s, an
d im
prov
e pa
tient
car
e co
ordi
natio
n am
ong
unaf
filia
ted
heal
th c
are
prov
ider
s. 19
. A
spel
in (8
8)
Web
pag
e / P
ost:
Mar
k A
spel
in, H
ealth
IT
Man
ager
/ W
riter
Unk
now
n U
S H
ealth
Info
rmat
ion
Exch
ange
(HIE
) is a
term
that
is u
sed
to d
escr
ibe
the
shar
ing
of h
ealth
info
rmat
ion
elec
troni
cally
am
ong
two
or m
ore
entit
ies.
The
te
rm is
als
o us
ed to
des
crib
e an
org
aniz
atio
n th
at p
rovi
des s
ervi
ces t
hat e
nabl
e th
e el
ectro
nic
shar
ing
of h
ealth
info
rmat
ion.
The
con
cept
of a
hea
lth
info
rmat
ion
exch
ange
is a
crit
ical
ele
men
t of M
eani
ngfu
l Use
, and
the
futu
re
of h
ealth
care
refo
rm a
t the
loca
l, re
gion
al, a
nd n
atio
nal l
evel
. 20
. A
xolo
tl C
orp.
(5
5)
Web
pag
e: A
xolo
tol
Cor
pora
tion
prov
ider
for
brow
sing
bas
ed-p
rodu
cts
2009
U
S N
eHII
is a
stat
ewid
e H
ealth
Info
rmat
ion
Exch
ange
des
igne
d to
shar
e cl
inic
al
and
adm
inis
trativ
e da
ta a
mon
g pr
ovid
ers i
n N
ebra
ska
and
neig
hbor
ing
stat
es.
NeH
II’s
pur
pose
is to
ach
ieve
hea
lth c
are
trans
form
atio
n th
roug
h co
mm
unity
be
tterm
ent c
olla
bora
tion
whi
le p
rote
ctin
g th
e se
curit
y an
d pr
ivac
y of
med
ical
in
form
atio
n.
21.
Bar
ton
et a
l (3
0)
Scie
ntifi
c 20
06
Aus
tralia
Th
e H
IE is
the
depa
rtmen
t’s c
orpo
rate
net
wor
k of
dat
a w
areh
ouse
s. It
cont
ains
648
S.N
o.
Aut
hor
Sour
ce
Yea
r of
Publ
icat
ion
Cou
ntry
D
efin
ition
data
on
surg
ical
pro
cedu
res o
n in
patie
nts a
nd in
tern
atio
nal c
lass
ifica
tions
of
dise
ases
, 10t
h ed
ition
(IC
D-1
0) d
iagn
ostic
cod
es, a
nd re
cord
s epi
sode
s of c
are
and
cont
ains
info
rmat
ion
on d
iagn
osis
, pro
cedu
res a
nd so
me
dem
ogra
phic
ite
ms
22.
Birk
le e
t al (
19)
Scie
ntifi
c 20
11
Ger
man
y H
ealth
care
Info
rmat
ion
Exch
ange
Net
wor
ks (H
IEN
) ena
bles
the
exch
ange
of
med
ical
info
rmat
ion
betw
een
diff
eren
t ins
titut
ions
. 23
. B
ostic
k et
al.
(89)
Rep
ort:
Sust
aini
ng
Hea
lth In
form
atio
n Ex
chan
ge: A
Sta
te
Tool
kit b
y N
atio
nal
Gov
erno
rs A
ssoc
iatio
n C
ente
r for
Bes
t Pra
ctic
es
Stat
e A
llian
ce fo
r eH
ealth
2011
U
S Th
e te
rm “
heal
th in
form
atio
n ex
chan
ge”
(HIE
) ref
ers t
o th
e el
ectro
nic
mov
emen
t of h
ealth
-rel
ated
info
rmat
ion
amon
g or
gani
zatio
ns su
ch a
s hea
lth
care
pro
vide
rs, p
ublic
hea
lth a
genc
ies,
and
paye
rs, a
ccor
ding
to n
atio
nally
re
cogn
ized
stan
dard
s.
24.
Bou
hadd
ou e
t al
(90)
Scie
ntifi
c 20
12
US
Hea
lth in
form
atio
n ex
chan
ge (H
IE) r
efer
s to
the
activ
ity o
f sec
ure
heal
th d
ata
exch
ange
bet
wee
n tw
o au
thor
ized
and
con
sent
ing
tradi
ng p
artn
ers.
It is
a
secu
re d
ata
serv
ice
that
util
izes
nat
iona
lly re
cogn
ized
stan
dard
s to
enab
le
elec
troni
c tra
nspo
rt of
clin
ical
info
rmat
ion
amon
g se
para
te h
ealth
car
e or
gani
zatio
ns th
at a
re m
otiv
ated
by
com
mon
inte
rest
s and
gov
erne
d by
rule
s th
at e
nsur
e th
e rig
hts o
f pat
ient
s and
par
ticip
ants
are
pro
tect
ed.
25.
Boy
le (2
8)
Whi
te p
aper
: Priv
acy
Less
ons L
earn
ed fr
om
an O
pera
tiona
l H
ealth
Info
rmat
ion
Exch
ange
by
FairW
arni
ng
2011
U
K
Hea
lth In
form
atio
n Ex
chan
ges (
HIE
s) w
hich
faci
litat
e th
e el
ectro
nic
exch
ange
of
pat
ient
info
rmat
ion
betw
een
care
pro
vide
rs a
t a p
rovi
ncia
l, st
ate,
regi
onal
or
natio
nal l
evel
.
26.
Bra
ithw
aite
(6)
Scie
ntifi
c 19
98
US
Wor
kgro
up E
lect
roni
c D
ata
Inte
rcha
nge
(WED
I), a
coa
litio
n of
re
pres
enta
tives
from
var
ious
com
pone
nts o
f the
hea
lth c
are
indu
stry
, inc
ludi
ng
insu
ranc
e co
mpa
nies
, man
aged
car
e or
gani
zatio
ns, h
ealth
car
e pr
ovid
er
orga
niza
tions
, gov
ernm
ent a
genc
ies,
and
heal
th c
are
clea
ringh
ouse
s.
27.
Bre
dfel
dt (9
1)
Scie
ntifi
c 20
13
US
Elec
troni
c he
alth
info
rmat
ion
exch
ange
(eH
IE) f
acili
tate
s coo
rdin
atio
n of
car
e by
ena
blin
g in
form
atio
n tra
nsfe
r acr
oss p
rovi
ders
and
med
ical
clin
ics.
By
incr
easi
ng c
are
coor
dina
tion,
eH
IE is
exp
ecte
d to
redu
ce h
ealth
care
cos
ts
resu
lting
from
redu
ndan
t lab
test
s and
radi
olog
y st
udie
s. 28
. B
resn
ick
(92)
Web
pag
e:
ehrin
telli
genc
e.co
m f
or
2013
U
nkno
wn
Hea
lth in
form
atio
n ex
chan
ge (H
IE) m
akes
man
y pr
omis
es: a
com
plet
e,
stru
ctur
ed, e
lect
roni
c pa
tient
reco
rd, a
vaila
ble
to a
ny p
rovi
der a
t the
pus
h of
a
649
S.N
o.
Aut
hor
Sour
ce
Yea
r of
Publ
icat
ion
Cou
ntry
D
efin
ition
late
st te
chno
logy
new
s an
d w
hite
pap
ers /
A
rticl
e
butto
n, in
stan
tly u
pdat
ed a
nd a
lway
s rel
iabl
e.
29.
Bug
ge e
t al
(26)
Scie
ntifi
c 20
06
UK
In
form
atio
n ex
chan
ge b
etw
een
patie
nts a
nd h
ealth
pro
fess
iona
ls is
fu
ndam
enta
l to
achi
evin
g pa
tient
par
ticip
atio
n in
dec
isio
n-m
akin
g an
d sh
ared
de
cisi
on-m
akin
g is
said
to re
quire
the
exch
ange
of “
all i
nfor
mat
ion
rele
vant
to
deci
sion
-mak
ing”
. 30
. B
yers
(5)
Sc
ient
ific
1957
U
S Th
e O
ccup
atio
nal H
ealth
Info
rmat
ion
Exch
ange
will
serv
e as
a c
entra
l age
ncy
for t
he c
olle
ctio
n, c
olla
tion,
and
dis
sem
inat
ion
of a
ll ty
pes o
f inf
orm
atio
n pe
rtine
nt to
occ
upat
iona
l hea
lth p
robl
ems.
31
. C
anno
y (2
0)
PhD
The
sis:
The
Im
plic
atio
ns o
f HIE
on
H
ealth
care
Con
sum
ers:
Th
e C
ase
of
Con
sum
er
Empo
wer
men
t.
Bus
ines
s Edu
catio
n D
epar
tmen
t,
Nor
th C
arol
ina
A&
T St
ate
Uni
vers
ity
2008
U
S Th
e ca
pabi
lity
to u
se te
chno
logy
to e
lect
roni
cally
exc
hang
e m
edic
al re
cord
s is
calle
d H
ealth
care
Info
rmat
ion
Exch
ange
(HIE
).
HIE
is t
he p
roce
ss o
f util
izin
g in
form
atio
n sy
stem
s and
tech
nolo
gy fo
r el
ectro
nic
stor
age,
retri
eval
, and
shar
ing
of h
ealth
care
info
rmat
ion
amon
g pa
rtici
pant
s in
the
heal
thca
re sy
stem
so th
at in
form
atio
n is
acc
essi
ble
at th
e po
int o
f car
e.
32.
Car
e A
ccor
d (9
3)
Web
pag
e: O
rego
n H
IE
Unk
now
n U
S H
ealth
info
rmat
ion
exch
ange
(HIE
) allo
ws d
octo
rs, n
urse
s, ph
arm
acis
ts a
nd
othe
r hea
lth c
are
prov
ider
s to
secu
rely
shar
e a
patie
nt’s
med
ical
info
rmat
ion
elec
troni
cally
— re
duci
ng th
e ne
ed fo
r pat
ient
s to
trans
port
or re
lay
thei
r m
edic
al h
isto
ry, l
ab re
sults
, im
ages
or p
resc
riptio
ns b
etw
een
heal
th
prof
essi
onal
s. In
stea
d, th
is in
form
atio
n is
shar
ed b
etw
een
heal
th c
are
prof
essi
onal
s bef
ore
the
patie
nt a
rriv
es fo
r an
appo
intm
ent o
r goe
s to
the
phar
mac
y. H
IE c
an a
lso
redu
ce o
rder
s for
dup
licat
e pr
oced
ures
or t
ests
be
caus
e in
form
atio
n is
ava
ilabl
e w
here
and
whe
n it
is n
eede
d, a
s wel
l as
enab
ling
smoo
ther
tran
sitio
ns o
f car
e be
caus
e pr
ovid
ers,
hosp
itals
and
long
te
rm c
are
faci
litie
s can
mor
e ea
sily
shar
e in
form
atio
n.
33.
Car
ter
(94)
Scie
ntifi
c 20
06
US
Ther
e ar
e a
mul
titud
e of
term
s cur
rent
ly u
sed
to d
escr
ibe
a ne
twor
ked
com
mun
ity o
f hea
lthca
re e
ntiti
es u
sing
inte
rope
rabl
e el
ectro
nic
heal
th re
cord
sy
stem
s to
exch
ange
hea
lth in
form
atio
n. T
hese
incl
ude
regi
onal
hea
lth
info
rmat
ion
orga
niza
tion
(RH
IO),
heal
th in
form
atio
n ex
chan
ge (H
IE),
the
natio
nwid
e he
alth
info
rmat
ion
netw
ork,
and
at o
ne ti
me,
com
mun
ity h
ealth
in
form
atio
n ne
twor
k.
650
S.N
o.
Aut
hor
Sour
ce
Yea
r of
Publ
icat
ion
Cou
ntry
D
efin
ition
34.
CD
C (9
5)
Pres
enta
tion:
D
epar
tmen
t of H
ealth
an
d H
uman
Ser
vice
s, U
SA /
Cen
tre fo
r D
isea
se C
ontro
l and
Pr
even
tion
Unk
now
n U
S H
IE p
rovi
des t
he c
apab
ility
to e
lect
roni
cally
mov
e cl
inic
al in
form
atio
n be
twee
n di
spar
ate
heal
th c
are
info
rmat
ion
syst
ems w
hile
mai
ntai
ning
the
mea
ning
of t
he in
form
atio
n be
ing
exch
ange
d. T
he g
oal o
f HIE
is to
faci
litat
e ac
cess
to a
nd re
triev
al o
f clin
ical
dat
a to
pro
vide
safe
r, m
ore
timel
y, e
ffic
ient
, ef
fect
ive
and
equi
tabl
e, p
atie
nt-c
ente
red
care
.”
35.
Cen
trici
ty (5
9)
Web
pag
e:
eHea
lthse
rver
New
s, G
E H
ealth
care
, a d
ivis
ion
of
Gen
eral
Ele
ctric
C
ompa
ny a
nd g
loba
l eH
ealth
spec
ialis
t In
terC
ompo
nent
War
e,
Inc.
(IC
W) j
oint
HIE
2009
U
S C
entri
city
® H
ealth
Info
rmat
ion
Exch
ange
serv
ices
con
nect
s, st
ores
and
shar
es
clin
ical
dat
a fr
om h
ospi
tals
, phy
sici
an o
ffic
es, p
harm
acie
s, la
bs a
nd o
ther
so
urce
s to
help
impr
ove
com
mun
icat
ion
flow
bet
wee
n ca
re p
rovi
ders
and
pa
tient
s and
clin
icia
ns. T
he re
sulti
ng n
etw
ork
enab
les s
tate
, gov
ernm
ent o
r he
alth
care
del
iver
y or
gani
zatio
ns to
cre
ate
a se
cure
exc
hang
e to
shar
e pa
tient
co
nditi
ons,
alle
rgie
s, m
edic
atio
n hi
stor
y an
d ot
her a
ppro
pria
te c
linic
al d
ata
acro
ss th
e co
ntin
uum
of c
are.
36.
Cer
ner (
96)
Web
pag
e: C
erne
r,
Solu
tion
Prov
ider
U
nkno
wn
US
Clin
ical
Exc
hang
e Pl
atfo
rm is
a m
ajor
Cer
ner N
etw
ork
offe
ring
that
focu
ses
on th
e se
cure
exc
hang
e of
crit
ical
pat
ient
sum
mar
ies w
ithin
the
clin
icia
n’s
wor
kflo
w. C
linic
al E
xcha
nge
Plat
form
leve
rage
s a su
ite o
f ope
n so
urce
so
lutio
ns b
roug
ht to
geth
er b
y pr
oprie
tary
inte
llect
ual p
rope
rties
cre
atin
g a
low
co
st IH
E St
anda
rds b
ased
exc
hang
e.
37.
Cha
udha
ry (9
7)
Scie
ntifi
c 20
12
US
Hea
lth In
form
atio
n Ex
chan
ge (H
IE) i
s the
pro
cess
of r
elia
ble
and
inte
rope
rabl
e el
ectro
nic
heal
th re
cord
(EH
R) s
harin
g, c
ondu
cted
in a
man
ner
that
pro
tect
s the
con
fiden
tialit
y, p
rivac
y, a
nd se
curit
y of
the
info
rmat
ion.
38
. C
isco
(98)
Web
page
: Cis
co,
Solu
tion
Prov
ider
U
nkno
wn
US
The
Cis
co M
edic
al D
ata
Exch
ange
Sol
utio
n (M
DES
) is a
n in
tegr
ated
end
-to-
end,
stan
dard
s-ba
sed
solu
tion
that
faci
litat
es p
atie
nt-c
entri
c ac
cess
to m
edic
al
reco
rds.
It gi
ves h
ealth
care
pro
fess
iona
ls fr
om m
ultip
le in
stitu
tions
acc
ess t
o pa
tient
dat
a fr
om p
revi
ousl
y di
scon
nect
ed sy
stem
s with
inco
mpa
tible
form
ats
and
disp
arat
e m
edic
al te
rmin
olog
y. N
ow p
rovi
ders
can
qui
ckly
and
eas
ily
acce
ss a
nd re
view
a p
atie
nt's
med
ical
dat
a ga
ther
ed b
y di
ffer
ent a
pplic
atio
ns
and
stor
ed in
sepa
rate
loca
tions
.
39.
Citi
us T
ech
(99)
Web
pag
e: T
echn
olog
y an
d So
lutio
n Pr
ovid
er
Unk
now
n U
S H
ealth
Info
rmat
ion
Exch
ange
s (H
IEs)
off
er si
gnifi
cant
opp
ortu
nity
for c
ross
en
terp
rise
docu
men
t sha
ring
in h
ealth
care
– p
ositi
vely
impa
ctin
g bo
th q
ualit
y an
d co
st o
f hea
lthca
re d
eliv
ery.
HIE
s pro
vide
flex
ible
dat
a sh
arin
g ca
pabi
litie
s w
ith h
ospi
tals
, pub
lic h
ealth
and
fede
ral r
epor
ting
entit
ies.
HIE
s can
als
o of
fer
stro
ng a
naly
tics a
nd re
porti
ng c
apab
ilitie
s to
track
pop
ulat
ion
heal
th a
nd
supp
ort a
wid
e ra
nge
of c
linic
al d
ecis
ion
supp
ort c
apab
ilitie
s.
651
S.N
o.
Aut
hor
Sour
ce
Yea
r of
Publ
icat
ion
Cou
ntry
D
efin
ition
40.
C. K
ibbe
(10
0)
Web
pag
e / P
ost:
The
Soci
ety
for P
artic
ipat
ory
Med
icin
e, e
-pat
ient
s.net
2009
U
S H
ealth
info
rmat
ion
exch
ange
bet
wee
n an
d am
ong
prov
ider
s, es
peci
ally
whe
n th
ese
prov
ider
s are
inde
pend
ent e
ntiti
es o
r exi
st in
sepa
rate
geo
grap
hica
l lo
catio
ns, h
elps
cre
ate
cont
inui
ty o
f pat
ient
s’ e
xper
ienc
e by
pro
vidi
ng
cont
inui
ty o
f inf
orm
atio
n flo
w a
nd a
cces
s whe
re o
nce
ther
e w
ere
only
isol
ated
si
los o
f hea
lth d
ata.
The
re is
wid
espr
ead
belie
f tha
t hea
lth d
ata
shar
ing
coul
d im
prov
e ca
re, s
afet
y, a
nd d
ecre
ase
was
te a
nd d
uplic
atio
n.
41.
C. L
ivin
good
et a
l. (1
01)
Rep
ort:
Publ
ic H
ealth
&
Elec
troni
c H
ealth
In
form
atio
n Ex
chan
ge:
A G
uide
To
Loca
l A
genc
y Le
ader
ship
by
The
Inst
itute
for P
ublic
H
ealth
Info
rmat
ics a
nd
Res
earc
h
Duv
al C
ount
y H
ealth
D
epar
tmen
t
Unk
now
n U
S Th
e fo
cus o
n el
ectro
nic
heal
th in
form
atio
n ex
chan
ge (E
HIE
) em
phas
izes
how
da
ta c
an b
est b
e sh
ared
and
util
ized
acr
oss h
ealth
care
inst
itutio
ns a
nd a
mon
g pr
ovid
ers t
o im
prov
e pa
tient
s’ h
ealth
, im
prov
e th
e qu
ality
of c
are,
incr
ease
ef
ficie
ncy,
and
redu
ce c
osts
.
42.
Cle
men
s (1
02)
Scie
ntifi
c 20
12
US
Hea
lth in
form
atio
n ex
chan
ges,
in w
hich
all
indi
vidu
al p
atie
nt in
form
atio
n is
ro
utin
ely
and
entir
ely
man
aged
thro
ugh
a ce
ntra
l inf
orm
atio
n sy
stem
43
. C
linic
al C
onne
ct
(103
) W
eb p
age:
Clin
ical
C
onne
ct is
a w
este
rn
Penn
sylv
ania
’s fi
rst H
IE
Unk
now
n U
S C
linic
alC
onne
ct is
wes
tern
Pen
nsyl
vani
a’s f
irst H
ealth
Info
rmat
ion
Exch
ange
(H
IE).
A p
artn
ersh
ip o
f lea
ding
regi
onal
hea
lth c
are
prov
ider
s, C
linic
alC
onne
ct w
ill h
elp
to im
prov
e th
e sa
fety
, qua
lity,
and
eff
icie
ncy
of c
are
for p
atie
nts t
hrou
ghou
t the
regi
on b
y se
cure
ly c
onne
ctin
g cl
inic
ians
with
pa
tient
s’ v
ital e
lect
roni
c m
edic
al re
cord
s 44
. C
odag
none
(42)
A st
udy
prep
ared
for t
he
Euro
pean
Com
mis
sion
20
13
Euro
pean
U
nion
H
ealth
Info
rmat
ion
Exch
ange
(HIE
): is
the
proc
ess o
f ele
ctro
nica
lly
trans
ferr
ing
/ sha
ring
/ ena
blin
g ac
cess
to p
atie
nt h
ealth
info
rmat
ion
and
data
. 45
. C
OR
HIO
(104
) R
epor
t: H
IPPA
and
HIE
by
Col
orad
o R
egio
nal
Hea
lth In
form
atio
n O
rgan
izat
ion
Unk
now
n U
S C
OR
HIO
’s H
IE m
akes
it p
ossi
ble
for p
rovi
ders
to a
cces
s and
exc
hang
e pa
tient
in
form
atio
n el
ectro
nica
lly, i
mpr
ovin
g pa
tient
safe
ty a
nd re
duci
ng d
elay
s in
care
that
can
be
caus
ed w
hen
pape
r rec
ords
are
ille
gibl
e, g
et lo
st, a
re
acci
dent
ally
des
troye
d by
fire
, flo
od o
r nat
ural
dis
aste
r, or
are
sent
to th
e w
rong
fax
mac
hine
or a
ddre
ss. I
t als
o he
lps p
rovi
ders
acc
ess m
ore
com
plet
e an
d up
-to-d
ate
patie
nt m
edic
al re
cord
s, w
hich
is e
spec
ially
hel
pful
in
emer
genc
y si
tuat
ions
or f
or p
atie
nts w
ho h
ave
a ch
roni
c m
edic
al c
ondi
tion
for
w
hich
they
see
man
y pr
ovid
ers o
ver t
he c
ours
e of
a y
ear.
46
. C
SC (3
1)
Web
pag
e: H
ealth
care
G
roup
/ Se
rvic
e Pr
ovid
er
Unk
now
n A
ustra
lia
CSC
is ta
king
a H
ealth
Info
rmat
ion
Exch
ange
app
roac
h to
ena
blin
g se
cure
he
alth
dat
a sh
arin
g be
twee
n ho
spita
ls a
nd o
ther
car
e pr
ovid
ers.
C
SC’s
app
roac
h to
Hea
lth In
form
atio
n Ex
chan
ge (H
IE) p
rovi
des n
ot o
nly
a
652
S.N
o.
Aut
hor
Sour
ce
Yea
r of
Publ
icat
ion
Cou
ntry
D
efin
ition
solu
tion
to e
nabl
e th
e m
any
and
dive
rse
CSC
app
licat
ions
for t
he e
Hea
lth
agen
da b
ut a
lso
an a
gnos
tic d
esig
n th
at w
ill a
llow
our
par
tner
s and
co
mpe
titor
s to
leve
rage
this
pla
tform
. 47
. D
aurio
et a
l (10
5)
Scie
ntifi
c 20
09
US
An
exch
ange
of c
linic
al in
form
atio
n be
twee
n B
rook
lyn
hosp
itals
, nur
sing
ho
mes
, and
hom
e he
alth
age
ncie
s tha
t aid
s in
the
trans
ition
of c
are
for i
ts
shar
ed p
atie
nts.
48.
Dea
s Jr a
nd
Solo
mon
(10
6)
Scie
ntifi
c 20
12
US
The
term
HIE
is a
lso
used
to d
escr
ibe
form
al o
rgan
izat
ions
that
pro
vide
the
infr
astru
ctur
e fo
r ele
ctro
nic
exch
ange
. 49
. D
e B
rant
es e
t al.
(45)
Scie
ntifi
c 20
07
US
Hea
lth in
form
atio
n ex
chan
ges o
r reg
iona
l hea
lth in
form
atio
n or
gani
zatio
ns
(HIE
s or R
HIO
s) h
ave
emer
ged
as v
ehic
les t
o fa
cilit
ate
the
flow
of c
linic
al
info
rmat
ion
betw
een
prov
ider
s in
the
com
mun
ity; t
hey
are
build
ing
on th
e fo
unda
tion
laid
by
the
pion
eers
in th
e fie
ld, t
he In
dian
a H
ealth
Info
rmat
ion
Exch
ange
, the
Inla
nd N
orth
wes
t Hea
lth S
yste
m, H
ealth
Brid
ge a
nd a
few
ot
hers
. The
prim
ary
busi
ness
focu
s of t
hese
net
wor
ks h
as so
ught
to c
reat
e va
lue
for t
he p
rovi
der c
omm
unity
by
crea
ting
prod
uctiv
e ef
ficie
ncie
s. In
doi
ng
so, t
hey
have
bee
n ab
le to
gen
erat
e m
odes
t rev
enue
, and
ther
efor
e ha
ve
achi
eved
a m
odes
t but
sust
aina
ble
busi
ness
mod
el.
50.
Del
fan
(32)
Mas
ter T
hesi
s:
Com
pute
r Sci
ence
Del
ft U
nive
rsity
of
Tech
nolo
gy
2013
N
ethe
rland
s H
ealth
Info
rmat
ion
Exch
ange
(HIE
) is a
term
use
d to
des
crib
e th
e sh
arin
g of
he
alth
info
rmat
ion
elec
troni
cally
am
ong
two
or m
ore
entit
ies.
Thes
e en
titie
s ar
e m
ostly
org
aniz
atio
ns, w
hich
pro
vide
hea
lth se
rvic
es to
thei
r clie
nts (
the
patie
nts)
and
als
o en
able
the
shar
ing
of e
lect
roni
c he
alth
info
rmat
ion.
The
ex
chan
ge o
f med
ical
dat
a ta
kes p
lace
prim
arily
bet
wee
n di
ffer
ent m
edic
al
depa
rtmen
ts w
ithin
the
sam
e he
alth
org
aniz
atio
n. T
his h
appe
ns m
ost o
f the
tim
e th
roug
h an
Ele
ctro
nic
Hea
lth R
ecor
ds (E
HR
) sys
tem
with
in th
e or
gani
zatio
n, b
ut a
lso
acro
ss th
e or
gani
zatio
nal b
orde
rs o
n th
e re
gion
al le
vel
(thro
ugh
Reg
iona
l Hea
lth In
form
atio
n Sy
stem
s, R
HIS
) or a
cros
s the
cou
ntry
(N
atio
nal E
HR
). 51
. D
imitr
opou
los a
nd
Riz
k
(53)
Scie
ntifi
c 20
09
US
An
inte
rope
rabl
e sy
stem
of H
IE—
that
is, o
ne in
whi
ch v
ario
us p
artie
s can
sh
are
and
exch
ange
dat
a am
ong
them
. 52
. D
obbs
et a
l (1
07)
Scie
ntifi
c 20
10
US
HIE
s wou
ld p
rovi
de a
uni
fied
view
of a
pat
ient
acr
oss h
ealth
car
e pr
ovid
ers
and
wou
ld se
rve
as d
ata
colle
ctio
n po
ints
for c
linic
al a
nd re
sour
ce u
tiliz
atio
n da
ta.
53.
Dow
ning
et a
l (1
08)
Scie
ntifi
c 20
10
US
Col
labo
rativ
e re
latio
nshi
ps a
mon
g pr
imar
y ca
re a
nd sp
ecia
lty p
rovi
ders
and
th
eir p
atie
nts a
nd fa
mili
es c
an b
e en
hanc
ed th
roug
h el
ectro
nic
HIE
. 54
. D
ulla
bh a
nd
Hov
ey (
109)
Scie
ntifi
c 20
12
US
Ther
e is
wid
espr
ead
cons
ensu
s tha
t Hea
lth In
form
atio
n Ex
chan
ge, t
he
elec
troni
c sh
arin
g of
pat
ient
s' he
alth
info
rmat
ion
betw
een
deliv
ery
setti
ngs,
is
653
S.N
o.
Aut
hor
Sour
ce
Yea
r of
Publ
icat
ion
Cou
ntry
D
efin
ition
criti
cal t
o im
prov
ing
the
qual
ity a
nd e
ffic
ienc
y of
pat
ient
car
e.
55.
eHea
lth In
itiat
ive
(110
) R
epor
t: H
ealth
In
form
atio
n Ex
chan
ge:
From
Sta
rt U
p to
Su
stai
nabi
lity
by
Foun
datio
n fo
r eH
ealth
In
itiat
ive
2007
U
S “H
ealth
info
rmat
ion
exch
ange
” de
scrib
es a
com
mon
ly u
nder
stoo
d ac
tivity
: the
sh
arin
g of
pat
ient
car
e da
ta b
etw
een
non-
alig
ned
heal
th c
are
orga
niza
tions
for
the
purp
oses
of e
nhan
cing
qua
lity
and
effic
ienc
y.
56.
eHEa
lth In
itiat
ive
(111
) 20
11 R
epor
t on
Hea
lth
Info
rmat
ion
Exch
ange
: Th
e
Cha
ngin
g La
ndsc
ape
2011
U
S Th
e ac
t of t
rans
ferr
ing
heal
th in
form
atio
n el
ectro
nica
lly b
etw
een
two
or m
ore
entit
ies.
57.
eHea
lth P
rivac
y 36
0 (1
12)
Web
pag
e: C
alifo
rnia
G
over
nmen
t 20
11
US
The
elec
troni
c ex
chan
ge o
f hea
lth in
form
atio
n al
low
s you
r hea
lth c
are
info
rmat
ion
to b
e sh
ared
bet
wee
n he
alth
car
e pr
ovid
ers.
This
exc
hang
e is
don
e th
roug
h th
e EH
R sy
stem
. You
r hea
lth in
form
atio
n m
ay b
e ex
chan
ged
betw
een
doct
ors,
labo
rato
ries,
hosp
itals
, pha
rmac
ies,
and
othe
r pro
vide
rs y
ou h
ave
visi
ted.
Hea
lth in
form
atio
n fr
om y
our h
ealth
pla
n m
ay a
lso
be e
xcha
nged
and
us
ed fo
r you
r car
e.
58.
Emde
on (1
13)
Web
pag
e: V
endo
r /
Solu
tion
Prov
ider
U
nkno
wn
US
Emde
on c
onne
cts p
hysi
cian
s, ho
spita
ls, p
harm
acie
s and
labs
to se
cure
ly
exch
ange
info
rmat
ion
whe
n it
can
save
the
mos
t mon
ey a
nd p
rovi
de th
e m
ost
bene
fit -
right
at t
he p
oint
-of-
care
. Em
deon
, cur
rent
ly p
erfo
rmin
g m
ore
than
6.
4 bi
llion
hea
lth in
form
atio
n ex
chan
ges p
er y
ear,
mak
es th
e pr
oces
s of
shar
ing
info
rmat
ion
easy
, eff
icie
nt a
nd a
ffor
dabl
e.
59.
Exce
licar
e (2
9)
Web
pag
e: A
xsys
H
ealth
, Exc
elic
are
Solu
tion
Prov
ider
Unk
now
n U
K
Exce
licar
e™ C
linic
al P
orta
l allo
ws u
sers
to e
xplo
re in
form
atio
n re
leva
nt to
th
e ca
re o
f eve
ry p
atie
nt, r
egar
dles
s of w
here
it w
as fi
rst r
ecor
ded.
As a
car
e-gi
ver,
the
porta
l off
ers y
ou a
com
posi
te v
iew
of p
atie
nt in
form
atio
n, in
a
clin
ical
ly re
leva
nt fo
rmat
, with
hyp
erlin
ks th
at le
t you
dril
l to
unde
rlyin
g de
tails
. Lab
orat
ory
resu
lts a
nd o
utst
andi
ng o
rder
s, re
cent
med
icat
ions
and
pr
escr
iptio
ns, x
-ray
imag
es a
nd re
ports
from
radi
olog
y, c
oded
pro
blem
list
, cl
inic
al n
otes
from
any
spec
ialty
– a
ll th
ese
are
pres
ente
d in
an
easy
-to-a
cces
s, re
leva
nt w
ay. B
ut it
doe
sn’t
have
to st
op th
ere.
Ref
erra
l and
dis
char
ge le
tters
, G
P no
tes,
appo
intm
ents
, ass
essm
ents
, clin
ical
alte
rs, a
nd in
form
atio
n fr
om
com
mun
ity h
ealth
can
be
incl
uded
. 60
. Fi
nn (1
14)
Scie
ntifi
c 20
11
US
Hea
lth in
form
atio
n ex
chan
ge (H
IE) i
s def
ined
as t
he m
obili
zatio
n of
hea
lth
care
info
rmat
ion
elec
troni
cally
acr
oss o
rgan
izat
ions
with
in a
regi
on o
r co
mm
unity
. It p
rovi
des t
he c
apab
ility
to e
lect
roni
cally
mov
e he
alth
in
form
atio
n be
twee
n va
rious
syst
ems,
whi
le m
aint
aini
ng th
e au
then
ticity
and
654
S.N
o.
Aut
hor
Sour
ce
Yea
r of
Publ
icat
ion
Cou
ntry
D
efin
ition
accu
racy
of t
he in
form
atio
n be
ing
exch
ange
d. T
his s
harin
g of
crit
ical
and
ad
min
istra
tive
heal
th d
ata
elec
troni
cally
ena
bles
a c
are
team
to m
ake
mor
e in
form
ed d
ecis
ions
. HIE
s are
mul
ti-st
akeh
olde
r org
aniz
atio
ns th
at o
vers
ee th
e bu
sine
ss a
nd le
gal i
ssue
s inv
olve
d in
the
exch
ange
of i
nfor
mat
ion.
The
st
akeh
olde
rs a
re d
iver
se a
nd g
ener
ally
incl
ude
larg
e do
ctor
gro
ups,
solo
pr
actic
es, c
ompe
ting
hosp
itals
, and
pay
ers.
Patie
nts h
ave
been
vis
ibly
abs
ent
from
the
disc
ussi
ons,
inte
ract
ions
, and
agr
eem
ents
that
form
and
run
thes
e H
IE
orga
niza
tions
. Pat
ient
acc
ess t
o th
eir o
wn
info
rmat
ion
from
an
HIE
has
als
o be
en li
mite
d, b
ut th
at p
rom
ises
to c
hang
e ov
er ti
me.
61
. Fl
orid
a H
IE (1
15)
Web
pag
e: F
lorid
a H
IE
Unk
now
n U
S Th
e Fl
orid
a H
ealth
Info
rmat
ion
Exch
ange
(HIE
) pro
vide
s ent
ities
with
tim
ely,
se
cure
, and
aut
horiz
ed e
xcha
nge
of p
atie
nt h
ealth
info
rmat
ion.
The
serv
ices
w
e of
fer a
re b
ased
on
natio
nal s
tand
ards
for s
ecur
e ex
chan
ge o
f hea
lth
info
rmat
ion.
62
. Fl
orid
a H
IN (1
16)
Web
pag
e: F
lorid
a H
ealth
Info
rmat
ion
Net
wor
k
Unk
now
n U
S Th
e Fl
orid
a H
ealth
Info
rmat
ion
Exch
ange
(Flo
rida
HIE
) ena
bles
the
secu
re
exch
ange
of h
ealth
info
rmat
ion.
It a
llow
s aut
horiz
ed m
edic
al p
rovi
ders
to
quic
kly
and
effic
ient
ly re
view
thei
r pat
ient
s’ m
edic
al re
cord
s to
faci
litat
e di
agno
sis a
nd tr
eatm
ent.
63.
Forc
are
(33)
Web
pag
e: D
utch
so
ftwar
e co
mpa
ny
prov
idin
g so
ftwar
e pr
oduc
ts a
nd se
rvic
e fo
r he
alth
care
Unk
now
n N
ethe
rland
s A
Hea
lth In
form
atio
n Ex
chan
ge is
a n
etw
ork,
allo
win
g ou
r cus
tom
ers t
o ex
chan
ge m
edic
al d
ata
to su
ppor
t key
clin
ical
pro
cess
es. E
xam
ples
incl
ude
imag
ing
netw
orks
, ref
erra
l net
wor
ks a
nd c
omm
unic
atio
n to
GPs
. An
HIE
can
be
bui
lt ar
ound
a si
ngle
hos
pita
l, or
can
cov
er a
regi
onal
or n
atio
nal g
roup
of
heal
thca
re in
stitu
tions
. 64
. Fr
anke
l et a
l (3
9)
Scie
ntifi
c 20
13
Isra
el
The
verti
cally
inte
grat
ed C
lalit
Hea
lth S
ervi
ces s
eeks
to c
ompl
etel
y op
en
info
rmat
ion
exch
ange
bet
wee
n ho
spita
l and
com
mun
ity c
are
by p
rovi
ding
a
sing
le m
edic
al in
form
atic
s sys
tem
acr
oss t
he sp
ectru
m o
f car
e.
65.
Fris
se (
117)
Scie
ntifi
c 20
10
US
This
mod
el —
ofte
n ca
lled
a he
alth
info
rmat
ion
exch
ange
— d
iffer
s fro
m
othe
rs in
that
the
colle
ctio
n of
hea
lth in
form
atio
n ex
chan
ge se
rvic
es
com
mon
ly is
man
aged
thro
ugh
a de
sign
ated
lega
l ent
ity, a
nd d
ata
may
be
acce
ssed
from
a h
ighl
y se
cure
set o
f ser
vice
s tha
t pro
vide
s the
per
form
ance
an
d si
mpl
icity
of a
cen
traliz
ed d
atab
ase.
66
. F
risse
et a
l (1
18)
Scie
ntifi
c 20
12
US
HIE
is a
set o
f ser
vice
s tha
t sup
ports
acc
ess a
mon
g pa
rties
who
are
mot
ivat
ed
by c
omm
on in
tere
st a
nd g
over
ned
to e
nsur
e th
at th
e rig
hts o
f pat
ient
s and
pa
rtici
pant
s are
pro
tect
ed.
67.
Furu
kaw
a et
al
(119
) Sc
ient
ific
2013
U
S El
ectro
nic
heal
th in
form
atio
n ex
chan
ge c
an im
prov
e ca
re c
oord
inat
ion
for
patie
nts b
y en
ablin
g m
ore
timel
y an
d co
mpl
ete
shar
ing
of c
linic
al in
form
atio
n am
ong
prov
ider
s and
hos
pita
ls.
655
S.N
o.
Aut
hor
Sour
ce
Yea
r of
Publ
icat
ion
Cou
ntry
D
efin
ition
68.
GA
O (1
20)
Rep
ort:
Hea
lth C
are
Entit
ies’
R
epor
ted
Dis
clos
ure
Pr
actic
es a
nd E
ffec
ts
on Q
ualit
y of
Car
e by
U
nite
d St
ates
G
over
nmen
t A
ccou
ntab
ility
Off
ice
Was
hing
ton,
DC
205
48
2010
U
S H
ealth
info
rmat
ion
exch
ange
s–en
titie
s tha
t wer
e fo
rmed
to fa
cilit
ate
the
elec
troni
c sh
arin
g of
pat
ient
s’ h
ealth
info
rmat
ion
amon
g pr
ovid
ers.
69.
Gad
d et
al.
(121
) Sc
ient
ific
2011
U
S Its
goa
l was
to c
reat
e an
HIE
that
mee
ts th
e ba
sic
need
s of a
n un
ders
erve
d m
etro
polit
an re
gion
thro
ugh
exch
ange
of c
linic
al d
ata
amon
g ho
spita
l em
erge
ncy
depa
rtmen
ts a
nd c
omm
unity
-bas
ed a
mbu
lato
ry c
linic
s. 70
. G
aebe
l (12
2)
Web
pag
e / P
ost :
H
IMSS
HIE
Wik
i U
nkno
wn
U
S A
Hea
lth In
form
atio
n Ex
chan
ge (H
IE) a
ssis
ts w
ith th
e tra
nsfe
r and
shar
ing
of
heal
th re
late
d in
form
atio
n th
at is
typi
cally
stor
ed in
mul
tiple
org
aniz
atio
ns,
whi
le m
aint
aini
ng th
e co
ntex
t and
inte
grity
of t
he in
form
atio
n be
ing
exch
ange
d. A
n H
IE p
rovi
des a
cces
s and
retri
eval
of p
atie
nt in
form
atio
n to
au
thor
ized
use
rs in
ord
er to
pro
vide
safe
, eff
icie
nt, e
ffec
tive,
and
tim
ely
patie
nt c
are.
71
. G
artn
er (6
8)
IT G
loss
ary:
Gar
tner
, In
c. R
esea
rch
and
Adv
isor
y C
ompa
ny
Unk
now
n U
S A
hea
lth in
form
atio
n ex
chan
ge (H
IE) i
s a re
gion
al c
olla
bora
tion
amon
g in
depe
nden
t hea
lthca
re o
rgan
izat
ions
for s
harin
g cl
inic
al in
form
atio
n. O
ften,
ad
min
istra
tive
info
rmat
ion
is sh
ared
as w
ell.
HIE
s may
be
cate
goriz
ed in
te
rms o
f the
ir ap
proa
ch to
gov
erna
nce.
In so
me
coun
tries
, the
y m
ay b
e ru
n by
a
gove
rnm
enta
l age
ncy.
Oth
er H
IEs m
ay b
e ru
n by
non
prof
it co
rpor
atio
ns
with
a b
oard
of g
over
nors
that
repr
esen
t com
mun
ity st
akeh
olde
rs. S
till o
ther
s ar
e lin
es o
f bus
ines
s of f
or-p
rofit
ven
dors
. A fi
nal f
orm
of H
IE is
fund
ed a
nd
cont
rolle
d by
hea
lthca
re d
eliv
ery
orga
niza
tions
(HD
Os)
to m
eet t
heir
own
busi
ness
con
cern
s, ra
ther
than
bei
ng n
eutra
l to
all c
omm
unity
stak
ehol
ders
. 72
. G
asse
rt (4
4)
Scie
ntifi
c 19
96
US
Mob
ile c
ompu
ting
tech
nolo
gy (M
TC) c
ould
pro
vide
old
er c
ardi
ac su
rger
y pa
tient
s with
a p
orta
ble
com
pute
r sys
tem
to b
e us
ed a
t hom
e fo
r acc
essi
ng,
colle
ctin
g an
d tra
nsm
ittin
g cl
inic
al in
form
atio
n re
late
d to
thei
r rec
over
y.
73.
Gei
ssbu
hler
(40
) Sc
ient
ific
2013
Sw
itzer
land
Th
e tra
nspa
renc
y re
sulti
ng fr
om a
stre
amlin
ed e
xcha
nge
of in
form
atio
n m
ay
impr
ove
the
cont
inui
ty, q
ualit
y an
d ef
ficie
ncy
of c
are,
whi
le, a
t the
sam
e tim
e,
reve
al a
nd c
halle
nge
habi
ts a
nd p
ract
ices
of c
are
prof
essi
onal
s and
of c
itize
ns.
74.
Gen
es e
t al
(123
) Sc
ient
ific
2011
U
S H
ealth
Info
rmat
ion
Exch
ange
(HIE
) has
the
pote
ntia
l to
impr
ove
patie
nt c
are
by b
ringi
ng re
leva
nt p
atie
nt d
ata
to th
e po
int o
f car
e. H
IE se
ems p
artic
ular
ly
prom
isin
g in
em
erge
ncy
depa
rtmen
ts (E
Ds)
, whe
re p
atie
nts f
requ
ently
pre
sent
656
S.N
o.
Aut
hor
Sour
ce
Yea
r of
Publ
icat
ion
Cou
ntry
D
efin
ition
outs
ide
thei
r usu
al m
edic
al h
ome
and
outs
ide
the
norm
al h
ours
dur
ing
whi
ch
prim
ary
care
doc
tors
, pha
rmac
ies o
r ins
urer
s can
typi
cally
be
reac
hed
75.
Geo
rgia
HIV
HIE
(1
24)
Web
pag
e: H
IV H
IE,
Geo
rgia
Dep
artm
ent o
f Pu
blic
Hea
lth
Unk
now
n U
S H
IE p
ropo
ses t
o de
velo
p an
d im
plem
ent a
syst
em to
ale
rt he
alth
care
pro
vide
rs
of a
pat
ient
's "o
ut-o
f-ca
re"
care
stat
us so
that
they
can
re-e
ngag
e th
em in
HIV
ca
re.
By
impr
ovin
g lin
kage
to a
nd re
tent
ion
in c
are,
and
enc
oura
ging
ad
here
nce
to a
ntire
trovi
ral t
hera
pies
, HIE
will
supp
ort c
linic
al e
ffor
ts to
re
duce
vira
l loa
ds a
nd a
chie
ve a
n "u
ndet
ecta
ble
vira
l loa
d" o
r vira
l su
ppre
ssio
n.
76.
Gra
nnis
et a
l. (1
25)
Scie
ntifi
c 20
10
US
HIE
s sta
ndar
dize
, agg
rega
te a
nd st
ream
line
info
rmat
ion
shar
ing
amon
g da
ta
partn
ers,
incl
udin
g pu
blic
hea
lth st
akeh
olde
rs, a
nd H
IE h
as su
ppor
ted
publ
ic
heal
th p
ract
ice
in In
dian
a fo
r mor
e th
an 1
0 ye
ars.
77.
Gre
enha
lgh
et a
l. (2
7)
Scie
ntifi
c 20
13
UK
A
nat
iona
lly-a
cces
sibl
e el
ectro
nic
reco
rd (k
now
n in
the
USA
as h
ealth
in
form
atio
n ex
chan
ge).
78.
Grin
span
et a
l.(11
) Sc
ient
ific
2013
U
S N
YC
LIX
(New
Yor
k C
linic
al In
form
atio
n Ex
chan
ge),
a re
gion
al h
ealth
in
form
atio
n or
gani
zatio
n (R
HIO
) tha
t dra
ws c
linic
al d
ata
from
seve
ral N
ew
Yor
k C
ity h
ospi
tals
. 79
. G
ross
man
et a
l. (1
26)
Scie
ntifi
c 20
08
US
Loca
l hea
lth in
form
atio
n ex
chan
ges (
HIE
s) h
old
the
prom
ise
of c
olle
ctin
g pa
tient
clin
ical
dat
a ac
ross
site
s of c
are
to p
rovi
de m
ore
com
plet
e an
d tim
ely
info
rmat
ion
for t
reat
men
t, as
wel
l as s
uppo
rting
qua
lity
impr
ovem
ent a
nd
repo
rting
, pub
lic h
ealth
act
iviti
es, a
nd c
linic
al re
sear
ch
80
. G
ulf C
oast
(127
) W
eb p
age:
Gul
f Coa
st
HIE
/ C
ompa
ny
Unk
now
n U
S H
ealth
Info
rmat
ion
Exch
ange
(HIE
) is t
he te
rm u
sed
to d
escr
ibe
larg
e-sc
ale
elec
troni
c co
mm
unic
atio
n of
pat
ient
info
rmat
ion
betw
een
unaf
filia
ted
heal
thca
re p
rovi
ders
. 81
. H
aggs
trom
and
D
oebb
elin
g (1
28)
Scie
ntifi
c 20
11
US
Info
rmat
ion
exch
ange
off
ers t
he p
oten
tial t
o po
ol a
sing
le p
atie
nt’s
dat
a ac
ross
m
ultip
le in
stitu
tions
; con
vers
ely,
info
rmat
ion
exch
ange
allo
ws i
nstit
utio
ns to
ag
greg
ate
thei
r ow
n da
ta a
cros
s mul
tiple
pat
ient
s. Pa
tient
-leve
l agg
rega
tion
offe
rs th
e pr
omis
e of
impr
ovin
g cl
inic
al c
are
acro
ss a
frag
men
ted
heal
th c
are
deliv
ery
syst
em, w
hile
inst
itutio
n le
vel a
ggre
gatio
n ha
s the
pot
entia
l of s
ervi
ng
as a
dat
a in
fras
truct
ure
for q
ualit
y m
easu
rem
ent.
82.
Hal
amka
(129
) Sc
ient
ific
2013
U
S In
tuiti
vely
, hea
lth in
form
atio
n ex
chan
ge sh
ould
impr
ove
safe
ty, q
ualit
y, a
nd
effic
ienc
y by
pro
vidi
ng e
mer
genc
y de
partm
ent (
ED) c
linic
ians
with
acc
urat
e lif
etim
e m
edic
al h
isto
ries,
up-to
-dat
e te
st re
sults
, and
evi
denc
e of
pre
viou
s pr
oble
mat
ic th
erap
ies.
How
ever
, stu
dies
dem
onst
ratin
g th
ese
bene
fits a
re fe
w.
83.
Hal
l (13
0)
Elec
troni
c A
rticl
e:
Dia
gnos
tic In
telli
genc
e 20
09
US
Bro
adly
def
ined
, a H
ealth
Info
rmat
ion
Exch
ange
(HIE
) exi
sts w
hene
ver t
wo
or m
ore
orga
niza
tions
shar
e he
alth
care
rela
ted
info
rmat
ion
elec
troni
cally
.
657
S.N
o.
Aut
hor
Sour
ce
Yea
r of
Publ
icat
ion
Cou
ntry
D
efin
ition
and
Hea
lth IT
Initi
ativ
es
Col
lege
of A
mer
ican
Pa
thol
ogis
ts
Exch
angi
ng h
ealth
care
info
rmat
ion
betw
een
orga
niza
tions
impr
oves
pat
ient
ca
re a
nd re
duce
s cos
ts b
y fo
ster
ing
colla
bora
tive
care
and
redu
cing
ad
min
istra
tive
burd
en.
84.
Har
ris (1
31)
Web
pag
e: H
arris
H
ealth
care
Sol
utio
ns
Unk
now
n U
S H
arris
ena
bles
IDN
s, ph
ysic
ian
prac
tices
, med
ical
gro
ups a
nd o
ther
car
e pr
ovid
ers t
o ex
chan
ge h
ealth
info
rmat
ion
as n
ever
bef
ore,
em
pow
erin
g pr
ovid
er c
olla
bora
tion
- sen
d an
d re
ceiv
e re
sults
and
dis
char
ge su
mm
arie
s, ex
chan
ge in
form
atio
n on
ord
ers,
enga
ge in
clin
ical
mes
sagi
ng a
nd sh
are
docu
men
ts. S
uch
data
exc
hang
e is
incr
easi
ngly
impo
rtant
as o
rgan
izat
ions
re
spon
d to
del
iver
y-sy
stem
refo
rm b
y tra
nsiti
onin
g to
new
mod
els s
uch
beco
min
g an
Acc
ount
able
Car
e O
rgan
izat
ion
(AC
O).
85
. H
asm
an e
t al.
(7)
Scie
ntifi
c 19
92
Net
herla
nds
Ele
ctro
nic
Dat
a In
terc
hang
e (E
DI)
is a
reas
onab
le su
bstit
ute
of th
e tra
ditio
nal
mai
l for
the
com
mun
icat
ion
betw
een
hosp
ital a
nd G
P. It
will
lead
to h
ighe
r qu
ality
of d
ata
and
to n
ew a
pplic
atio
ns th
at w
ill e
nhan
ce th
e qu
ality
of c
are.
86
. H
azam
y et
al.
(14)
Scie
ntifi
c 20
13
US
HEA
LTH
eLIN
K, a
clin
ical
dat
a ex
chan
ge sy
stem
to sh
are
patie
nt in
form
atio
n as
a w
ay to
impr
ove
patie
nt c
are.
87
. H
C (1
32)
Web
pag
e: G
reat
er
Hou
ston
Hea
lth
Con
nect
, G
reat
er
Hou
ston
Hea
lth
Info
rmat
ion
Exch
ange
(G
HH
IE)
Unk
now
n U
S A
hea
lth in
form
atio
n ex
chan
ge is
a n
etw
ork
of e
lect
roni
c he
alth
reco
rds
desi
gned
to li
nk a
ll pr
ovid
ers i
n a
spec
ific
regi
on. W
ith th
is n
etw
ork,
pat
ient
in
form
atio
n m
oves
ele
ctro
nica
lly b
etw
een
phys
icia
ns, h
ospi
tals
, lab
s and
ph
arm
acie
s.
88.
Hea
lthca
re IT
(1
33)(
140)
(140
)(1
35)(
192)
Web
pag
e: H
ealth
care
IT
New
s U
nkno
wn
US
Hea
lth in
form
atio
n ex
chan
ge is
the
trans
mis
sion
of h
ealth
care
-rel
ated
dat
a am
ong
faci
litie
s, he
alth
info
rmat
ion
orga
niza
tions
and
gov
ernm
ent a
genc
ies,
acco
rdin
g to
nat
iona
l sta
ndar
ds fo
r int
erop
erab
ility
, sec
urity
and
co
nfid
entia
lity.
It is
an
impo
rtant
par
t of t
he h
ealth
info
rmat
ion
tech
nolo
gy
(HIT
) inf
rast
ruct
ure
unde
r dev
elop
men
t in
the
U.S
., an
d th
e as
soci
ated
N
atio
nal H
ealth
Info
rmat
ion
Net
wor
k (N
HIN
).
89.
Hea
ltheL
ink
(9)
Web
pag
e: H
ealth
eLin
k is
a n
on-g
over
nmen
tal,
mul
ti-st
akeh
olde
r RH
IO
Unk
now
n U
S H
EALT
HeL
INK
, the
Wes
tern
New
Yor
k C
linic
al In
form
atio
n Ex
chan
ge, i
s co
llabo
ratio
n am
ong
the
regi
on’s
hos
pita
ls, p
hysi
cian
s, he
alth
pla
ns a
nd o
ther
he
alth
car
e pr
ovid
ers t
o se
rve
the
eigh
t cou
ntie
s of w
este
rn N
ew Y
ork
Stat
e.
HEA
LTH
eLIN
K w
as c
reat
ed to
ena
ble
the
exch
ange
of c
linic
al in
form
atio
n in
secu
re a
nd m
eani
ngfu
l way
s to
impr
ove
both
eff
icie
ncy
and
qual
ity, w
hile
al
so h
elpi
ng to
con
trol h
ealth
car
e co
sts.
Pat
ient
s who
pro
vide
con
sent
allo
w
phys
icia
ns a
nd p
rovi
ders
dire
ctly
invo
lved
in th
eir t
reat
men
t to
secu
rely
acc
ess
rele
vant
med
ical
info
rmat
ion
via
HEA
LTH
eLIN
K, r
esul
ting
in m
ore
timel
y an
d ef
fect
ive
treat
men
t at t
he p
oint
of c
are.
658
S.N
o.
Aut
hor
Sour
ce
Yea
r of
Publ
icat
ion
Cou
ntry
D
efin
ition
90.
Hea
lth In
sigh
ts
(134
) R
epor
t: Pu
blic
Pe
rcep
tion
and
Uta
h’s
Clin
ical
Hea
lth
Info
rmat
ion
Exch
ange
, ba
sed
on c
onsu
mer
fo
cus g
roup
s con
duct
ed
by H
ealth
Insi
ghts
2011
-201
2 U
S O
ne o
f the
firs
t sta
te-r
un H
ealth
Info
rmat
ion
Exch
ange
s (H
IEs)
, cH
IE a
llow
s hea
lthca
re p
rovi
ders
to sh
are
thei
r ele
ctro
nic
heal
th re
cord
s (EH
Rs)
to b
ette
r coo
rdin
ate
patie
nt c
are
91.
Hea
lth IT
(135
) W
eb p
age:
Hea
lthIT
.gov
U
nkno
wn
US
Hea
lth In
form
atio
n Ex
chan
ge a
llow
s hea
lth c
are
prof
essi
onal
s and
pat
ient
s to
appr
opria
tely
acc
ess a
nd se
cure
ly sh
ares
a p
atie
nt’s
vita
l med
ical
info
rmat
ion
elec
troni
cally
. The
re a
re m
any
heal
th c
are
deliv
ery
scen
ario
s driv
ing
the
tech
nolo
gy b
ehin
d th
e di
ffer
ent f
orm
s of h
ealth
info
rmat
ion
exch
ange
ava
ilabl
e to
day.
92
. H
ealth
IT(1
35)
Web
pag
e: H
ealth
IT.g
ov
Unk
now
n U
S El
ectro
nic
heal
th in
form
atio
n ex
chan
ge (H
IE) a
llow
s doc
tors
, nur
ses,
phar
mac
ists
, oth
er h
ealth
car
e pr
ovid
ers a
nd p
atie
nts t
o ap
prop
riate
ly a
cces
s and
se
cure
ly sh
are
a pa
tient
’s v
ital m
edic
al in
form
atio
n el
ectro
nica
lly—
impr
ovin
g th
e sp
eed,
qua
lity,
safe
ty a
nd c
ost o
f pat
ient
car
e.
93.
Hea
lth L
eade
rs
(136
) W
eb p
age:
Hea
lth
Lead
ers i
s a m
ulti-
plat
form
med
ia c
ompa
ny
to m
eet t
he in
form
atio
n ne
eds o
f hea
lth
prof
essi
onal
s
2009
U
S Th
e Ex
chan
ge is
an
elec
troni
c he
alth
info
rmat
ion
syst
em th
at w
ill a
llow
for
the
exch
ange
of d
igita
l med
ical
reco
rds b
etw
een
heal
thca
re fa
cilit
ies,
doct
ors'
offic
es, a
nd th
e K
entu
cky
Dep
artm
ent.
94.
Hea
lth U
nity
(1
37)
Web
pag
e: V
endo
r /
solu
tion
Prov
ider
U
nkno
wn
US
The
Hea
lthU
nity
HIE
solu
tion
prov
ides
a o
ne-s
top
solu
tion
for e
nabl
ing
seam
less
bid
irect
iona
l com
mun
icat
ion
betw
een
a w
ide
arra
y of
ent
ities
in
clud
ing
vario
us ty
pes o
f pro
vide
rs, p
atie
nts a
s wel
l as p
ublic
hea
lth. S
ervi
ces
we
prov
ide
incl
ude
secu
re m
essa
ging
, rec
ord
loca
tion
serv
ice,
ana
lytic
s se
rvic
e, re
sults
del
iver
y se
rvic
e et
c.
95.
Her
sh (1
38)
Scie
ntifi
c 20
09
US
Hea
lth in
form
atio
n ex
chan
ge (H
IE),
whi
ch is
the
exch
ange
of h
ealth
in
form
atio
n fo
r pat
ient
car
e ac
ross
trad
ition
al b
usin
ess b
ound
arie
s in
heal
th
care
96
. H
erw
ehe
et a
l (1
39)
Scie
ntifi
c 20
12
US
The
Loui
sian
a Pu
blic
Hea
lth In
form
atio
n Ex
chan
ge (L
aPH
IE) i
s a n
ovel
, se
cure
bi-d
irect
iona
l pub
lic h
ealth
info
rmat
ion
exch
ange
, lin
king
stat
e-w
ide
publ
ic h
ealth
surv
eilla
nce
data
with
ele
ctro
nic
med
ical
reco
rd d
ata.
97
. H
HS
(140
) R
epor
t: N
atio
nal
Bio
surv
eilla
nce
Stra
tegy
fo
r Hum
an H
ealth
V2.
0
2010
U
S El
ectro
nic
heal
th in
form
atio
n ex
chan
ge is
def
ined
as t
he sh
arin
g of
dig
itize
d hu
man
hea
lth d
ata
and
info
rmat
ion
acco
rdin
g to
nat
iona
lly re
cogn
ized
st
anda
rds a
mon
g or
gani
zatio
ns th
at c
an u
tiliz
e th
e in
form
atio
n to
impr
ove
659
S.N
o.
Aut
hor
Sour
ce
Yea
r of
Publ
icat
ion
Cou
ntry
D
efin
ition
by C
ente
rs fo
r Dis
ease
C
ontro
l and
Pre
vent
ion,
U
S D
ept.
of H
ealth
and
H
uman
Ser
vice
s
indi
vidu
al a
nd c
omm
unity
hea
lth se
curit
y.
98.
HIE
Ans
wer
s (1
41)
Web
pag
e: H
IE
Ans
wer
s, A
dvan
cing
H
ealth
Info
rmat
ion
/ O
nlin
e kn
owle
dge
reso
urce
Unk
now
n U
S H
ealth
Info
rmat
ion
Exch
ange
s are
typi
cally
cat
egor
ized
by
how
a p
atie
nt’s
he
alth
info
rmat
ion
is st
ored
and
how
the
legi
timat
e m
embe
rs o
r par
ticip
ants
ca
n ac
cess
pat
ient
hea
lth in
form
atio
n.
99.
HIE
Brid
ge (1
42)
Web
pag
e: A
Min
neso
ta
certi
fied
HIE
by
a ce
rtifie
d H
IO
Unk
now
n U
S H
IE-B
ridge
™ is
a M
inne
sota
stat
e ce
rtifie
d he
alth
info
rmat
ion
exch
ange
(H
IE) a
llow
ing
prov
ider
s to
loca
te a
nd a
cces
s key
clin
ical
info
rmat
ion
that
is
vita
l whe
n m
akin
g m
edic
al d
ecis
ions
. Thr
ough
HIE
-Brid
ge h
ealth
pro
vide
rs
have
acc
ess t
o au
thor
ized
pat
ient
info
rmat
ion
thro
ugh
a se
cure
web
-bas
ed
info
rmat
ion
exch
ange
pla
tform
. 10
0.
H
IEC
C (4
8)
Mee
ting:
Mea
ning
ful
Hea
lth In
form
atio
n Ex
chan
ge b
y H
ealth
In
form
atio
n Ex
chan
ge
Coo
rdin
atin
g C
omm
ittee
(H
IEC
C) a
nd S
tate
El
ectro
nic
Pres
crib
ing
Adv
isor
y Pa
nel
(SEP
AP)
2009
U
S “M
eani
ngfu
l hea
lth in
form
atio
n ex
chan
ge”
refe
rs to
ach
ievi
ng a
hig
h le
vel o
f pa
rtici
patio
n in
ele
ctro
nic
heal
th in
form
atio
n ex
chan
ge a
mon
g ho
spita
ls,
clin
ics,
phys
icia
ns, p
ublic
hea
lth fa
cilit
ies,
othe
r hea
lth c
are
prov
ider
s, he
alth
pl
ans a
nd st
ate
agen
cies
incl
udin
g da
ta fr
om h
ealth
enc
ount
er c
laim
s, pr
ovid
er
heal
th re
cord
s and
stat
e re
gist
ries t
hat h
as a
mea
sure
able
eff
ect o
n co
mm
unity
he
alth
car
e in
clud
ing
impr
oved
eff
icie
ncy
of c
are
(48)
man
agem
ent p
roce
sses
, en
hanc
ed p
atie
nt sa
fety
, inc
reas
ed e
ffec
tiven
ess o
f car
e, a
nd a
mea
sure
able
ef
fect
on
popu
latio
n he
alth
incl
udin
g re
duce
d di
seas
e in
cide
nce
and
prev
alen
ce.
101.
HIE
Nev
ada
(143
) W
eb p
age:
Hea
lth H
IE
Nev
ada,
stat
e-w
ide
com
mun
ity H
IE
Unk
now
n U
S H
ealtH
IE N
eved
a is
the
new
stat
e-w
ide
com
mun
ity-b
ased
Hea
lth In
form
atio
n Ex
chan
ge (H
IE) t
hat l
ets d
octo
rs’ o
ffic
es, h
ospi
tals
, clin
ic, l
abs,
phar
mac
ies
and
othe
r hea
lthca
re p
rofe
sion
als e
asily
acc
ess a
nd sh
are
patie
nt m
edic
al
reco
rds q
uick
ly, s
ecur
ely
and
accu
rate
ly a
t the
poi
nt o
f car
e.
The
HIE
hel
ps N
eved
a he
alth
car
e pr
ovid
ers i
mpr
ove
the
coor
dina
tion
and
qual
ity o
f pat
ient
car
e. D
ecis
ions
can
be
mad
e m
ore
quic
kly
and
with
a g
reat
er
unde
rsta
ndin
g of
pat
ient
his
tory
than
eve
r bef
ore.
102.
HIE
Ohi
o (1
44)
Sum
mar
y of
Ohi
o R
evis
ed C
ode
Cha
pter
37
98
2012
U
S H
ealth
Info
rmat
ion
Exch
ange
is d
efin
ed a
s “an
y pe
rson
or g
over
nmen
tal e
ntity
th
at p
rovi
des i
n th
is st
ate
a te
chni
cal i
nfra
stru
ctur
e to
con
nect
com
pute
r sy
stem
s or o
ther
ele
ctro
nic
devi
ces u
sed
by c
over
ed e
ntiti
es to
faci
litat
e th
e se
cure
tran
smis
sion
of h
ealth
info
rmat
ion.
”
103.
HIM
SS (1
45)
Rep
ort:
Putti
ng th
e H
IE
into
Pra
ctic
e by
HIM
SS
Unk
now
n U
S Th
e el
ectro
nic
mov
emen
t of h
ealth
-rel
ated
info
rmat
ion
amon
g di
spar
ate
orga
niza
tions
acc
ordi
ng to
nat
iona
lly re
cogn
ized
stan
dard
s in
an a
utho
rized
660
S.N
o.
Aut
hor
Sour
ce
Yea
r of
Publ
icat
ion
Cou
ntry
D
efin
ition
and
secu
re m
anne
r. 10
4.
H
IMSS
HIE
C
omm
ittee
(146
) R
epor
t: H
IE
Impl
icat
ions
in
Mea
ning
ful U
se S
tage
1
Req
uire
men
ts, b
y H
IMSS
2010
U
S In
its m
ost c
onse
rvat
ive
defin
ition
, HIE
(the
ver
b) is
the
activ
ity o
f sec
ure
heal
th d
ata
exch
ange
bet
wee
n tw
o au
thor
ized
and
con
sent
ing
tradi
ng p
artn
ers.
Dat
a ex
chan
ge o
ccur
s bet
wee
n an
y tw
o tra
ding
par
ties—
a da
ta su
pplie
r and
a
data
rece
iver
. It c
an a
lso
be fa
cilit
ated
by
one,
two
or m
ore
third
par
ties w
ho
oper
ate
betw
een
the
data
supp
lier a
nd th
e da
ta re
ceiv
er. T
o ad
d co
mpl
exity
, a
third
par
ty c
ould
als
o be
stor
ing
data
from
and
on
beha
lf of
the
data
supp
lier
and
be tr
ansm
ittin
g da
ta o
n be
half
of th
e da
ta su
pplie
r (in
such
cas
e, th
e th
ird
party
wou
ld b
e co
nsid
ered
to b
e th
e da
ta su
pplie
r). F
urth
er, a
third
par
ty c
ould
be
rece
ivin
g da
ta o
n be
half
of a
dat
a re
ceiv
er. W
hile
this
may
be
com
plex
, H
IE a
ctiv
ity c
an e
nhan
ce v
irtua
lly a
ny c
linic
al fu
nctio
n by
virt
ue o
f pro
vidi
ng
a br
oade
r set
of d
ata
upon
whi
ch c
linic
al d
ecis
ions
can
be
base
d.
105.
HIN
Az
(147
) W
eb p
age:
Hea
lth
Info
rmat
ion
Net
wor
k of
A
rizon
a
Unk
now
n U
S A
Hea
lth In
form
atio
n Ex
chan
ge, s
uch
as H
INA
z, is
a se
cure
net
wor
k th
at
take
s hea
lth c
are
info
rmat
ion
from
mul
tiple
hea
lth c
are
orga
niza
tions
and
so
urce
s and
pro
vide
s it t
o a
patie
nt's
phys
icia
n at
the
poin
t of c
are
whe
n it
is
need
ed.
106.
HIN
Az
(148
) W
eb p
age:
Hea
lth
Info
rmat
ion
Net
wor
k of
A
rizon
a
Unk
now
n U
S A
Hea
lth In
form
atio
n Ex
chan
ge p
rovi
des a
net
wor
k an
d un
iver
sal f
orm
at th
at
conn
ects
hos
pita
ls, d
octo
rs a
nd o
ther
pro
vide
rs. W
hen
need
ed, H
IEs a
llow
el
ectro
nic
heal
th re
cord
s, co
ntai
ning
hea
lth-r
elat
ed in
form
atio
n ab
out a
pa
tient
, to
be se
cure
ly sh
ared
am
ong
heal
th c
are
orga
niza
tions
. 10
7.
H
inca
pie
et a
l (1
49)
Scie
ntifi
c 20
11
US
Hea
lth in
form
atio
n ex
chan
ge (H
IE) i
s a p
oten
tial s
olut
ion
to p
rovi
ding
tim
ely
and
effe
ctiv
e cl
inic
al in
form
atio
n at
the
poin
t of c
are
108.
HIS
(150
) W
eb p
age:
Indi
an H
ealth
Se
rvic
e fo
r Am
eric
an
Indi
ans a
nd A
lask
a N
ativ
es
Unk
now
n U
S Th
e go
al o
f a H
ealth
Info
rmat
ion
Exch
ange
(HIE
) is t
o dr
ive
tow
ards
eff
icie
nt
exch
ange
of p
atie
nt d
ata,
so th
at a
uni
fied
and
holis
tic v
iew
of p
atie
nt d
ata
is
obta
ined
. Thi
s, in
turn
, will
ena
ble
phys
icia
ns to
off
er b
ette
r car
e fo
r pat
ient
s be
caus
e pr
ovid
ers o
f car
e w
ill h
ave
a co
mpl
ete
pict
ure
incl
udin
g al
l ava
ilabl
e m
edic
al re
cord
s. 10
9.
H
ISO
(37)
Rep
ort:
Hea
lth
Info
rmat
ion
Exch
ange
A
rchi
tect
ure
Bui
ldin
g B
lock
s by
Nat
iona
l H
ealth
IT B
oard
2012
N
ew
Zeal
and
App
licat
ion-
leve
l com
mun
icat
ion
med
ium
with
stan
dard
ised
con
tent
and
tra
nspo
rt, a
cros
s whi
ch p
artic
ipan
ts e
xcha
nge
heal
th in
form
atio
n.
110.
HIT
ECH
(49)
HIT
ECH
AC
T 20
09
US
A c
ritic
al st
ep to
war
d re
aliz
ing
the
full
pote
ntia
l of e
lect
roni
c he
alth
reco
rds
(EH
Rs)
to im
prov
e th
e co
ordi
natio
n, e
ffic
ienc
y, a
nd q
ualit
y of
car
e.
111.
Hix
ny (1
51)
Web
page
: Hea
lthca
er
Info
rmat
ion
Xch
ange
of
Unk
now
n U
S H
IXN
Y (“
hix-
knee
”), t
he H
ealth
care
Info
rmat
ion
Xch
ange
of N
ew Y
ork,
is a
no
t-for
-pro
fit c
olla
bora
tive
of h
ealth
pla
ns, h
ospi
tals
, phy
sici
an p
ract
ices
, and
661
S.N
o.
Aut
hor
Sour
ce
Yea
r of
Publ
icat
ion
Cou
ntry
D
efin
ition
New
Yor
k, a
n In
terS
yste
ms p
artn
er
othe
r hea
lthca
re e
ntiti
es w
orki
ng to
geth
er to
ena
ble
secu
re a
cces
s and
el
ectro
nic
exch
ange
of m
edic
al in
form
atio
n to
coo
rdin
ate
qual
ity c
are,
im
prov
e pa
tient
safe
ty a
nd re
duce
hea
lthca
re c
osts
. 11
2.
H
RSA
(152
) W
eb p
age:
US
Dep
artm
ent o
f Hea
lth
and
Hum
an S
ervi
ce,
Hea
lth R
esou
rce
and
Serv
ice
Adm
inis
tratio
n
Unk
now
n
US
Hea
lth in
form
atio
n ex
chan
ge (H
IE) i
s the
ele
ctro
nic
of h
ealth
-rel
ated
in
form
atio
n am
ong
orga
niza
tions
acc
ordi
ng to
nat
iona
lly re
cogn
ized
st
anda
rds.
The
goa
l of h
ealth
info
rmat
ion
exch
ange
is to
faci
litat
e ac
cess
to
and
retri
eval
of c
linic
al d
ata
to p
rovi
de sa
fer,
timel
ier,
effic
ient
, eff
ectiv
e,
equi
tabl
e, p
atie
nt-c
ente
red
care
. 11
3.
H
ripcs
ak e
t al (
2)
Scie
ntifi
c 20
07
US
Hea
lth in
form
atio
n ex
chan
ge (H
IE) p
roje
cts—
whi
ch a
re o
ften
run
by re
gion
al
heal
th in
form
atio
n or
gani
zatio
ns—
may
be
a st
eppi
ng st
one
to a
fully
in
tero
pera
ble
heal
th in
form
atio
n in
fras
truct
ure
that
impr
oves
the
qual
ity a
nd
effic
ienc
y of
hea
lth c
are
in th
e U
nite
d St
ates
11
4.
H
T (1
53)
Whi
te p
apar
Hea
lth
Texa
s Pro
vide
Net
wor
k U
nkno
wn
US
HIE
stan
ds fo
r Hea
lth In
form
atio
n Ex
chan
ge a
nd is
a te
rm u
sed
to d
escr
ibe
the
shar
ing
of h
ealth
info
rmat
ion
thro
ugh
a se
cure
ele
ctro
nic
netw
ork
that
allo
ws
parti
cipa
ting
heal
th c
are
syst
ems a
nd p
rovi
ders
to e
lect
roni
cally
shar
e he
alth
in
form
atio
n ab
out t
heir
patie
nts w
ith e
ach
othe
r, w
ith o
ther
pro
vide
rs w
ho
have
a tr
eatm
ent r
elat
ions
hip
with
the
patie
nt, a
nd fo
r oth
er h
ealth
care
op
erat
ions
rela
ted
activ
ities
. 11
5.
(2
3)
Web
pag
e: S
olut
ion
Prov
ider
U
nkno
wn
US
Iatri
c Sy
stem
s Clin
ical
Doc
umen
t Exc
hang
e al
low
s you
r hea
lthca
re
orga
niza
tion
to se
nd a
nd re
ceiv
e th
e pe
rtine
nt c
linic
al, d
emog
raph
ic, a
nd
adm
inis
trativ
e da
ta in
real
tim
e fo
r a si
ngle
pat
ient
in in
dust
ry-s
tand
ard
docu
men
ts, s
uch
as th
ose
liste
d in
Con
solid
ated
Clin
ical
Doc
umen
t A
rchi
tect
ure
(C-C
DA
) for
Mea
ning
ful U
se. T
his d
ocum
ent e
xcha
nge
prov
ides
ca
regi
vers
a m
ore
com
plet
e pi
ctur
e of
pat
ient
hea
lth, l
eadi
ng to
mor
e in
form
ed
treat
men
t dec
isio
ns a
nd b
ette
r coo
rdin
atio
n of
car
e.
116.
ICA
(154
) W
eb p
age:
Info
rmat
ics
Cor
pora
tion
of A
mer
ica,
pr
ovid
es p
latfo
rms a
nd
serv
ices
2012
U
S A
llied
HIE
is a
pat
ient
-cen
tric,
pur
pose
-driv
en, p
oint
-of-
care
focu
sed
natio
nal
heal
th in
form
atio
n ex
chan
ge c
ompa
ny w
ith a
mis
sion
to in
clud
e al
lied
heal
th
orga
niza
tions
in o
rder
to p
riorit
y co
nnec
t our
mos
t vul
nera
ble
and
at-r
isk
patie
nts.
11
7.
IH
IE (5
2)
Rep
ort:
Nat
ionw
ide
Hea
lth In
form
atio
n N
etw
ork
(NH
IN) T
rial
Impl
emen
tatio
ns
pres
ente
d to
Off
ice
of
the
Nat
iona
l Coo
rdin
ator
fo
r Hea
lth In
form
atio
n
2009
U
S H
IE is
a b
usin
ess a
nd a
s with
all
busi
ness
es, c
reat
ing
a su
stai
nabl
e H
IE
requ
ires o
ffer
ing
serv
ices
that
the
mar
ket w
ants
at a
pric
e th
e m
arke
t will
bea
r an
d do
ing
so in
such
a w
ay th
at re
venu
e ex
ceed
s exp
ense
s. It
also
mea
ns th
at
the
serv
ices
del
iver
ed b
y th
e H
IE m
ust b
e at
a le
vel t
hat h
ealth
care
or
gani
zatio
ns h
ave
com
e to
exp
ect f
rom
thei
r sup
plie
rs.
662
S.N
o.
Aut
hor
Sour
ce
Yea
r of
Publ
icat
ion
Cou
ntry
D
efin
ition
Tech
nolo
gy U
S H
HS
by
Indi
ana
Hea
lth
Info
rmat
ion
Exch
ange
11
8.
IG
I Glo
bal (
155)
Dic
tiona
ry: I
GI G
loba
l, pu
blis
her
Unk
now
n U
nkno
wn
Hea
lth in
form
atio
n ex
chan
ge (H
IE) r
efer
s to
the
proc
ess o
f rel
iabl
e an
d in
tero
pera
ble
elec
troni
c he
alth
-rel
ated
info
rmat
ion
shar
ing
cond
ucte
d in
a
man
ner t
hat p
rote
cts t
he c
onfid
entia
lity,
priv
acy,
and
secu
rity
of th
e in
form
atio
n. E
ssen
tial t
o th
is p
roce
ss is
the
capa
bilit
y to
em
ploy
reco
gniz
ed
stan
dard
s as t
hey
are
esta
blis
hed
incr
emen
tally
, fur
ther
ena
blin
g in
tero
pera
bilit
y, se
curit
y an
d co
nfid
entia
lity
of th
e in
form
atio
n as
wel
l as
auth
oriz
atio
n of
thos
e w
ho a
cces
s the
info
rmat
ion.
11
9.
IL
HIE
(156
) R
epor
t: Ill
inoi
s HIE
St
rate
gic
& O
pera
tiona
l Pl
an
by th
e Ill
inoi
s Off
ice
of
Hea
lth In
form
atio
n Te
chno
logy
2010
U
S Th
e cr
eatio
n of
a S
tate
-leve
l hea
lth in
form
atio
n ex
chan
ge sy
stem
will
allo
w,
amon
g ot
her b
enef
its, t
he w
ides
prea
d ut
iliza
tion
of e
lect
roni
c he
alth
reco
rds
by h
ealth
car
e pr
ovid
ers a
nd p
atie
nts i
n or
der t
o en
sure
that
Illin
ois h
ealth
car
e pr
ovid
ers c
an a
chie
ve th
e M
eani
ngfu
l Use
of e
lect
roni
c re
cord
s, as
def
ined
by
fede
ral l
aw, a
nd p
artic
ipat
e fu
lly in
the
heal
th in
form
atio
n te
chno
logy
in
cent
ives
ava
ilabl
e fr
om th
e fe
dera
l gov
ernm
ent u
nder
the
Med
icar
e an
d M
edic
aid
prog
ram
s.”
120.
Illin
ois G
ener
al
Ass
embl
y (1
57)
Web
page
: Illi
nois
Hea
lth
Info
rmat
ion
Exch
ange
an
d Te
chno
logy
Act
Unk
now
n U
S Th
e Ill
inoi
s Hea
lth In
form
atio
n Ex
chan
ge ("
ILH
IE")
, to
prom
ote
and
faci
litat
e th
e sh
arin
g of
hea
lth in
form
atio
n am
ong
heal
th c
are
prov
ider
s with
in Il
linoi
s an
d in
oth
er st
ates
. ILH
IE sh
all b
e an
ent
ity o
pera
ted
by th
e A
utho
rity
to se
rve
as a
Sta
te-le
vel e
lect
roni
c m
edic
al re
cord
s exc
hang
e pr
ovid
ing
for t
he tr
ansf
er
of h
ealth
info
rmat
ion,
med
ical
reco
rds,
and
othe
r hea
lth d
ata
in a
secu
re
envi
ronm
ent f
or th
e be
nefit
of p
atie
nt c
are,
pat
ient
safe
ty, r
educ
tion
of
dupl
icat
e m
edic
al te
sts,
redu
ctio
n of
adm
inis
trativ
e co
sts,
and
any
othe
r be
nefit
s dee
med
app
ropr
iate
by
the
Aut
horit
y.
121.
Info
r (15
8)
Web
pag
e: In
for
Com
pany
/ So
lutio
n pr
ovid
er (I
BM
En
terp
rise
Mas
ter
Pers
on In
dex
(EM
PI))
Unk
now
n U
S H
ealth
info
rmat
ion
exch
ange
(HIE
) ini
tiativ
es th
at fo
cus o
n fa
cilit
atin
g th
e ex
chan
ge o
f hea
lth in
form
atio
n el
ectro
nica
lly a
mon
g ph
ysic
ians
, hos
pita
ls,
heal
th p
lans
, and
pat
ient
s.
122.
Info
r Clo
verle
af
(15)
Web
pag
e: :
Info
r C
ompa
ny /
Solu
tion
prov
ider
/ Pr
oduc
ts
Unk
now
n U
S In
for C
love
rleaf
Hos
ted
Hea
lthca
re In
form
atio
n Ex
chan
ge is
a se
cure
, st
anda
rds-
base
d in
fras
truct
ure
that
inte
grat
es c
linic
al d
ata
from
acr
oss
disp
arat
e sy
stem
s and
man
ages
the
wid
e va
riety
of c
linic
al re
cord
s, do
cum
ent
type
s, an
d co
nten
t per
vasi
ve in
toda
y's h
ealth
care
com
mun
ity.
663
S.N
o.
Aut
hor
Sour
ce
Yea
r of
Publ
icat
ion
Cou
ntry
D
efin
ition
123.
iNex
x (1
59)
Web
pag
e: S
olut
ion
prov
ider
U
nkno
wn
US
Hea
lth in
form
atio
n ex
chan
ge (H
IE) i
s the
secu
re, e
lect
roni
c ex
chan
ge o
f he
alth
info
rmat
ion
amon
g au
thor
ized
stak
ehol
ders
in th
e he
alth
care
co
mm
unity
– su
ch a
s car
e pr
ovid
ers,
patie
nts,
and
publ
ic h
ealth
age
ncie
s –
to
driv
e tim
ely,
eff
icie
nt, h
igh-
qual
ity, p
reve
ntiv
e, a
nd p
atie
nt-c
ente
red
care
. Th
is e
xcha
nge
of h
ealth
care
info
rmat
ion
impr
oves
pat
ient
car
e an
d re
duce
s co
sts b
y fo
ster
ing
care
col
labo
ratio
n an
d lo
wer
ing
adm
inis
trativ
e en
cum
bran
ces.
124.
Insp
ira (1
60)
Web
pag
e: In
spira
H
ealth
Net
wor
k / s
ervi
ce
prov
ider
Unk
now
n U
S H
ealth
info
rmat
ion
exch
ange
(HIE
) allo
ws t
he sh
arin
g of
you
r hea
lth
info
rmat
ion
amon
g pa
rtici
patin
g do
ctor
s’ o
ffic
es, h
ospi
tals
, lab
s, ra
diol
ogy
cent
ers,
and
othe
r hea
lth c
are
prov
ider
s thr
ough
secu
re, e
lect
roni
c m
eans
. Th
e pu
rpos
e is
to p
rovi
de p
artic
ipat
ing
care
give
rs th
e m
ost r
ecen
t hea
lth
info
rmat
ion
avai
labl
e. T
his h
ealth
info
rmat
ion
may
incl
ude
lab
test
resu
lts,
radi
olog
y re
ports
, med
icat
ions
, hos
pita
lizat
ion
sum
mar
ies,
alle
rgie
s, an
d ot
her
clin
ical
info
rmat
ion
vita
l to
your
car
e.
Cer
tain
dem
ogra
phic
info
rmat
ion
used
to
iden
tify
the
indi
vidu
al su
ch a
s nam
e, d
ate
of b
irth,
add
ress
, ins
uran
ce m
ay
also
be
shar
ed.
125.
(161
)(16
8)(1
67)(
163
)Int
eli C
hart
(161
)
Web
pag
e: In
teli
Cha
rt /
Solu
tion
Prov
ider
U
nkno
wn
US
Hea
lth In
form
atio
n Ex
chan
ge is
muc
h m
ore
than
just
mov
ing
data
from
one
sp
ot to
ano
ther
– it
’s a
bout
mak
ing
the
data
mea
ning
ful,
usef
ul a
nd re
leva
nt.
Inte
liCha
rt’s a
ppro
ach
to H
IE so
lutio
ns fo
cus o
n th
e ac
quis
ition
of d
ata
and
then
agg
rega
ting
the
data
into
a st
anda
rdiz
ed a
nd st
ruct
ured
form
at.
126.
Inte
rSys
tem
(36)
Web
page
: eh
ealth
new
s.eu
/ D
enm
ark
Sele
cts
Inte
rSys
tem
s H
ealth
Shar
e fo
r C
ount
ryw
ide
Hea
lth
Info
rmat
ion
Exch
ange
2012
Den
mar
k In
terS
yste
ms H
ealth
Shar
e is
a st
rate
gic
heal
thca
re in
form
atic
s pla
tform
that
en
able
s the
shar
ing
of p
atie
nt in
form
atio
n vi
a se
amle
ss, b
i-dire
ctio
nal
inte
grat
ion,
usi
ng a
ctiv
e an
alyt
ics t
o dr
ive
deci
sion
-mak
ing,
and
unl
ocki
ng th
e un
stru
ctur
ed d
ata
that
is fo
und
in p
atie
nt re
cord
s
127.
IOM
(162
) R
epor
t: In
stitu
te o
f M
edic
ine
, Cro
ssin
g th
e qu
ality
Cha
sm
2001
U
S H
ealth
info
rmat
ion
exch
ange
(HIE
), th
e ex
chan
ge o
f ele
ctro
nic
heal
th
info
rmat
ion
acro
ss h
ealth
car
e cl
inic
ians
and
org
aniz
atio
ns, h
as th
e po
tent
ial t
o im
prov
e he
alth
car
e qu
ality
del
iver
ed b
y th
e U
S he
alth
car
e sy
stem
12
8.
J.
(163
) Sc
ient
ific
2011
U
S H
ealth
info
rmat
ion
exch
ange
—th
e co
llect
ion
of a
ctiv
ities
and
tech
nolo
gies
fo
r sha
ring
data
gen
erat
ed fr
om se
para
te so
urce
s of c
linic
al in
form
atio
n— to
m
anag
e bo
th in
divi
dual
pat
ient
s and
gro
upin
gs o
f peo
ple
with
sim
ilar c
linic
al
cond
ition
s
664
S.N
o.
Aut
hor
Sour
ce
Yea
r of
Publ
icat
ion
Cou
ntry
D
efin
ition
129.
Josh
i (16
4)
Scie
ntifi
c 20
10
US
Hea
lth In
form
atio
n Ex
chan
ges (
HIE
) are
rapi
dly
adva
ncin
g as
the
next
step
in
impr
ovin
g pa
tient
car
e us
ing
tech
nolo
gica
l app
licat
ions
. HIE
aff
ect t
he
fund
amen
tal p
atie
nt c
are
syst
em b
y tra
nsfo
rmin
g ho
w m
edic
al in
form
atio
n is
de
liver
ed a
nd d
isse
min
ate
130.
John
son
and
Gad
d
(165
) Sc
ient
ific
2007
U
S H
ealth
info
rmat
ion
exch
ange
(HIE
) sys
tem
s are
larg
e, m
ultim
illio
n do
llar
effo
rts th
at a
re im
plem
ente
d de
spite
initi
al in
stitu
tiona
l app
rehe
nsio
n, w
ith
larg
ely
unan
ticip
ated
eff
ects
on
the
clin
ical
wor
kflo
w, a
nd w
ith a
prim
ary
goal
of
est
ablis
hing
a re
ason
to su
stai
n th
e ef
fort.
13
1.
Jo
nes e
t al (
166)
Scie
ntifi
c 20
11
US
Hea
lth in
form
atio
n ex
chan
ge (H
IE),
i.e.,
elec
troni
cally
exc
hang
ing
key
clin
ical
info
rmat
ion
such
as d
isch
arge
sum
mar
ies,
proc
edur
es, p
robl
em li
sts,
med
icat
ion
lists
, med
icat
ion
alle
rgie
s, an
d di
agno
stic
test
resu
lts w
ith o
ther
ex
tern
al h
ealth
care
pro
vide
rs is
a c
ore
requ
irem
ent o
f Sta
ge 1
“m
eani
ngfu
l us
e” fo
r hos
pita
ls.
132.
Kae
lber
and
Bat
e (1
67)
Scie
ntifi
c 20
07
US
Bet
ter p
atie
nt sa
fety
thro
ugh
enha
nced
, tec
hnol
ogy
enab
led,
HIE
will
dire
ctly
im
prov
e pa
tient
safe
ty b
ecau
se it
will
pro
vide
a m
ore
com
plet
e cl
inic
al p
ictu
re
of a
pat
ient
. 13
3. K
arl (
168)
Sc
ient
ific
2012
U
S Th
e te
rm "
HIE
," a
cron
ym fo
r hea
lth in
form
atio
n ex
chan
ge, i
s bei
ng u
sed
inte
rcha
ngea
bly
to d
efin
e bo
th th
e or
gani
zatio
n th
at is
resp
onsi
ble
for
man
agin
g th
e ex
chan
ge o
f the
dat
a (th
e no
un) a
nd th
e pr
oces
s by
whi
ch th
e da
ta c
an b
e ex
chan
ged
(the
verb
). 13
4.
K
C (1
69)
Web
pag
e: K
ane
Cou
nty
Hea
lth D
epar
tmen
t U
nkno
wn
US
The
Hea
lth In
form
atio
n Ex
chan
ge (H
IE) w
ill a
llow
loca
l pub
lic h
ealth
de
partm
ents
to b
e ab
le to
eva
luat
e re
al-ti
me
heal
th d
ata
on a
pop
ulat
ion
leve
l, in
ord
er to
mon
itor t
he h
ealth
of o
ur c
omm
unity
, as w
ell a
s to
assu
re th
at w
e pr
ovid
e th
e hi
ghes
t qua
lity
serv
ice
to o
ur re
side
nts.
In a
dditi
on, w
e w
ill b
e be
tter a
ble
to re
spon
d to
hea
lth is
sues
in o
ur c
omm
unity
. 13
5. K
ern
and
Kau
shal
(1
70)
Scie
ntifi
c 20
07
US
HIE
invo
lves
the
shar
ing
of h
ealth
info
rmat
ion
elec
troni
cally
acr
oss h
ealth
ca
re se
tting
s. 13
6.
K
ern
et a
l (17
1)
Scie
ntifi
c 20
09
US
Hea
lth in
form
atio
n ex
chan
ge in
volv
es th
e el
ectro
nic
shar
ing
of c
linic
al d
ata,
in
clud
ing
shar
ing
of c
linic
al d
ata
acro
ss h
ealth
car
e pr
ovid
ers c
arin
g fo
r the
sa
me
patie
nt.
137.
Key
Sto
ne (1
72)
Web
pag
e: K
ey S
tone
H
IE, P
rovi
der
Unk
now
n U
S K
eyst
one
Hea
lth In
form
atio
n Ex
chan
ge (K
eyH
IE) s
tream
lines
trea
tmen
t de
cisi
ons a
nd c
are
coor
dina
tion
with
qui
ck a
cces
s to
both
in a
nd o
ut-o
f-ne
twor
k el
ectro
nic
heal
th re
cord
s (EH
Rs)
-whe
n an
d w
here
you
nee
d th
em.
138.
Kijs
anay
otin
et
al.(1
73)
Scie
ntifi
c 20
07
US
In a
hea
lth in
form
atio
n ex
chan
ge (H
IE) p
roje
ct, l
inki
ng p
atie
nts'
heal
th re
cord
s ac
ross
org
aniz
atio
ns w
hile
mai
ntai
ning
app
ropr
iate
pat
ient
s ano
nym
ity is
es
sent
ial.
665
S.N
o.
Aut
hor
Sour
ce
Yea
r of
Publ
icat
ion
Cou
ntry
D
efin
ition
139.
KLA
S (1
74)
Web
pag
e: R
esea
rch
com
pany
20
14
US
Hea
lth in
form
atio
n ex
chan
ges (
HIE
s) a
re d
efin
ed a
s non
-ow
ned
hosp
itals
, he
alth
syst
ems,
ambu
lato
ry e
ntiti
es, a
nd/o
r oth
er th
ird p
artie
s tha
t sh
are/
exch
ange
pat
ient
dat
a an
d ot
her i
nfor
mat
ion.
14
0.
K
ongs
tved
t (17
5)
Boo
k: E
ssen
tials
of
Man
aged
Hea
lth C
are,
Si
xth
Editi
on
2012
U
S A
n en
tity
to fa
cilit
ate
the
elec
troni
c ex
chan
ge o
f hea
lth in
form
atio
n be
twee
n ph
ysic
ians
, hos
pita
ls, l
abor
ator
ies p
ayer
s and
so o
n, t
hat i
s spo
nsor
ed b
y a
stat
e or
a fe
dera
l gov
ernm
ent.
141.
Kra
lew
ski e
t al
(176
) Sc
ient
ific
2012
U
S El
ectro
nic
heal
th in
form
atio
n ex
chan
ge (H
IE) a
mon
g ph
ysic
ians
, hos
pita
ls,
and
publ
ic h
ealth
age
ncie
s is a
fund
amen
tal d
imen
sion
of m
ost p
ropo
sals
for
heal
th c
are
refo
rm. I
t is a
rgue
d th
at e
nabl
ing
prov
ider
s in
diff
eren
t set
tings
ea
sy a
cces
s to
a pa
tient
’s h
ealth
reco
rd w
ould
redu
ce d
uplic
atio
n of
serv
ices
an
d im
prov
e tre
atm
ent d
ecis
ions
. 14
2.
K
uper
man
(177
) Sc
ient
ific
2011
U
S H
ealth
-info
rmat
ion
exch
ange
, tha
t is,
enab
ling
the
inte
rope
rabi
lity
of
auto
mat
ed h
ealth
dat
a, c
an fa
cilit
ate
impo
rtant
impr
ovem
ents
in h
ealth
care
qu
ality
and
eff
icie
ncy.
14
3.
L.
Blo
ck (1
78)
Web
pag
e: H
ealth
In
form
atio
n Te
chno
logy
K
now
ledg
e B
ase
Unk
now
n U
S H
ealth
info
rmat
ion
exch
ange
supp
orts
the
shar
ing
of h
ealth
-rel
ated
in
form
atio
n to
faci
litat
e co
ordi
nate
d ca
re th
roug
h th
e ut
iliza
tion
of E
HR
s. EH
Rs d
raw
info
rmat
ion
from
man
y so
urce
s thr
ough
hea
lth in
form
atio
n ex
chan
ge. T
hus,
the
proc
ess o
f hea
lth in
form
atio
n ex
chan
ge is
ano
ther
pie
ce
of th
e he
alth
info
rmat
ion
tech
nolo
gy in
fras
truct
ure
and
info
rmat
ics
144.
Lee
et a
l (1
79)
Scie
ntifi
c 20
10
US
The
Sout
h C
arol
ina
Hea
lth In
form
atio
n Ex
chan
ge (S
CH
IEx)
pro
vide
s a st
ate-
leve
l inf
orm
atio
n in
fras
truct
ure
for c
onne
ctin
g lo
cal h
ealth
care
pro
vide
rs a
nd
othe
r sta
keho
lder
s. Th
e ne
twor
k en
able
s pro
vide
rs to
vie
w c
linic
al d
ata
that
in
clud
e m
edic
atio
ns, d
iagn
oses
, and
pro
cedu
res.
HIE
s pro
vide
the
infr
astru
ctur
e fo
r inf
orm
atio
n ex
chan
ge, i
nclu
ding
the
busi
ness
mod
el, g
over
nanc
e st
ruct
ure,
ope
ratin
g pr
inci
ples
, leg
al m
odel
, and
te
chno
logy
mod
el fo
r the
exc
hang
e of
hea
lthca
re in
form
atio
n am
ong
vario
us
orga
niza
tions
. 14
5.
Li
u (1
80)
Scie
ntifi
c 20
07
US
To p
rovi
de p
atie
nt c
are
acro
ss th
e co
ntin
uum
of h
ealth
care
del
iver
y si
tes,
care
de
liver
y or
gani
zatio
ns n
eed
to c
onso
lidat
e th
e cl
inic
al in
form
atio
n fr
om
hosp
itals
, clin
ics,
phys
icia
ns’ o
ffice
s, la
bs, s
peci
alty
faci
litie
s, an
d ev
en h
ome
666
S.N
o.
Aut
hor
Sour
ce
Yea
r of
Publ
icat
ion
Cou
ntry
D
efin
ition
heal
thca
re in
to a
sing
le p
atie
nt re
cord
to su
ppor
t the
del
iver
y of
hea
lthca
re
serv
ices
. .Th
e ab
ility
to e
xcha
nge
and
aggr
egat
e in
form
atio
n fr
om th
ese
vario
us sy
stem
s is e
ssen
tial t
o im
prov
e he
alth
, qua
lity,
and
safe
ty w
ithin
the
US
heal
thca
re sy
stem
. 14
6.
L
loyd
-Pur
year
an
d B
row
er (
181)
Scie
ntifi
c 20
10
US
Whi
le se
vera
l ele
men
ts a
re in
pla
ce to
real
ize
a sy
stem
s app
roac
h, th
e au
thor
s th
ink
that
the
key
is a
n in
tegr
ated
, mul
tidire
ctio
nal h
ealth
info
rmat
ion
exch
ange
syst
em th
at fu
nctio
ns lo
cally
, reg
iona
lly a
nd n
atio
nally
, and
ena
bles
in
form
atio
n ex
chan
ge b
etw
een
priv
ate
and
publ
ic h
ealth
sect
ors.
147.
LMO
(182
) W
eb p
age:
Liq
uid
Med
ical
Off
ice,
Inc.
So
lutio
n Pr
ovid
er
Unk
now
n U
S H
ealth
info
rmat
ion
exch
ange
(HIE
) is a
secu
re e
lect
roni
c ex
chan
ge o
f hea
lth
info
rmat
ion
amon
g au
thor
ized
hea
lthca
re n
etw
orks
to im
prov
e sa
fety
, ef
ficie
ncy,
and
con
tinui
ty o
f car
e. D
ata
exch
ange
d th
roug
h th
e H
IE is
shar
ed
safe
ly a
nd se
cure
ly, m
eetin
g or
exc
eedi
ng H
IPA
A st
anda
rds.
148.
Loba
ch e
t al (
183)
Scie
ntifi
c 20
07
US
Info
rmat
ion
tech
nolo
gy, a
nd in
par
ticul
ar a
hea
lth in
form
atio
n ex
chan
ge
(HIE
), ha
s the
cap
acity
to e
nhan
ce th
e m
anag
emen
t of t
he h
ealth
of
popu
latio
ns b
y pr
omot
ing
the
shar
ing
of h
ealth
info
rmat
ion
acro
ss
inde
pend
ent h
ealth
care
org
aniz
atio
ns. T
he in
form
atio
n av
aila
ble
thro
ugh
HIE
s ca
n be
use
d by
clin
ical
dec
isio
n su
ppor
t (C
DS)
syst
ems t
o id
entif
y se
ntin
el
heal
th e
vent
s and
pat
ient
-spe
cific
car
e ne
eds,
and
then
to p
rom
ote
proa
ctiv
e in
terv
entio
ns.
149.
Loon
sk (
184)
Web
pag
e: C
GI,
Initi
ativ
e fo
r C
olla
bora
tive
Gov
ernm
ent
2010
U
S H
IE”
is u
sed
to d
escr
ibe:
hos
pita
ls sh
arin
g la
b re
ports
and
dis
char
ge
sum
mar
ies w
ith a
ffili
ated
pro
vide
rs; m
ulti-
stak
ehol
der R
egio
nal o
r Sta
te
Hea
lth In
form
atio
n O
rgan
izat
ions
(RH
IOs,
HIE
s, H
IOs)
; the
exc
hang
e of
in
form
atio
n am
ong
the
prod
ucts
of a
sing
le E
MR
ven
dor;
the
secu
re e
mai
ling
of d
ocum
ents
; and
, per
haps
mos
t sim
ply
and
broa
dly,
the
abili
ty o
f any
pie
ce
of so
ftwar
e to
exc
hang
e in
form
atio
n. H
IE c
an in
clud
e in
form
atio
n be
ing
brow
sed,
“pu
lled”
and
/or “
push
ed,”
and
info
rmat
ion
that
is fu
lly c
oded
with
na
tiona
lly re
cogn
ized
voc
abul
arie
s or i
nfor
mat
ion
that
is in
bar
ely
proc
essa
ble
docu
men
t for
mat
s. 15
0.
Lo
ri (1
85)
Whi
te p
aper
: Wha
t is
HIE
? A
Fed
eral
and
St
ate
Pers
pect
ive
bu
Obj
ect H
ealth
, LLC
. W
omen
Con
sulti
ng
Gro
up
Unk
now
n U
S Th
e m
ovem
ent o
f dat
a be
twee
n he
alth
info
rmat
ion
syst
ems f
or th
e pu
rpos
es
of:
Patie
nt c
omm
unic
atio
n Pr
ovid
er C
omm
unic
atio
n St
ate
Com
mun
icat
ion
H
ealth
info
rmat
ion
exch
ange
des
crib
es a
n ac
tion:
Pr
ovid
er o
rder
s a la
b te
st
Lab
resu
lt is
del
iver
ed to
Pro
vide
r
667
S.N
o.
Aut
hor
Sour
ce
Yea
r of
Publ
icat
ion
Cou
ntry
D
efin
ition
Prov
ider
tells
the
patie
nt th
e re
sults
. 15
1.
Lo
uisi
ana
(186
) W
ebpa
ge: L
ouis
iana
H
ealth
Info
rmat
ion
Exch
ange
Unk
now
n U
S K
now
n as
LaH
IE, t
he e
xcha
nge
allo
ws a
utho
rized
pro
vide
rs a
nd o
rgan
izat
ions
to
ele
ctro
nica
lly a
cces
s and
shar
e he
alth
-rel
ated
info
rmat
ion
thro
ugh
a se
cure
an
d co
nfid
entia
l net
wor
k fo
r the
pur
pose
of i
mpr
ovin
g pa
tient
safe
ty, q
ualit
y of
car
e an
d he
alth
out
com
es.
152.
Luo
(187
) Sc
ient
ific
2006
U
S Ex
chan
ge o
f inf
orm
atio
n is
one
of t
he k
ey e
lem
ents
to m
akin
g EM
Rs
bene
ficia
l to
patie
nts a
cros
s the
hea
lthca
re sp
ectru
m, w
heth
er a
t the
ph
ysic
ian'
s off
ice,
hos
pita
l, or
pha
rmac
y.
153.
Mäe
npää
et a
l. (3
8)
Scie
ntifi
c 20
11
Finl
and
/ Sw
eden
Th
e im
plem
enta
tion
of a
tech
nolo
gy su
ch a
s hea
lth in
form
atio
n ex
chan
ge
(HIE
) thr
ough
an
(reg
iona
l hea
lth in
form
atio
n sy
stem
s) R
HIS
shou
ld im
prov
e th
e m
obili
zatio
n of
hea
lth c
are
info
rmat
ion
elec
troni
cally
acr
oss o
rgan
izat
ions
w
ithin
a re
gion
, by
coor
dina
ting
care
and
brin
ging
toge
ther
loca
l sta
keho
lder
s.
154.
Mai
ne (1
88)
Web
pag
e: M
aine
Sta
te
HIE
U
nkno
wn
US
CM
S de
fines
HIE
as t
he se
cure
and
inte
rope
rabl
e sh
arin
g of
hea
lth
info
rmat
ion
in a
man
ner t
hat p
rote
cts t
he c
onfid
entia
lity,
priv
acy,
and
secu
rity
of a
n in
divi
dual
’s in
form
atio
n.
155.
mar
chca
rson
100
(189
) B
log:
man
dmhi
tech
20
11
Unk
now
n H
IE is
a g
roup
of e
ntiti
es w
ith th
e ca
pabi
lity
to m
ove
info
dig
itally
usi
ng
natio
nwid
e st
anda
rds.
HIE
is a
Pro
cess
H
ealth
Info
Exc
hang
e (H
IE) r
efer
s bac
k to
the
stra
tegy
of e
nabl
ing
the
depe
ndab
le sh
arin
g of
dig
ital p
atie
nt c
are-
asso
ciat
ed d
ata
amon
gst h
ealth
car
e as
soci
ated
ent
ities
and
net
wor
ks. T
his s
harin
g is
don
e in
a w
ay th
at p
rote
cts
the
conf
iden
tialit
y, p
rivac
y an
d sa
fety
of t
he in
form
atio
n. C
entra
l to
this
co
ncep
t is t
he u
sage
of n
atio
nally
reco
gniz
ed st
anda
rds c
urre
ntly
in p
lace
and
fu
ture
one
s as t
hey
are
publ
ishe
d.
HIE
s can
eve
n pr
ovid
e ke
y in
form
atio
n to
peo
ple
to p
rom
ote
impr
oved
hea
lth
and
wel
lnes
s, an
d ca
n be
use
d to
ass
ist r
esea
rch,
pub
lic w
ell-b
eing
, em
erge
ncy
resp
onse
, and
hig
h qu
ality
impr
ovem
ent.
Add
ition
ally
, an
HIE
allo
ws t
he
shar
ing
of h
ealth
-rel
ated
dat
a am
ongs
t hea
lthca
re o
rgan
izat
ions
and
with
in
divi
dual
s on
a ne
ighb
orho
od, r
egio
nal,
and
natio
nwid
e ba
sis.
156.
Mar
chib
roda
(1
90)
Boo
k: H
ealth
Lite
racy
, eH
ealth
, and
C
omm
unic
atio
n
2009
U
S H
ealth
info
rmat
ion
exch
ange
is a
noth
er m
ajor
com
pone
nt o
f eH
ealth
. Thi
s re
fers
to th
e el
ectro
nic
exch
ange
of d
ata
acro
ss o
rgan
izat
ions
and
dis
para
te
info
rmat
ion
syst
ems,
incl
udin
g da
ta fr
om la
bora
torie
s, ph
arm
acie
s, pl
ans,
phys
icia
ns, o
r hos
pita
ls
668
S.N
o.
Aut
hor
Sour
ce
Yea
r of
Publ
icat
ion
Cou
ntry
D
efin
ition
157.
Mat
thew
s et a
l. (1
91)
Whi
te P
aper
: Ind
iana
an
d O
hio
Hea
lth
Info
rmat
ion
Exch
ange
s C
onne
ct fo
r Nat
ion’
s Fi
rst
Live
, Mul
ti-R
egio
n C
linic
al In
form
atio
n Ex
chan
ge
2009
U
S Li
ve e
xcha
nge
will
allo
w se
cure
ele
ctro
nic
exch
ange
of h
ealth
info
rmat
ion,
re
duce
dup
licat
ion,
impr
ove
effic
ienc
y, im
prov
e pa
tient
car
e an
d fu
rther
the
natio
n’s g
oal t
o in
terc
onne
ct h
ealth
care
158.
McI
lwai
n an
d La
sset
ter
(192
) Sc
ient
ific
2009
U
S A
wel
l-des
igne
d H
IE sh
ould
ena
ble
bi-d
irect
iona
l int
egra
tion
betw
een
prac
tice
and
hosp
ital E
MR
s, as
wel
l as i
nter
oper
abili
ty w
ith o
ther
phy
sici
ans'
EMR
s or
outs
ide
syst
ems,
such
as r
efer
ence
labs
. Pat
ient
s sho
uld
also
be
able
to
inte
grat
e th
eir m
edic
al h
isto
ries w
ith a
per
sona
l hea
lth re
cord
(PH
R),
such
as
Goo
gle
Hea
lth o
r Mic
roso
ft's H
ealth
Vau
lt.
159.
(60)
Web
page
: Com
pute
r W
orld
, New
s. V
eriz
on
crea
tes m
edic
al
info
rmat
ion
exch
ange
cl
oud
2010
U
S V
eriz
on H
ealth
Info
rmat
ion
Exch
ange
, con
solid
ates
clin
ical
pat
ient
dat
a fr
om
vario
us p
rovi
ders
and
tran
slat
es it
into
a st
anda
rdiz
ed fo
rmat
that
can
then
be
acce
ssed
via
a se
cure
Web
por
tal.
160.
Mer
rill (
16)
Web
pag
e: M
olly
M
erril
l is t
he A
ssoc
iate
Ed
itor o
f Hea
lthca
re IT
N
ews.
She
cove
rs
phys
icia
n pr
actic
e IT
is
sues
and
nat
iona
l br
eaki
ng n
ews.
2009
U
S Th
e G
eorg
ia C
ance
r Coa
litio
n, a
n in
depe
nden
t, no
t-for
-pro
fit o
rgan
izat
ion
base
d in
Atla
nta,
will
use
a st
ate-
wid
e he
alth
care
info
rmat
ion
exch
ange
to
shar
e ev
iden
ce-b
ased
med
icin
e w
ith c
omm
unity
can
cer c
are
cent
ers.
The
exch
ange
will
serv
e as
a tr
uste
d th
ird p
arty
in th
e st
ate
to a
cqui
re, a
naly
se a
nd
repo
rt de
-iden
tifie
d pa
tient
dat
a ar
ound
qua
lity
mea
sure
s fro
m p
rovi
ders
and
ho
spita
ls th
at d
eliv
er c
ance
r car
e.
161.
Mer
rill e
t al (
193)
Scie
ntifi
c 20
13
US
Elec
troni
c H
IE fo
r pub
lic h
ealth
repo
rting
(HIE
for P
H) i
s a p
ower
ful s
trate
gy
for s
hapi
ng b
oth
shor
t and
long
term
pol
icie
s to
prom
ote
the
heal
th o
f po
pula
tions
thro
ugh:
rapi
d an
d ef
ficie
nt id
entif
icat
ion,
mon
itorin
g,
inve
stig
atio
n, a
nd tr
eatm
ent o
f com
mun
icab
le a
nd e
mer
ging
dis
ease
s; e
arly
id
entif
icat
ion
of fo
od b
orne
out
brea
ks a
nd e
nviro
nmen
tal e
xpos
ures
; id
entif
icat
ion
of h
ealth
risk
fact
ors;
and
pla
nnin
g an
d ev
alua
tion
of p
ublic
he
alth
serv
ices
. 16
2.
M
enta
l Hea
lth
(194
) M
enta
l Hea
lth
Info
rmat
ion
and
Prim
ary
Car
e In
tegr
atio
n A
ct o
f
2011
U
S H
ealth
info
rmat
ion
exch
ange
: an
elec
troni
c sy
stem
that
rece
ives
mai
ntai
ns a
nd
faci
litat
es th
e tra
nsfe
r of p
rote
cted
hea
lth a
nd m
enta
l hea
lth in
form
atio
n by
an
d be
twee
n m
enta
l hea
lth a
nd h
ealth
care
pro
vide
rs.
669
S.N
o.
Aut
hor
Sour
ce
Yea
r of
Publ
icat
ion
Cou
ntry
D
efin
ition
2011
16
3.
M
HIE
(195
) W
eb p
age:
Mem
oria
l H
erm
ann
Info
rmat
ion
Exch
ange
for a
utho
rized
ex
chan
ge m
embe
rs
Unk
now
n U
S M
HiE
’s (M
emor
ial H
erm
ann
Info
rmat
ion
Exch
ange
) sui
te o
f sol
utio
ns
faci
litat
es a
cces
s to
impo
rtant
clin
ical
info
rmat
ion
to p
rovi
de sa
fer,
effic
ient
an
d eq
uita
ble
patie
nt-c
ente
red
care
.
164.
Mic
higa
n (1
96)
Rep
ort:
2007
-200
8 R
epor
t to
the
Mic
higa
n Le
gisl
atur
e by
the
Mic
higa
n H
ealth
In
form
atio
n Te
chno
logy
C
omm
issi
on
2008
U
S H
ealth
Info
rmat
ion
Exch
ange
is a
way
to e
lect
roni
cally
mov
e pe
rson
al h
ealth
an
d m
edic
al in
form
atio
n se
cure
ly b
etw
een
vario
us h
ealth
car
e or
gani
zatio
ns
and
prov
ider
s und
er c
urre
nt m
edic
al p
rivac
y an
d co
nfid
entia
lity
stan
dard
pr
oced
ures
. The
goa
l of H
IE is
to fa
cilit
ate
deliv
ery
and
retri
eval
of c
linic
al
data
to p
rovi
de sa
fe, t
imel
y, e
ffic
ient
, eff
ectiv
e, a
nd e
quita
ble
patie
nt-c
ente
red
care
. In
shor
t, th
e go
al o
f HIE
is to
ens
ure
that
pro
vide
rs h
ave
the
right
in
form
atio
n ab
out t
heir
patie
nt a
t the
righ
t tim
e to
pro
vide
the
best
pos
sibl
e ca
re.
165.
Min
neso
ta (1
97)
Web
pag
e: M
inne
sota
D
epar
tmen
t of H
ealth
U
nkno
wn
US
Hea
lth in
form
atio
n ex
chan
ge, o
r HIE
, in
Min
neso
ta m
eans
the
elec
troni
c tra
nsm
issi
on o
f hea
lth re
late
d in
form
atio
n be
twee
n or
gani
zatio
ns a
ccor
ding
to
natio
nally
reco
gniz
ed st
anda
rds .
This
mea
ns e
ach
time
info
rmat
ion
is se
nt
elec
troni
cally
to a
noth
er p
rovi
der i
t is d
one
in a
uni
form
ly a
ccep
ted
way
that
m
eets
spec
ific
stan
dard
s to
ensu
re p
rote
ctio
n of
the
data
and
priv
acy
of th
e pa
tient
. It a
lso
mea
ns th
e in
form
atio
n w
ill b
e re
ceiv
ed in
a w
ay th
at is
usa
ble
for t
he re
cipi
ent.
16
6.
M
inne
sota
hea
lth
(198
) W
eb p
age:
A P
ract
ical
G
uide
to U
nder
stan
ding
H
IE, A
sses
sing
You
r R
eadi
ness
and
Sel
ectin
g H
IE O
ptio
ns in
M
inne
sota
by
Min
neso
ta
Dep
artm
ent o
f Hea
lth
Unk
now
n U
S H
IE re
fers
to th
e se
cure
ele
ctro
nic
send
ing
and
rece
ivin
g of
clin
ical
hea
lth
info
rmat
ion
in w
ays t
hat t
he in
form
atio
n ca
n be
und
erst
ood
by b
oth
the
send
er
and
the
rece
iver
of t
he in
form
atio
n.
167.
Mob
ile M
D (1
99)
Web
pag
e: S
iem
ens H
IE
Solu
tion
20
11
US
Mob
ileM
D®
is a
ven
dor-
neut
ral,
fully
out
sour
ced
heal
th in
form
atio
n ex
chan
ge (H
IE) f
or h
ealth
syst
ems,
hosp
itals
, phy
sici
ans,
labs
and
anc
illar
y he
alth
care
pro
vide
rs. I
t off
ers s
ecur
e m
essa
ging
, ana
lytic
solu
tions
, an
EMR
to
phys
icia
n pr
actic
es, a
nd c
onne
cts h
ealth
care
pro
vide
rs a
nd p
atie
nts t
hrou
gh
secu
re c
linic
al a
nd p
atie
nt p
orta
ls. T
oget
her,
the
HIE
enr
iche
s car
e te
ams w
ith
info
rmat
ion
as p
atie
nts m
ove
thro
ugh
the
heal
thca
re sy
stem
. 16
8.
M
obile
MD
(200
) W
eb p
age:
Sie
men
s HIE
So
lutio
n U
nkno
wn
US
Mob
ileM
D®
, a S
iem
ens s
olut
ion,
is a
four
-dim
ensi
onal
hea
lth in
form
atio
n ex
chan
ge –
car
e, se
rvic
e, e
cono
mic
s, an
d te
chno
logy
– p
rovi
ding
phy
sici
ans
670
S.N
o.
Aut
hor
Sour
ce
Yea
r of
Publ
icat
ion
Cou
ntry
D
efin
ition
with
nea
r rea
l-tim
e, se
cure
, clin
ical
and
adm
inis
trativ
e in
form
atio
n re
gard
less
of
loca
tion,
aff
iliat
ion,
EM
R te
chno
logy
, or v
endo
r. 16
9.
M
oore
(201
) B
log
/ Rep
ort
2011
U
S A
Hea
lth In
form
atio
n Ex
chan
ge (H
IE) i
s a te
chno
logy
net
wor
k in
fras
truct
ure
who
se p
rimar
y pu
rpos
e is
to in
sure
the
secu
re, d
igita
l exc
hang
e of
clin
ical
in
form
atio
n am
ong
all s
take
hold
ers t
hat a
re e
ngag
ed in
the
care
of a
pat
ient
to
prom
ote
colla
bora
tive
care
mod
els t
hat i
mpr
ove
the
qual
ity a
nd v
alue
of c
are
prov
ided
. 17
0.
M
oore
et a
l. (2
02)
Scie
ntifi
c 20
12
US
A h
ealth
info
rmat
ion
exch
ange
(HIE
) can
pro
vide
aut
omat
ic n
otifi
catio
ns to
its
mem
bers
by
build
ing
serv
ices
on
top
of th
eir e
xist
ing
infr
astru
ctur
e.
171.
Mor
gan
Hun
ter
(203
) B
log:
Com
pany
, Mor
gan
Hun
ter H
ealth
care
Inc.
U
nkno
wn
Unk
now
n H
IE re
fers
to a
ny o
ngoi
ng e
xcha
nge
of e
lect
roni
c cl
inic
al in
form
atio
n be
twee
n or
gani
zatio
ns su
ch a
s hos
pita
ls, p
hysi
cian
off
ices
, clin
ics,
clin
ical
rese
arch
gr
oups
, pub
lic h
ealth
ent
ities
and
qua
lity
assu
ranc
e gr
oups
. It a
lso
incl
udes
the
ongo
ing
exch
ange
bet
wee
n ca
re p
rovi
der o
rgan
izat
ions
and
con
sum
ers’
pe
rson
al h
ealth
reco
rds (
PHR
s).
172.
Mor
risse
y (2
04)
Mag
azin
e 20
13
US
Hea
lth in
form
atio
n ex
chan
ge —
that
set o
f act
iviti
es c
once
rned
with
get
ting
clin
ical
doc
umen
tatio
n fr
om th
e pl
aces
whe
re it
was
cre
ated
to o
ther
pla
ces
that
cou
ld re
ally
use
the
info
rmat
ion
— la
cked
som
e ba
sic
com
pone
nts:
a
criti
cal m
ass o
f com
pute
r sys
tem
s to
crea
te d
iscr
ete
data
; sta
ndar
ds a
llow
ing
data
from
one
ele
ctro
nic
heal
th re
cord
to b
e ta
ken
in b
y an
othe
r; an
d ro
utin
e m
etho
ds to
tran
smit
the
data
any
whe
re it
nee
ded
to g
o.
173.
Mos
bys (
205)
Mos
bys M
edic
al
Dic
tiona
ry
2009
U
S A
nur
sing
inte
rven
tion
from
the
Nur
sing
Inte
rven
tions
Cla
ssifi
catio
n (N
IC)
defin
ed a
s pro
vidi
ng p
atie
nt c
are
info
rmat
ion
to o
ther
hea
lth p
rofe
ssio
nals
17
4.
M
ount
Sin
ai (2
06)
Web
pag
e: M
ount
Sin
ai
HIE
, Mou
nt S
inai
H
ospi
tal
Unk
now
n U
S H
ealth
Info
rmat
ion
Exch
ange
is th
e sh
arin
g of
hea
lth in
form
atio
n el
ectro
nica
lly b
etw
een
prov
ider
s. Th
is e
xcha
nge
can
be d
one
dire
ctly
bet
wee
n tw
o pr
ovid
ers t
hat c
are
for t
he sa
me
patie
nt o
r can
be
enab
led
thro
ugh
a te
chno
logy
that
pro
vide
s the
ele
ctro
nic
info
rmat
ion
to a
pro
vide
r. In
form
atio
n ca
n on
ly b
e sh
ared
bet
wee
n pr
ovid
ers i
f a re
latio
nshi
p ex
ists
with
a p
atie
nt o
r th
e pa
tient
exp
licitl
y gi
ves t
heir
appr
oval
to a
cces
s the
ir in
form
atio
n.
175.
MSV
(207
) W
e pa
ge: M
edic
al
Soci
ety
of V
irgin
ia
Unk
now
n U
S V
irgin
ia's
heal
th in
form
atio
n ex
chan
ge (H
IE) a
ims t
o he
lp c
onne
ct p
rovi
ders
an
d pa
tient
s. A
HIE
pro
vide
s aut
horiz
ed u
sers
with
acc
ess t
o pa
tient
s' he
alth
-re
late
d in
form
atio
n th
at is
typi
cally
stor
ed in
mul
tiple
org
aniz
atio
ns, w
hile
m
aint
aini
ng th
e in
tegr
ity o
f the
info
rmat
ion
bein
g ex
chan
ged.
It m
ay b
e a
com
mun
ity-b
ased
, reg
iona
l, st
atew
ide
or la
rger
exc
hang
e th
at fa
cilit
ates
the
elec
troni
c ex
chan
ge o
f inf
orm
atio
n be
twee
n pr
ovid
ers.
Thes
e re
sour
ces w
ill
help
you
und
erst
and
the
stat
e's fr
amew
ork
for h
ealth
info
rmat
ion
exch
ange
an
d ho
w it
will
faci
litat
e im
prov
emen
ts in
car
e co
ordi
natio
n an
d in
form
atio
n
671
S.N
o.
Aut
hor
Sour
ce
Yea
r of
Publ
icat
ion
Cou
ntry
D
efin
ition
shar
ing.
17
6.
M
TBC
(208
) W
hite
Pap
er: W
hat i
s H
ealth
Info
rmat
ion
Exch
ange
(HIE
) by
MTB
C, h
ealth
care
IT
com
pany
Unk
now
n U
S H
ealth
Info
rmat
ion
Exch
ange
s (H
IE) a
re o
rgan
izat
ions
that
syne
rgiz
e an
d ef
fect
ivel
y st
ream
line
heal
th in
form
atio
n re
cord
s. M
any
stat
e go
vern
men
ts
prov
ide
fund
ing
for H
IE im
plem
enta
tion
with
the
goal
of f
acili
tatin
g ac
cess
to
and
retri
eval
of c
linic
al d
ata
to p
rovi
de m
ore
timel
y, fo
cuse
d, a
nd e
quita
ble
patie
nt-c
ente
red
care
. 17
7.
M
unoz
et a
l. (2
09)
Scie
ntifi
c 20
13
US
HIE
s are
ele
ctro
nic
netw
orks
into
whi
ch h
ealth
pro
vide
rs c
an c
onne
ct to
hav
e ac
cess
to a
ll m
edic
al re
cord
s for
an
indi
vidu
al w
ithin
a p
artic
ular
com
mun
ity
178.
Mur
phy
a (2
10)
Web
pag
e:
ehrin
telli
genc
e.co
m f
or
late
st te
chno
logy
new
s an
d w
hite
pap
ers /
A
rticl
e
2012
U
S Ex
chan
ge o
f ele
ctro
nic
info
rmat
ion
betw
een
prov
ider
s and
acr
oss p
latfo
rms
that
is se
cure
and
safe
guar
ds p
atie
nt p
rivac
y. H
IE is
clo
sely
alig
ned
with
in
tero
pera
bilit
y so
that
info
rmat
ion
can
flow
bac
k an
d fo
rth b
etw
een
doct
ors,
patie
nts,
and
heal
th n
etw
orks
.
179.
Mur
phy
b (2
11)
Web
pag
e:
ehrin
telli
genc
e.co
m f
or
late
st te
chno
logy
new
s an
d w
hite
pap
ers /
A
rticl
e
2012
U
S A
n H
IE b
ridge
s the
kno
wle
dge
gap
betw
een
prov
ider
s, a
llow
ing
them
to tr
ace
the
treat
men
t of p
atie
nts b
y va
rious
pro
vide
rs a
nd a
ct u
pon
this
info
rmat
ion
in
a m
eani
ngfu
l way
. But
on
a hi
gher
leve
l, an
HIE
cou
ld p
rove
inva
luab
le fo
r an
entir
e po
pula
tion.
180.
Mye
rs e
t al.(
212)
Scie
ntifi
c 20
12
US
Hea
lth in
form
atio
n ex
chan
ges (
HIE
) tha
t fac
ilita
te th
e ex
chan
ge o
f hea
lth
info
rmat
ion
acro
ss c
linic
al a
nd n
on-c
linic
al se
tting
s can
supp
ort t
eam
s of
prov
ider
s – p
hysi
cian
s, he
alth
edu
cato
rs, s
ocia
l wor
kers
, and
pha
rmac
ists
–
carin
g fo
r pat
ient
s with
HIV
(213
) by
expa
ndin
g ac
cess
to p
atie
nt in
form
atio
n.
181.
NA
HIT
(214
) R
epor
t to
the
Off
ice
of
the
Nat
iona
l Coo
rdin
ator
fo
r Hea
lth In
form
atio
n Te
chno
logy
on
defin
ing
key
heal
th in
form
atio
n te
chno
logy
term
s
2008
U
S H
ealth
info
rmat
ion
exch
ange
is a
noth
er fo
rm o
f HIT
, whi
ch e
nabl
es e
lect
roni
c m
ovem
ent o
f hea
lth-r
elat
ed in
form
atio
n am
ong
orga
niza
tions
.
182.
NA
HP
(215
) R
epor
t: EH
R b
y N
atio
nal A
ssoc
iatio
n fo
r H
ealth
Pro
fess
iona
ls
2011
U
S H
ealth
info
rmat
ion
exch
ange
(HIE
) has
em
erge
d as
a c
ore
capa
bilit
y fo
r ho
spita
ls a
nd p
hysi
cian
s to
achi
eve
"mea
ning
ful u
se"
and
rece
ive
stim
ulus
fu
ndin
g. H
ealth
care
ven
dors
are
pus
hing
HIE
as a
way
to a
llow
EH
R sy
stem
s to
pul
l dis
para
te d
ata
and
func
tion
on a
mor
e in
tero
pera
ble
leve
l.
183.
Nak
amur
a et
al
(216
) Sc
ient
ific
2010
U
S H
ospi
tals
' inv
olve
men
t in
HIE
, def
ined
as a
ctiv
e ex
chan
ge o
f ele
ctro
nic
data
by
a h
ospi
tal o
utsi
de it
s sys
tem
. 18
4.
N
aviN
et (2
17)
Blo
g: T
he M
edic
al
Qua
k, p
ost:
Nav
iNet
U
nkno
wn
Unk
now
n N
aviN
et h
elps
doc
tors
’ off
ices
inst
antly
acc
ess p
atie
nts’
insu
ranc
e in
form
atio
n, su
ch a
s the
ir be
nefit
s elig
ibili
ty a
nd c
laim
s sta
tus,
over
the
Web
.
672
S.N
o.
Aut
hor
Sour
ce
Yea
r of
Publ
icat
ion
Cou
ntry
D
efin
ition
Hea
lthC
are
Com
mun
icat
ion
Net
wor
k –
Tran
sact
iona
l Po
rtal I
nfor
mat
ion
Exch
ange
18
5.
N
CH
ICA
(54)
Rep
ort:
Prep
ared
by
the
NC
HIC
A C
onsu
mer
A
dvis
ory
Cou
ncil
on
Hea
lth In
form
atio
n (C
AC
HI)
fo
r Th
e N
orth
Car
olin
a H
ealth
Info
rmat
ion
Tech
nolo
gy
Stra
tegi
c Pl
anni
ng T
ask
Forc
e
2009
U
S Th
e st
anda
rdiz
ed e
lect
roni
c ex
chan
ge o
f hea
lth re
cord
s (ty
pica
lly E
HR
s)
betw
een
heal
thca
re p
rovi
ders
to e
nabl
e co
ntin
uity
of c
are.
186.
NC
HIE
(218
) W
eb p
age:
Nor
th
Car
olin
a H
ealth
In
form
atio
n Ex
chan
ge
Unk
now
n U
S N
C H
IE o
pera
tes N
orth
Car
olin
a’s s
tate
wid
e he
alth
info
rmat
ion
exch
ange
, a
secu
re, s
tand
ardi
zed
elec
troni
c sy
stem
in w
hich
pro
vide
rs c
an sh
are
impo
rtant
pa
tient
hea
lth in
form
atio
n. T
he u
se o
f thi
s sys
tem
pro
mot
es th
e ac
cess
, ex
chan
ge, a
nd a
naly
sis o
f hea
lth in
form
atio
n. N
C H
IE e
nabl
es p
artic
ipat
ing
orga
niza
tions
to:
Save
tim
e an
d re
duce
pap
erw
ork
Faci
litat
e m
ore
info
rmed
trea
tmen
t dec
isio
n-m
akin
g Le
ads t
o im
prov
ed c
are
coor
dina
tion,
hig
her q
ualit
y of
car
e, a
nd b
ette
r hea
lth
outc
omes
. 18
7.
N
DH
IN (2
19)
Web
pag
e: N
orth
Dak
ota
Hea
lth In
form
atio
n N
etw
ork
Unk
now
n U
S H
ealth
info
rmat
ion
exch
ange
that
util
izes
info
rmat
ion
infr
astru
ctur
e an
d sy
stem
s in
a se
cure
and
cos
t-eff
ectiv
e m
anne
r to
faci
litat
e th
e co
llect
ion,
st
orag
e, a
nd tr
ansm
issi
on o
f hea
lth in
form
atio
n.
188.
NR
C (2
20)
Boo
k: N
etw
orki
ng
Hea
lth: P
resc
riptio
ns fo
r th
e In
tern
et
2000
U
S H
ealth
info
rmat
ion
exch
ange
(HIE
) mak
es p
revi
ousl
y in
acce
ssib
le d
ata
avai
labl
e, re
sulti
ng in
the
avai
labi
lity
of m
ore
com
plet
e cl
inic
al in
form
atio
n,
whi
ch c
ould
impr
ove
the
qual
ity o
f car
e.
189.
NV
HIE
(221
) W
eb p
age:
Nev
ada
HIE
U
nkno
wn
US
The
chie
f pur
pose
of t
he N
V-H
IE is
to p
rovi
de o
vers
ight
and
gov
erna
nce
of
the
stat
ewid
e sy
stem
for t
he a
utho
rized
and
secu
re e
lect
roni
c ex
chan
ge o
f he
alth
info
rmat
ion
and
to e
stab
lish
and
mai
ntai
n a
sust
aina
ble
gove
rnan
ce a
nd
busi
ness
stru
ctur
e w
hich
ach
ieve
s bro
ad-b
ased
pub
lic-p
rivat
e st
akeh
olde
r
673
S.N
o.
Aut
hor
Sour
ce
Yea
r of
Publ
icat
ion
Cou
ntry
D
efin
ition
colla
bora
tion
with
tran
spar
ency
and
acc
ount
abili
ty w
hile
pro
tect
ing
the
publ
ic
inte
rest
19
0.
O
CI (
222)
Rep
ort:
Bui
ldin
g a
Hea
lth In
form
atio
n Ex
chan
ge
for t
he S
tate
of M
isso
uri
by O
bjec
t Com
putin
g,
Inc.
2009
U
S A
Hea
lth In
form
atio
n Ex
chan
ge (H
IE) e
nabl
es sh
arin
g of
ele
ctro
nic
heal
th-
rela
ted
info
rmat
ion
amon
g he
alth
car
e pr
ovid
ers,
patie
nts,
and
publ
ic h
ealth
ag
enci
es.
191.
(69)
(76)
(78)
(73)
One
Par
tner
HIE
(6
9)
Web
pag
e: O
ne P
artn
er
HIE
U
nkno
wn
US
A h
ealth
info
rmat
ion
exch
ange
(HIE
) is t
he e
lect
roni
c m
obili
zatio
n of
hea
lth
info
rmat
ion
acro
ss h
ealth
care
org
aniz
atio
ns w
ithin
a re
gion
, acr
oss t
he n
atio
n,
and
glob
ally
. Bas
ical
ly, i
t’s th
e "o
ne-to
-man
y" o
r the
"m
any-
to-m
any"
de
liver
y of
hea
lth in
form
atio
n to
impr
ove
care
, mak
ing
care
mor
e pa
tient
-ce
ntric
. Th
e fo
rem
ost g
oal o
f an
HIE
is to
mak
e po
ssib
le th
e ac
cess
and
retri
eval
of
clin
ical
dat
a so
car
e m
ay b
e de
liver
ed in
a sa
fer a
nd m
ore
timel
y m
anne
r. Fo
ster
ing
impr
oved
pat
ient
car
e by
enc
oura
ging
invo
lvem
ent o
f mul
tiple
cl
inic
ians
from
acr
oss t
he p
atie
nt c
are
spec
trum
, con
tinui
ty o
f car
e is
gre
atly
im
prov
ed.
192.
Ony
ile e
t al.
(12)
Scie
ntifi
c 20
11
US
The
New
Yor
k C
linic
al In
form
atio
n Ex
chan
ge (N
YC
LIX
), a
func
tioni
ng
heal
th in
form
atio
n ex
chan
ge, i
s use
d by
em
erge
ncy
depa
rtmen
t (ED
) pe
rson
nel t
o ob
tain
prio
r hea
lth d
ata.
19
3.
O
nyile
et a
l.(13
) Sc
ient
ific
2013
U
S Th
e N
ew Y
ork
Clin
ical
Info
rmat
ion
Exch
ange
(NY
CLI
X) w
as a
Man
hatta
n-ba
sed
RH
IO, w
hich
bui
lt an
ope
ratio
nal,
secu
re H
IE a
vaila
ble
to a
utho
rized
ho
spita
ls a
nd o
ther
hea
lthca
re p
rovi
ders
in th
e N
YC
met
ropo
litan
are
a.
NY
CLI
X w
as a
col
labo
ratio
n am
ong
ambu
lato
ry p
hysi
cian
gro
ups,
long
-term
ca
re fa
cilit
ies,
a M
edic
aid
man
aged
car
e pl
an, t
he n
atio
n's l
arge
st h
ome
heal
thca
re p
rovi
der a
nd a
cade
mic
med
ical
cen
ters
.
194.
Ope
n So
urce
(2
23)
Web
pag
e: H
artfo
rd
Hos
pita
l: O
pen
Sour
ce
HIE
. Ope
n So
urce
C
omm
unity
for
Hea
lthca
re.
U
S H
ealth
Info
rmat
ion
Exch
ange
(HIE
) tha
t will
link
the
acut
e ca
re h
ospi
tals
with
th
e am
bula
tory
and
terti
ary
care
faci
litie
s alo
ng w
ith th
e la
bs a
nd d
iagn
ostic
ce
ntre
s in
the
regi
on.
195.
OPT
UM
(224
) W
eb p
age:
Com
pany
/ So
lutio
n Pr
ovid
er
Unk
now
n U
S H
IE p
rovi
des t
he c
apab
ility
to e
lect
roni
cally
mov
e cl
inic
al in
form
atio
n am
ong
disp
arat
e he
alth
car
e in
form
atio
n sy
stem
s whi
le m
aint
aini
ng th
e m
eani
ng o
f th
e in
form
atio
n be
ing
exch
ange
d. A
n H
IE is
a fo
unda
tiona
l pie
ce o
f the
A
ccou
ntab
le C
are
Org
aniz
atio
ns (A
CO
) bec
ause
it p
rovi
des a
way
for E
MR
s
674
S.N
o.
Aut
hor
Sour
ce
Yea
r of
Publ
icat
ion
Cou
ntry
D
efin
ition
to e
xcha
nge
info
rmat
ion
acro
ss d
iffer
ent t
ypes
of m
edic
al re
cord
s. 19
6.
O
racl
e (2
25)
Whi
te p
aper
Ora
cle
Hea
lth In
form
atio
n
Exch
ange
: Sec
ure,
Se
amle
ss D
ata
Shar
ing
2012
U
S H
ealth
info
rmat
ion
exch
ange
(HIE
)—th
e se
amle
ss, s
ecur
e, e
lect
roni
c sh
arin
g of
hea
lth d
ata
acro
ss n
etw
orks
.
197.
Orio
n H
IE (2
26)
Web
pag
e: O
rion
Hea
lth, S
olut
ion
Prov
ider
Unk
now
n U
S O
rion
Hea
lth™
Hea
lth In
form
atio
n Ex
chan
ge (H
IE) i
s a p
ower
ful h
ealth
in
form
atio
n ba
ckbo
ne th
at e
nabl
es o
rgan
izat
ions
and
clin
ical
com
mun
ities
to
exch
ange
med
ical
info
rmat
ion
and
shar
e co
mpl
ete
patie
nt re
cord
s. W
heth
er a
ho
spita
l or h
ealth
syst
em, a
pub
lic o
r reg
iona
l HIE
, Orio
n H
ealth
get
s you
r or
gani
zatio
n co
nnec
ted.
Orio
n H
ealth
HIE
ena
bles
the
exch
ange
of a
ny
clin
ical
info
rmat
ion
betw
een
orga
niza
tions
, ens
urin
g th
at a
ll cl
inic
al st
aff h
ave
acce
ss to
rele
vant
, up-
to-d
ate
and
accu
rate
pat
ient
info
rmat
ion
rega
rdle
ss o
f w
here
car
e is
pro
vide
d or
the
clin
icia
n is
loca
ted.
19
8.
O
verh
age
et a
l (2
27)
Scie
ntifi
c 20
05
US
Hea
lth in
form
atio
n ex
chan
ge, d
efin
ed a
s the
ele
ctro
nic
shar
ing
of h
ealth
in
form
atio
n ac
ross
hea
lth c
are
orga
niza
tions
with
in a
regi
on, c
omm
unity
, or
hosp
ital s
yste
m, i
s adv
ocat
ed a
s ess
entia
l to
impr
ovin
g he
alth
car
e qu
ality
and
re
duci
ng c
osts
19
9.
O
verh
age
et a
l (2
28)
Scie
ntifi
c 20
07
US
The
coun
try h
as id
entif
ied
heal
th in
form
atio
n ex
chan
ge (H
IE) a
s an
esse
ntia
l st
rate
gy to
add
ress
our
cris
is o
f cos
t, qu
ality
, and
safe
ty in
hea
lth c
are.
(HIE
) ne
twor
ks th
at a
re, i
n tu
rn, a
col
lect
ion
of in
terc
onne
cted
, int
erop
erab
le h
ealth
in
form
atio
n sy
stem
s (H
IS).
200.
Ozk
ayna
k an
d B
renn
an (
229)
Scie
ntifi
c 20
13
US
Hea
lth in
form
atio
n ex
chan
ge (H
IE) a
llow
s clin
icia
ns to
acc
ess p
atie
nt le
vel
heal
th c
are
info
rmat
ion.
20
1.
PA
eHea
lth (2
30)
Elec
troni
c A
rticl
e:
Wha
t is t
he D
iffer
ence
be
twee
n H
IX a
nd H
IE?
By
PA e
Hea
lth
Partn
ersh
ip A
utho
rity
Unk
now
n U
S H
IE st
ands
for h
ealth
info
rmat
ion
exch
ange
. HIE
pla
ys a
n im
porta
nt ro
le in
gi
ving
the
heal
thca
re sy
stem
a 2
1st c
entu
ry u
pgra
de. I
t giv
es p
rovi
ders
—do
ctor
s, nu
rses
, hos
pita
ls, p
harm
acie
s, la
bora
torie
s and
oth
ers—
the
abili
ty to
ex
chan
ge h
ealth
info
rmat
ion
elec
troni
cally
with
oth
er p
rovi
ders
in a
secu
re
envi
ronm
ent
202.
Palm
etto
(231
) W
eb p
age:
Pal
met
to
Hea
lth: H
ealth
care
, non
-pr
ofit
heal
thca
re
reso
urce
Unk
now
n U
S A
Hea
lth In
form
atio
n Ex
chan
ge (H
IE) i
s a c
onve
nien
t ele
ctro
nic
serv
ice
that
al
low
s hea
lthca
re p
rovi
ders
at m
ultip
le si
tes t
o ha
ve a
cces
s to
a pa
tient
’s
EMR
. Pal
met
to H
ealth
rece
ntly
laun
ched
Pro
vide
r HIE
, whi
ch in
clud
es
Palm
etto
Hea
lth h
ospi
tals
and
phy
sici
an p
ract
ices
. The
re is
no
cost
to y
ou to
al
low
you
r EM
R to
be
acce
ssib
le th
roug
h th
e H
IE.
203.
Payn
e et
al.
(10)
Scie
ntifi
c 20
11
UK
C
linic
al in
form
atio
n ex
chan
ge in
the
UK
was
acc
ompl
ishe
d by
est
ablis
hing
a
foun
datio
n of
pol
icy,
infr
astru
ctur
e, a
nd sy
stem
s of c
are,
by
crea
ting
and
acqu
iring
clin
ical
com
putin
g ap
plic
atio
ns, a
nd w
ith st
rong
use
of f
inan
cial
and
675
S.N
o.
Aut
hor
Sour
ce
Yea
r of
Publ
icat
ion
Cou
ntry
D
efin
ition
clin
ical
ince
ntiv
es.
204.
PCM
AG
(66)
W
eb p
age:
pcm
ag.c
om
for t
ech
new
s, bu
ying
gu
ides
, rev
iew
s etc
.
Unk
now
n U
S H
ealth
Info
rmat
ion
Exch
ange
, a se
rvic
e th
at e
nabl
es e
xcha
nge
of h
ealth
care
in
form
atio
n be
twee
n ho
spita
ls a
nd re
gion
s. Th
e in
form
atio
n is
not
onl
y us
ed
to p
rovi
de m
edic
al d
ata
for p
eopl
e w
ho m
ove
to a
diff
eren
t geo
grap
hic
area
, bu
t als
o to
pro
vide
stat
istic
s for
pub
lic h
ealth
in g
ener
al. T
here
are
man
y re
gion
al h
ealth
info
rmat
ion
orga
niza
tions
(RH
IOs)
thro
ugho
ut th
e U
.S. t
hat
are
invo
lved
in h
ealth
info
rmat
ion
exch
ange
(HIE
), an
d th
e te
rms R
HIO
and
H
IE a
re u
sed
syno
nym
ousl
y.
205.
PDN
(232
) W
eb p
age:
Pro
fess
iona
l D
ynam
ics N
etw
ork
Inc.
20
11/1
2 U
S H
IE (H
ealth
Info
rmat
ion
Exch
ange
) ref
ers t
o th
e te
chno
logi
cal n
etw
ork
infr
astru
ctur
e, th
at h
as th
e ch
ief p
urpo
se o
f ass
urin
g ac
cura
te m
edic
al
info
rmat
ion
exch
ange
. Th
is p
atie
nt d
ata
and
elec
troni
c he
alth
reco
rds (
EHR
), w
hich
is d
igita
l inf
orm
atio
n an
d se
cure
, is c
linic
al in
form
atio
n us
ed in
be
twee
n m
edic
al o
rgan
izat
ions
who
are
resp
onsi
ble
for p
rovi
ding
hea
lthca
re to
th
e pa
tient
s. A
Hea
lth In
form
atio
n Ex
chan
ge p
rovi
des a
tech
nolo
gy p
latfo
rm
that
pro
mot
es c
olla
bora
tive
care
mod
els t
hat a
re c
ruci
al to
impr
ove
the
valu
e an
d qu
ality
of t
he h
ealth
care
pro
vide
d.
206.
PDN
(233
) W
eb p
age:
Pro
fess
iona
l D
evel
opm
ent N
etw
ork,
In
c.
Unk
now
n U
S H
ealth
info
rmat
ion
exch
ange
syst
em is
resp
onsi
ble
for m
obili
zing
the
heal
thca
re in
form
atio
n el
ectro
nica
lly th
roug
hout
the
asso
ciat
ed o
rgan
izat
ions
th
at a
re b
orde
red
by c
omm
unity
, hos
pita
l sys
tem
and
regi
on. H
ealth
in
form
atio
n ex
chan
ge c
an e
ndow
us t
he a
bilit
y to
tran
sfer
clin
ical
info
rmat
ion
elec
troni
cally
in b
etw
een
the
netw
ork
of h
ealth
car
e (2
33)in
form
atio
n sy
stem
s an
d at
the
sam
e tim
e m
aint
aini
ng a
nd se
curin
g th
e tru
e m
eani
ng o
f the
in
form
atio
n be
ing
exch
ange
d. It
is th
e jo
b of
hea
lth in
form
atio
n ex
chan
ge
syst
em to
pro
vide
the
acce
ss to
and
retri
eval
of t
he m
edic
al d
ata
in o
rder
to
faci
litat
e ef
fect
ive,
pat
ient
-cen
tere
d, ti
mel
y, sa
fe, s
ecur
ed a
nd e
quita
ble
heal
th
care
. The
hea
lth in
form
atio
n ex
chan
ge sy
stem
is a
lso
frui
tful i
n te
rms o
f pr
ovid
ing
assi
stan
ce to
the
Publ
ic H
ealth
aut
horit
ies i
n th
e an
alys
es o
f the
co
untry
wid
e po
pula
tion
heal
th.
207.
Penn
sylv
ania
(2
34)
Rep
ort:
Penn
sylv
ania
eH
ealth
Col
labo
rativ
e
Stra
tegi
c Pl
an fo
r Hea
lth
Info
rmat
ion
Exch
ange
20
12
2012
U
S H
ealth
Info
rmat
ion
Exch
ange
s (H
IEs)
are
ent
ities
ofte
n bu
ilt o
n a
serie
s of
ofte
n bi
late
ral l
egal
agr
eem
ents
bet
wee
n di
ffer
ent,
ofte
n pr
oprie
tary
in
form
atio
n sy
stem
s to
be a
ble
to sh
are
certa
in k
inds
of d
ata.
The
ele
ctro
nic
mov
emen
t of h
ealth
-rel
ated
info
rmat
ion
amon
g un
affil
iate
d or
gani
zatio
ns
acco
rdin
g to
nat
iona
lly re
cogn
ized
stan
dard
s. H
IE p
rovi
des t
he o
ppor
tuni
ty to
im
prov
e qu
ality
and
safe
ty o
f car
e, im
prov
e ef
ficie
ncy,
redu
ce c
osts
and
mak
e ca
re m
ore
conv
enie
nt fo
r 20
8.
Pr
ince
ton
(235
) W
eb p
age:
Prin
ceto
n U
nkno
wn
US
Prin
ceto
n H
ealth
Car
e Sy
stem
's H
ealth
Info
rmat
ion
Exch
ange
(HIE
) cal
led
676
S.N
o.
Aut
hor
Sour
ce
Yea
r of
Publ
icat
ion
Cou
ntry
D
efin
ition
Hea
lthca
re S
yste
m
Prin
ceto
n H
ealth
Con
nect
® u
ses h
ealth
car
e te
chno
logy
allo
ws h
ospi
tals
, do
ctor
s and
oth
er h
ealth
car
e pr
ovid
ers t
o el
ectro
nica
lly sh
are
heal
th
info
rmat
ion
with
eac
h ot
her i
n a
secu
re, t
imel
y m
anne
r. Th
is h
ealth
in
form
atio
n co
uld
incl
ude
repo
rts a
bout
you
r illn
esse
s, in
jurie
s, al
lerg
ies,
med
icin
es a
nd te
st re
sults
. 20
9.
Pr
ivac
y R
ight
s (2
36)
Web
pag
e: C
alifo
rnia
M
edic
al P
rivac
y Fa
ct
Shee
t C2:
H
ow Is
You
r Med
ical
In
form
atio
n U
sed
and
Dis
clos
ed -
With
and
W
ithou
t by
Priv
acy
Rig
hts C
lear
ing
Hou
se
2012
U
S H
IE w
ill m
ake
your
reco
rds e
lect
roni
cally
acc
essi
ble
to a
ll pe
rmis
sibl
e he
alth
ca
re p
erso
nnel
, whe
reve
r tho
se re
cord
s may
be.
210.
Pris
m (2
37)
Web
pag
e: P
rism
Hea
lth
Serv
ices
, Con
sulti
ng
Com
pany
Unk
now
n U
S A
n H
IE e
nabl
es th
e ex
chan
ge o
f hea
lth-r
elat
ed d
ata
amon
g he
alth
pro
vide
rs,
publ
ic h
ealth
age
ncie
s, pa
yers
, and
pat
ient
s. A
gain
, the
cor
e pu
rpos
e is
for
impr
ovin
g th
e qu
ality
and
eff
icie
ncy
of h
ealth
care
del
iver
y an
d, u
ltim
atel
y, th
e im
prov
emen
t of p
opul
atio
n he
alth
. Bui
ldin
g tru
st a
nd c
onse
nsus
am
ong
stak
ehol
ders
is k
ey to
ens
urin
g th
e su
cces
s of a
n H
IE.
211.
RC
HN
(65)
Web
pag
e: R
CH
N
Com
mun
ity H
ealth
Fo
unda
tion
(RC
HN
C
HF)
is a
not
-for
-pro
fit
oper
atin
g fo
unda
tion
Unk
now
n U
S So
met
imes
the
term
HIE
is u
sed
as p
art o
f the
nam
e of
a R
egio
nal H
ealth
In
form
atio
n O
rgan
izat
ion,
or R
HIO
, def
ined
in th
e sa
me
repo
rt as
, “a
heal
th
info
rmat
ion
orga
niza
tion
that
brin
gs to
geth
er h
ealth
car
e st
akeh
olde
rs w
ithin
a
defin
ed g
eogr
aphi
c ar
ea a
nd g
over
ns h
ealth
info
rmat
ion
exch
ange
am
ong
them
for t
he p
urpo
se o
f im
prov
ing
heal
th c
are
in th
at c
omm
unity
.” H
ere
“HIE
” m
ean
the
proc
ess o
f sha
ring
info
rmat
ion
and
“RH
IO”
mea
n th
e or
gani
zatio
n th
at fa
cilit
ates
the
shar
ing.
21
2.
R
ebry
na (3
4)
Scie
ntifi
c 20
09
Can
ada
Reg
iona
l hea
lth in
form
atio
n or
gani
zatio
ns (R
HIO
s) o
r hea
lth in
form
atio
n ex
chan
ges (
HIE
s) v
ary
in d
efin
ition
, but
the
over
all c
once
pt re
sts o
n th
e ex
chan
ge o
f hea
lth in
form
atio
n ac
ross
org
aniz
atio
ns.
213.
Rec
ogni
ti (2
38)
Web
pag
e: R
ecog
niti,
So
lutio
n pr
ovid
er
Unk
now
n U
S H
ealth
Info
rmat
ion
Exch
ange
allo
ws h
ealth
car
e pr
ofes
sion
als a
nd p
atie
nts t
o ap
prop
riate
ly a
cces
s and
secu
rely
shar
es a
pat
ient
’s v
ital m
edic
al in
form
atio
n el
ectro
nica
lly. T
here
are
man
y he
alth
car
e de
liver
y sc
enar
ios d
rivin
g th
e te
chno
logy
beh
ind
the
diff
eren
t for
ms o
f hea
lth in
form
atio
n ex
chan
ge
avai
labl
e to
day.
Hea
lth In
form
atio
n Ex
chan
ge (H
IE) i
s one
of t
he m
ost
com
mon
form
s of u
tiliz
ing
an E
HR
solu
tion.
21
4.
R
eede
r (23
9)
Web
pag
e / P
ost:
Ven
dor,
EHR
Doc
tors
20
11-2
012
US
Whe
n as
ked
for a
def
initi
on o
f HIE
, the
ans
wer
s we
get b
ack
rang
e fr
om:
pape
rless
, em
ail,
prov
ider
por
tals
, and
ele
ctro
nic
sum
mar
y of
car
e re
cord
s.
677
S.N
o.
Aut
hor
Sour
ce
Yea
r of
Publ
icat
ion
Cou
ntry
D
efin
ition
215.
Ree
der e
t al (
240)
Scie
ntifi
c 20
12
US
A H
ealth
Info
rmat
ion
Exch
ange
(HIE
) pro
vide
s a se
cure
, int
erop
erab
le
infr
astru
ctur
e fo
r ele
ctro
nica
lly m
ovin
g cl
inic
al d
ata
betw
een
hete
roge
neou
s he
alth
info
rmat
ion
syst
ems a
nd it
s sta
keho
lder
s, in
clud
ing
publ
ic h
ealth
. 21
6.
R
egan
(8)
Scie
ntifi
c 19
91
Aus
tralia
El
ectro
nic
Dat
a In
terc
hang
e (E
DI)
pro
mis
es to
spee
d th
e tra
nsfe
r of m
edic
al
data
, ins
uran
ce in
form
atio
n an
d pa
ymen
ts.
217.
Rev
ere
and
Stev
ens (
241)
Scie
ntifi
c 20
10
US
HIE
s hav
e de
velo
ped
real
-tim
e, n
atio
nwid
e pu
blic
hea
lth e
vent
-mon
itorin
g ca
pabi
lity
to a
ssis
t with
and
impr
ove
early
eve
nt d
etec
tion,
pub
lic h
ealth
si
tuat
iona
l aw
aren
ess,
outb
reak
man
agem
ent,
and
coun
term
easu
re a
nd
resp
onse
adm
inis
tratio
n.
218.
Rho
de Is
land
(2
42)
Web
pag
e: S
tate
of
Rho
de Is
land
, D
epar
tmen
t of H
ealth
Unk
now
n U
S R
hode
Isla
nd's
heal
th in
form
atio
n ex
chan
ge sy
stem
is a
n el
ectro
nic
netw
ork
that
giv
es m
edic
al p
rofe
ssio
nals
acc
ess t
o th
eir p
atie
nt's
heal
th in
form
atio
n. It
w
ill h
elp
heal
thca
re p
rovi
ders
giv
e th
eir p
atie
nts t
he b
est p
ossi
ble
care
by
givi
ng h
ealth
care
pro
vide
rs a
cces
s to
thei
r pat
ient
's he
alth
info
rmat
ion,
in
clud
ing
info
rmat
ion
that
com
es fr
om o
ther
pro
vide
rs. H
ealth
car
e co
nsum
ers
can
choo
se to
par
ticip
ate
in c
urre
nt c
are
and
can
cont
rol w
ho c
an a
cces
s the
ir he
alth
info
rmat
ion.
21
9.
R
IQI (
243)
Web
pag
e: C
urre
nt C
are
Rho
de Is
land
HIE
, R
hode
Isla
nd Q
ualit
y In
stitu
te
Unk
now
n U
S C
urre
ntC
are,
Rho
de Is
land
’s th
e St
atew
ide
Hea
lth In
form
atio
n Ex
chan
ge
(HIE
), is
a se
cure
ele
ctro
nic
syst
em w
hich
will
allo
w d
octo
rs a
nd o
ther
car
e gi
vers
imm
edia
te a
cces
s to
a pa
tient
’s u
p-to
-dat
e he
alth
info
rmat
ion
in o
rder
to
prov
ide
the
best
pos
sibl
e an
d m
ost c
ompr
ehen
sive
car
e.
220.
Ros
s et a
l.(24
4)
Scie
ntifi
c 20
10
US
CO
MM
UN
ITY
-HIE
: Cur
rent
ly e
ngag
ed in
com
mun
ity-w
ide
HIE
, def
ined
as a
sy
stem
that
con
solid
ates
and
pro
vide
s mor
e th
an o
ne c
ateg
ory
of in
form
atio
n (e
.g.,
labo
rato
ry te
st re
sults
, rad
iogr
aphi
c re
sults
, clin
ical
not
es) f
rom
mor
e th
an o
ne in
depe
nden
t org
aniz
atio
n. C
OM
MU
NIT
Y-H
IE p
ract
ices
cou
ld u
se
eith
er p
aper
or e
lect
roni
c m
edic
al re
cord
s. 22
1.
R
ouzt
an (2
45)
Web
pag
e / B
log:
C
entra
l Illi
nois
Hea
lth
Info
rmat
ion
Exch
ange
B
log
2013
U
S W
hat a
n H
IE d
oes i
s allo
w a
hea
lthca
re p
rovi
der t
o lo
g in
to a
secu
red
web
site
an
d pu
ll up
all
of th
e m
edic
al in
form
atio
n ab
out y
ou fr
om a
ll of
you
r med
ical
ca
regi
vers
(as l
ong
as th
ey a
re p
artic
ipat
ing
in sh
arin
g da
ta w
ith th
e H
IE) i
n on
e pl
ace.
Thi
s is s
imila
r to
sear
chin
g a
site
like
Exp
edia
for t
rave
l opt
ions
. It
goes
out
and
pul
ls a
ll th
e in
form
atio
n in
to o
ne sc
reen
for y
ou.
222.
Row
ley
(246
) Po
st: H
ealth
care
Te
chno
logy
Con
sulta
nt
2013
U
S H
ealth
Info
rmat
ion
Exch
ange
s (H
IEs)
are
def
ined
in H
ITEC
H, a
nd a
re
envi
sion
ed a
s hub
s whe
re d
iffer
ent s
yste
ms c
an e
xcha
nge
heal
th d
ata
(ass
umin
g th
ey h
ave
crac
ked
the
patie
nt-id
entit
y nu
t) an
d br
eak
dow
n th
e si
los
of E
HR
dat
a.
223.
RSA
Inde
x (2
47)
Web
pag
e: N
ew
Ham
pshi
re R
evis
ed
1989
U
S “H
ealth
info
rmat
ion
exch
ange
” m
eans
an
entit
y es
tabl
ishe
d fo
r the
prim
ary
purp
ose
of e
nabl
ing
and
over
seei
ng th
e ex
chan
ge o
f pro
tect
ed h
ealth
678
S.N
o.
Aut
hor
Sour
ce
Yea
r of
Publ
icat
ion
Cou
ntry
D
efin
ition
Stat
utes
Ann
otat
ed
(RSA
) Ind
ex
in
form
atio
n fo
r clin
ical
dec
isio
n-m
akin
g pu
rpos
es. T
he e
ntity
may
ope
rate
on
a re
gion
al, s
tate
wid
e, o
r mul
ti-st
ate
basi
s. Th
e en
tity
may
be
deve
lope
d by
m
ultip
le st
akeh
olde
rs, i
nclu
ding
, but
not
lim
ited
to, t
he d
epar
tmen
t of h
ealth
an
d hu
man
serv
ices
, a n
on-p
rofit
ent
ity, o
r a fo
r-pr
ofit
entit
y.
224.
Safe
Net
(18)
Secu
rity
Gui
de: W
hat
You
Nee
d to
Kno
w
Abo
ut S
ecur
ing
Hea
lthca
re In
form
atio
n Ex
chan
ges b
y , S
afeN
et,
a gl
obal
lead
er in
in
form
atio
n se
curit
y
2010
U
S H
ealth
care
Info
rmat
ion
Exch
ange
s (H
IE) p
rovi
de th
e ca
pabi
lity
to
elec
troni
cally
mov
e cl
inic
al in
form
atio
n am
ong
diff
eren
t hea
lthca
re
orga
niza
tion
like
hosp
itals
, phy
sici
an o
ffic
es, p
harm
acie
s, an
d he
alth
in
sura
nce
com
pani
es. H
IEs a
re q
uick
ly e
mer
ging
sinc
e th
ey fa
cilit
ate
acce
ss to
cl
inic
al d
ata
allo
win
g he
alth
care
pro
fess
iona
ls a
mor
e ef
ficie
nt a
nd si
mpl
e w
ay
to a
cces
s pat
ient
dat
a
225.
San
Die
go (1
7)
Web
pag
e: S
an D
iego
R
egio
nal H
IE
Unk
now
n U
S Th
e Sa
n D
iego
Reg
iona
l Hea
lthca
re In
form
atio
n Ex
chan
ge (S
an D
iego
B
eaco
n) is
a c
olla
bora
tive
of lo
cal h
ospi
tal s
yste
ms,
com
mun
ity c
linic
s, em
erge
ncy
med
ical
serv
ices
and
pub
lic h
ealth
org
aniz
atio
ns w
hose
goa
l is t
o de
liver
the
high
est q
ualit
y he
alth
car
e to
all
San
Die
gans
. 22
6.
SC
A (2
48)
Whi
te P
aper
: Hea
lthca
re
Iden
tity
Man
agem
ent:
The
Foun
datio
n fo
r a
Secu
re a
nd T
rust
ed
Nat
iona
l Hea
lth
Info
rmat
ion
Net
wor
k.
Smar
t Car
d A
llian
ce
Posi
tion
Pape
r for
G
over
nmen
t Pol
icy
Mak
ers a
nd H
ealth
care
St
akeh
olde
rs
2009
US
An
HIE
pro
vide
s the
cap
abili
ty to
secu
rely
and
con
fiden
tially
ena
ble
elec
troni
c tra
nsfe
r of c
linic
al in
form
atio
n am
ong
sepa
rate
hea
lthca
re
info
rmat
ion
syst
ems,
whi
le m
aint
aini
ng th
e m
eani
ng o
f the
info
rmat
ion
bein
g ex
chan
ged.
227.
Schu
lte (2
49)
Boo
k: H
ealth
care
D
eliv
ery
in th
e U
.S.A
.: A
n In
trodu
ctio
n
2012
U
S H
IE re
fers
to th
e te
chno
logy
and
pro
cess
infr
astru
ctur
e th
at su
ppor
ts th
e sh
arin
g of
clin
ical
and
oth
er p
atie
nt d
ata
with
in a
geo
grap
hic
regi
on a
nd
amon
g th
e or
gani
zatio
nally
unr
elat
ed p
rovi
ders
of c
are
in th
at re
gion
. 22
8.
SE
MH
IE (2
50)
Web
pag
e: S
outh
east
M
ichi
gan
Hea
lth
Info
rmat
ion
Exch
ange
(S
EMH
IE)
Unk
now
n U
S Th
e So
uthe
ast M
ichi
gan
Hea
lth In
form
atio
n Ex
chan
ge (S
EMH
IE) i
s a m
ulti-
stak
ehol
der i
nitia
tive
dedi
cate
d to
del
iver
ing
the
prom
ise
of in
tegr
ated
hea
lth
info
rmat
ion
exch
ange
thro
ugho
ut S
outh
east
Mic
higa
n. W
hen
succ
essf
ully
de
ploy
ed, S
EMH
IE w
ill:
Enha
nce
patie
nt c
are,
qua
lity
and
safe
ty
Incr
ease
eff
ectiv
enes
s and
eff
icie
ncy
of h
ealth
care
del
iver
y R
educ
e he
alth
care
cos
ts.
679
S.N
o.
Aut
hor
Sour
ce
Yea
r of
Publ
icat
ion
Cou
ntry
D
efin
ition
229.
Shad
e et
al
(251
) Sc
ient
ific
2012
U
S H
ealth
info
rmat
ion
exch
ange
(HIE
) is t
he p
roce
ss o
f ele
ctro
nic
mul
ti-di
rect
iona
l tra
nsfe
r of i
dent
ifiab
le, p
atie
nt-le
vel i
nfor
mat
ion
betw
een
diff
eren
t or
gani
zatio
ns.
230.
Shap
iro e
t al.(
252)
Scie
ntifi
c 20
07
US
Hea
lth in
form
atio
n ex
chan
ge (H
IE) i
s a p
oten
tially
pow
erfu
l tec
hnol
ogy
that
ca
n im
prov
e th
e qu
ality
of c
are
deliv
ered
in e
mer
genc
y de
partm
ents
, 23
1.
Sh
apiro
(253
) Sc
ient
ific
2007
U
S Th
ey (H
IE) a
im to
brin
g pr
evio
usly
una
vaila
ble
clin
ical
dat
a fr
om p
atie
nts’
di
spar
ate
heal
th re
cord
s, w
hich
may
be
spre
ad o
ver m
ultip
le p
rovi
der a
nd
paye
r net
wor
ks, t
o th
e po
int o
f car
e w
here
clin
icia
ns a
nd th
eir p
atie
nts n
eed
it m
ost.
232.
Shap
iro e
t al
(254
) Sc
ient
ific
2010
U
S H
ealth
info
rmat
ion
exch
ange
, whi
ch e
nabl
es th
e flo
w o
f ele
ctro
nic
data
am
ong
disp
arat
e pr
ovid
ers a
nd e
lect
roni
c he
alth
reco
rds
233.
Shap
iro e
t al
(255
) Sc
ient
ific
2013
U
S Th
e N
YC
LIX
HIE
pro
vide
d th
e te
chni
cal,
orga
niza
tiona
l, an
d po
licy
infr
astru
ctur
e to
supp
ort e
lect
roni
c da
ta e
xcha
nge
acro
ss m
embe
r site
s. 23
4.
Si
cotte
and
Par
é (2
56)
Scie
ntifi
c 20
10
Can
ada
Inte
rest
in h
ealth
info
rmat
ion
exch
ange
(HIE
), de
fined
as t
he u
se o
f in
form
atio
n te
chno
logy
to su
ppor
t the
ele
ctro
nic
trans
fer o
f clin
ical
in
form
atio
n ac
ross
hea
lth c
are
orga
niza
tions
, and
con
tinue
s to
grow
am
ong
thos
e pu
rsui
ng g
reat
er p
atie
nt sa
fety
and
hea
lth c
are
acce
ssib
ility
and
ef
ficie
ncy.
23
5.
Si
ttig
and
Joe
(257
) Sc
ient
ific
2010
U
S Th
e lo
cal a
nd re
gion
al H
ealth
Info
rmat
ion
Exch
ange
s (H
IEs)
shou
ld p
rovi
de
the
tech
nica
l, fin
anci
al, p
rivac
y ov
ersi
ght a
nd g
over
nanc
e of
all
aspe
cts o
f an
elec
troni
c po
rtal t
hrou
gh w
hich
indi
vidu
al p
atie
nts’
hea
lth d
ata
can
be
trans
ferr
ed b
etw
een
and
amon
g au
thor
ized
use
rs, i
n ac
cord
ance
with
agr
eed-
upon
info
rmat
ion
exch
ange
pol
icie
s and
stan
dard
s, an
d su
bjec
t to
stric
t pr
ivac
y an
d se
curit
y pr
otec
tions
. Use
rs o
f an
HIE
can
incl
ude
patie
nts,
prov
ider
s, pu
blic
hea
lth o
ffic
ials
, pay
ers,
and
rese
arch
ers.
23
6.
Sm
ith (2
58)
Web
pag
e / P
ost
2012
U
S H
ealth
Info
rmat
ion
Exch
ange
(HIE
) is b
oth
a ve
rb a
nd a
nou
n; it
is th
e tra
nsm
issi
on o
f clin
ical
or c
laim
s inf
orm
atio
n fr
om o
ne p
arty
to a
noth
er, a
nd
may
occ
ur w
ithou
t the
pre
senc
e of
a d
ata
war
ehou
se o
r cen
traliz
ed re
gist
ry,
typi
cally
kno
wn
as a
HIE
. 23
7.
St
ewar
d et
al
(259
) Sc
ient
ific
2012
U
S H
ealth
info
rmat
ion
exch
ange
s (H
IEs)
requ
ire a
synt
hesi
s of g
oals
, pro
toco
ls,
data
form
ats,
and
infr
astru
ctur
e w
ithin
and
acr
oss o
rgan
izat
ions
. 23
8.
ST
HL
(260
) W
eb p
age:
Sou
ther
n Ti
er
Hea
lthLi
nk (S
THL)
, a
non-
prof
it R
HIO
Unk
now
n U
S A
hea
lth in
form
atio
n ex
chan
ge (H
IE) i
s tec
hnol
ogy
that
allo
ws h
ealth
care
in
form
atio
n to
pas
s ele
ctro
nica
lly a
cros
s org
aniz
atio
ns w
ithin
a p
artic
ular
re
gion
or c
omm
unity
. C
lear
and
stric
t sta
te a
nd fe
dera
l gui
delin
es g
over
n ho
w
the
info
rmat
ion
can
be e
xcha
nged
, vie
wed
, and
use
d. T
he g
oal o
f the
HIE
is
to m
ake
the
info
rmat
ion
avai
labl
e w
hen
and
whe
re it
is n
eede
d.
680
S.N
o.
Aut
hor
Sour
ce
Yea
r of
Publ
icat
ion
Cou
ntry
D
efin
ition
239.
Stot
en (6
7)
Scie
ntifi
c 20
09
US
The
Indi
ana
Hea
lth In
form
atio
n Ex
chan
ge (I
HIE
), kn
own
thro
ugho
ut th
e U
nite
d St
ates
as b
eing
in th
e fo
refr
ont o
f the
Reg
iona
l Hea
lth In
form
atio
n O
rgan
izat
ions
(RH
IO) i
nitia
tive,
allo
ws p
hysi
cian
s to
acce
ss in
form
atio
n di
rect
ly fr
om th
eir w
ebsi
te o
r thr
ough
a h
ospi
tal p
orta
l. IH
IE p
rovi
des r
esul
ts
such
as d
icta
tion,
lab,
and
radi
olog
y re
sults
and
info
rmat
ion
is d
eliv
ered
to th
e ph
ysic
ians
thro
ugh
dire
ct c
onne
ctio
ns w
ith a
n EH
R
240.
Succ
essE
HS
(261
) W
eb p
age:
Su
cces
sEH
S So
lutio
n Pr
ovid
er
Unk
now
n U
S H
IE is
bot
h a
verb
and
a n
oun.
H
IE a
s a n
oun:
A h
ealth
info
rmat
ion
exch
ange
(HIE
) ref
ers t
o an
exc
hang
e ne
twor
k or
an
orga
niza
tion
that
ope
rate
s a n
etw
ork
that
con
nect
s the
ele
ctro
nic
heal
th in
form
atio
n sy
stem
s of d
iffer
ent h
ealth
car
e pr
ovid
ers.
HIE
s ena
ble
thos
e pr
ovid
ers t
o sh
are
clin
ical
and
dem
ogra
phic
dat
a of
pat
ient
s the
y ha
ve in
co
mm
on. F
or in
stan
ce, a
prim
ary
care
phy
sici
an m
ay sh
are
a pa
tient
's da
ta
with
that
pat
ient
's ca
rdio
logi
st.
HIE
as a
ver
b: H
ealth
info
rmat
ion
exch
ange
is th
e ac
tual
tran
smis
sion
of
heal
th in
form
atio
n. T
here
are
mul
tiple
type
s of H
IE, i
nclu
ding
Dire
ct, X
DS,
Ex
chan
ge a
nd c
usto
m H
L7.
241.
Suen
aga
(262
) W
eb p
age:
Abo
ut th
e St
ate
HIE
, H
awai
i H
ealth
Info
rmat
ion
Exch
ange
2012
U
S Th
e St
ate
Hea
lth In
form
atio
n Ex
chan
ge is
a se
cure
ele
ctro
nic
netw
ork
that
en
able
s Haw
aii h
ealth
car
e pr
ovid
ers –
such
as p
hysi
cian
s, ph
arm
acie
s, la
bs
and
othe
r med
ical
pro
vide
rs –
to e
xcha
nge
sele
ct p
atie
nt m
edic
al in
form
atio
n.
242.
Tang
and
Lee
(2
63)
Scie
ntifi
c 20
09
US
Hea
lth in
form
atio
n ex
chan
ge (H
IE),
a pr
oces
s tha
t has
bee
n re
ferr
ed to
as
‘teth
erin
g’ o
r ‘in
terc
onne
ctin
g’
243.
Texa
s HIE
(264
) W
eb p
age:
Tex
as H
IE
U
S El
ectro
nic
heal
th in
form
atio
n ex
chan
ge, o
r HIE
, is t
he se
cure
ele
ctro
nic
mov
emen
t of h
ealth
info
rmat
ion
amon
g tre
atin
g ph
ysic
ians
and
oth
er
heal
thca
re p
rovi
ders
and
rela
ted
orga
niza
tions
acc
ordi
ng to
nat
iona
l and
stat
e la
ws a
nd n
atio
nally
reco
gniz
ed st
anda
rds.
244.
THH
SC (2
65)
Web
pag
e: T
exas
Hea
lth
and
Hum
an S
ervi
ce
Com
mis
sion
Unk
now
n U
S Th
e cr
eatio
n of
a st
atew
ide
heal
th in
form
atio
n ex
chan
ge w
ill a
llow
hea
lth
info
rmat
ion
to b
e se
cure
ly e
xcha
nged
bet
wee
n pr
ovid
ers w
ithin
Tex
as. T
his
will
incr
ease
the
coor
dina
tion
and
qual
ity o
f car
e w
hile
impr
ovin
g ef
ficie
ncy
in th
e he
alth
car
e sy
stem
and
incr
easi
ng c
onsu
mer
em
pow
erm
ent a
nd c
ontro
l. 24
5.
Th
omas
(266
) W
eb p
age
/ Pos
t: O
pen
HIE
Wik
i 20
13
Unk
now
n A
Hea
lth In
form
atio
n Ex
chan
ge (H
IE) m
akes
the
shar
ing
of h
ealth
dat
a ac
ross
in
form
atio
n sy
stem
s pos
sibl
e. L
ike
a un
iver
sal t
rans
lato
r, an
HIE
nor
mal
izes
da
ta a
nd se
cure
s the
tran
smis
sion
of h
ealth
info
rmat
ion
thro
ugho
ut d
atab
ases
, be
twee
n fa
cilit
ies,
and
acro
ss re
gion
s or c
ount
ries
246.
Trip
athi
et a
l (2
67)
Scie
ntifi
c 20
09
US
Hea
lth in
form
atio
n te
chno
logy
(IT)
and
hea
lth in
form
atio
n ex
chan
ge (H
IE)
are
incr
easi
ngly
vie
wed
as k
ey st
eps i
n im
prov
ing
the
qual
ity, s
afet
y, a
nd
681
S.N
o.
Aut
hor
Sour
ce
Yea
r of
Publ
icat
ion
Cou
ntry
D
efin
ition
effic
ienc
y pr
oble
ms t
hat p
lagu
e U
.S. h
ealth
car
e de
liver
y 24
7.
U
nertl
et a
l.(26
8)
Scie
ntifi
c 20
12
US
Hea
lth in
form
atio
n ex
chan
ges (
HIE
) sup
port
auto
mat
ed sh
arin
g of
hea
lth d
ata
acro
ss o
rgan
izat
iona
l bou
ndar
ies.
248.
Uta
h (2
1)
Rep
ort:
U
tah
Stat
ewid
e
Clin
ical
Hea
lth
Info
rmat
ion
Exch
ange
20
11,
Ann
ual L
egis
lativ
e R
epor
t by
T
he U
tah
Legi
slat
ive
Hea
lth a
nd H
uman
Se
rvic
es In
terim
C
omm
ittee
2011
U
S Th
e go
al o
f the
Uta
h cH
IE in
itiat
ive
is to
cre
ate
a se
cure
ele
ctro
nic
clin
ical
he
alth
info
rmat
ion
exch
ange
(cH
IE) n
etw
ork
whe
reby
a U
tah
heal
th c
are
prov
ider
can
, with
pat
ient
per
mis
sion
, acc
ess b
asic
med
ical
info
rmat
ion
abou
t th
eir p
atie
nts n
o m
atte
r whe
re th
e pa
tient
rece
ives
are
in U
tah.
Hea
lth c
are
prov
ider
s are
not
requ
ired
to p
artic
ipat
e bu
t may
cho
ose
the
optio
n to
pa
rtici
pate
in th
e cH
IE.
249.
Uta
h St
ate
(22)
Rep
ort:
Uta
h C
linic
al
Hea
lth In
form
atio
n Ex
chan
ge, G
over
nmen
t to
Bus
ines
s, St
ate
of
Uta
h
2011
U
S Th
e C
linic
al H
ealth
Info
rmat
ion
Exch
ange
(cH
IE) p
rovi
des p
hysi
cian
s a w
ay
to sh
are
and
view
pat
ient
info
rmat
ion
in a
secu
re e
lect
roni
c m
anne
r. Th
is
info
rmat
ion
is a
cces
sibl
e, w
ith p
atie
nt c
onse
nt, t
o au
thor
ized
use
rs w
hile
m
aint
aini
ng th
e hi
ghes
t sta
ndar
ds o
f pat
ient
priv
acy.
Th
e go
al o
f the
cH
IE is
to im
prov
e th
e qu
ality
of c
are
you
rece
ive
by
incr
easi
ng e
ffic
ienc
y an
d m
aint
aini
ng p
atie
nt sa
fety
. Thi
s is a
ccom
plis
hed
by
enab
ling
heal
thca
re p
rofe
ssio
nals
to b
e be
tter i
nfor
med
, and
by
redu
cing
tim
e an
d ex
pens
e as
soci
ated
with
mis
sing
info
rmat
ion
and
orde
ring
of d
uplic
ate
test
s. 25
0.
U
W H
ealth
(269
) W
hite
pap
er: T
he
Uni
vers
ity o
f W
isco
nsin
-Mad
ison
, sc
hool
of m
edic
ine
and
publ
ic h
ealth
Unk
now
n U
S El
ectro
nic
heal
th in
form
atio
n ex
chan
ge is
a se
rvic
e fo
r pat
ient
s who
may
re
ceiv
e ca
re a
t mor
e th
an o
ne h
ealth
car
e or
gani
zatio
n us
ing
elec
troni
c he
alth
re
cord
softw
are.
251.
Vai
dya
et a
l. (2
70)
Scie
ntifi
c 20
12
US
HIE
, whi
ch e
nabl
es th
e ex
chan
ge o
f clin
ical
info
rmat
ion
amon
g m
ultip
le
stak
ehol
ders
, off
ers h
ope
for i
mpr
ovin
g th
e qu
ality
of c
are
deliv
ered
by
regi
ster
ed n
urse
s (R
N)s
wor
king
in h
ome
heal
thca
re.
252.
Van
guar
d Sy
stem
s (2
71)
Web
page
: Van
guar
d Sy
stem
s, So
lutio
n Pr
ovid
er
Unk
now
n U
S C
onve
rgen
t’s O
mni
MD
hea
lth in
form
atio
n ex
chan
ge (H
IE) i
s mea
nt to
tra
nsm
it he
alth
care
-rel
ated
dat
a am
ong
faci
litie
s, he
alth
info
rmat
ion
orga
niza
tions
(HIO
) and
gov
ernm
ent a
genc
ies a
ccor
ding
to n
atio
nal s
tand
ards
25
3.
V
est (
272)
Scie
ntifi
c 20
09
US
Hea
lth in
form
atio
n ex
chan
ge (H
IE) m
akes
pre
viou
sly
inac
cess
ible
dat
a av
aila
ble
to c
linic
ians
, res
ultin
g in
mor
e co
mpl
ete
info
rmat
ion.
682
S.N
o.
Aut
hor
Sour
ce
Yea
r of
Publ
icat
ion
Cou
ntry
D
efin
ition
254.
Ves
t and
Ja
sper
son
(273
) Sc
ient
ific
2012
U
S H
ealth
info
rmat
ion
exch
ange
(HIE
) is a
n av
enue
to im
prov
ing
patie
nt c
are
and
an im
porta
nt p
riorit
y un
der t
he M
eani
ngfu
l Use
requ
irem
ents
. 25
5.
V
est (
274)
Scie
ntifi
c 20
12
US
Hea
lth in
form
atio
n ex
chan
ge (H
IE),
the
proc
ess o
f ele
ctro
nica
lly m
ovin
g pa
tient
-leve
l inf
orm
atio
n be
twee
n di
ffer
ent o
rgan
izat
ions
, is v
iew
ed a
s a
solu
tion
to th
e fr
agm
enta
tion
of d
ata
in h
ealth
car
e.
256.
Ves
t et a
l. (2
75)
Scie
ntifi
c 20
13
US
Hea
lth in
form
atio
n ex
chan
ge (H
IE) i
s a p
rom
isin
g ap
proa
ch to
impr
ovin
g th
e co
st a
nd q
ualit
y of
hea
lthca
re
257.
Virg
inia
(276
) W
eb p
age:
C
onne
ctV
irgin
ia H
IE,
Inc.
is th
e St
atew
ide
Hea
lth In
form
atio
n Ex
chan
ge (H
IE) f
or th
e C
omm
onw
ealth
of
Virg
inia
Unk
now
n U
S C
onne
ctV
irgin
ia p
rovi
des a
secu
re, c
onfid
entia
l ele
ctro
nic
syst
em to
supp
ort
the
exch
ange
of p
atie
nt m
edic
al re
cord
s am
ong
parti
cipa
ting
heal
th c
are
prov
ider
s in
Virg
inia
and
bey
ond.
258.
VIT
L (2
77)
Web
pag
e: V
ITL
Solu
tion
Prov
ider
U
nkno
wn
US
A h
ealth
info
rmat
ion
exch
ange
(HIE
) is a
secu
re c
ompu
ter n
etw
ork
that
co
nnec
ts th
e el
ectro
nic
heal
th in
form
atio
n sy
stem
s of d
iffer
ent h
ealth
car
e pr
ovid
ers,
enab
ling
thos
e pr
ovid
ers t
o sh
are
clin
ical
and
dem
ogra
phic
dat
a of
pa
tient
s the
y ha
ve in
com
mon
. 25
9.
V
oigt
and
To
rzew
ski (
278)
Scie
ntifi
c 20
11
US
Hea
lth in
form
atio
n ex
chan
ge (H
IE) h
as lo
ng b
een
tout
ed a
s a si
lver
bul
let,
stre
amlin
ing
patie
nt tr
ansf
ers,
redu
cing
dup
licat
ion,
enl
ight
enin
g po
pula
tion
heal
th, a
nd g
ener
ally
impr
ovin
g he
alth
out
com
es. I
t pro
mis
es to
con
nect
cl
inic
ians
, em
pow
er p
atie
nts,
feed
dat
a re
posi
torie
s, an
d tri
gger
dec
isio
n su
ppor
t ale
rts fr
om a
com
mun
ity-w
ide
set o
f pat
ient
reco
rds,
amon
g ot
her
thin
gs. C
ritic
al to
thes
e so
lutio
ns is
an
HIE
net
wor
k th
at is
bro
adly
ado
pted
w
ithin
a p
atie
nt c
omm
unity
and
a ri
ch fl
ow o
f dis
cret
e cl
inic
al in
form
atio
n.
260.
Vre
eman
(279
) Sc
ient
ific
2007
U
S A
com
preh
ensi
ve h
ealth
info
rmat
ion
exch
ange
mus
t coa
lesc
e al
l of t
he v
ario
us
sour
ces t
hat p
rodu
ce h
ealth
dat
a in
ord
er to
pro
vide
clin
icia
ns w
ith
info
rmat
ion
whe
n an
d w
here
they
nee
d it.
26
1.
W
alke
r et a
l.(28
0)
Scie
ntifi
c 20
05
US
Man
y pr
ovid
ers a
nd p
olic
y m
aker
s now
reco
gniz
e th
at th
e sh
arin
g of
dat
a am
ong
hosp
itals
, doc
tors
, and
oth
er h
ealth
car
e or
gani
zatio
ns in
a g
iven
city
, st
ate,
or r
egio
n of
ten
refe
rred
to a
s hea
lth in
form
atio
n ex
chan
ge (H
IE) c
an
mak
e he
alth
car
e sa
fer,
mor
e ef
ficie
nt, a
nd m
ore
effe
ctiv
e.
262.
War
hola
k et
al
(281
) Sc
ient
ific
2011
U
S H
IE w
as d
efin
ed a
s a c
ompu
ter-
base
d sy
stem
that
mob
ilize
s hea
lth c
are
info
rmat
ion
elec
troni
cally
acr
oss o
rgan
izat
ions
with
in a
regi
on.
263.
Whi
ttenb
urg
(282
) Sc
ient
ific
2008
U
S H
ealth
info
rmat
ion
exch
ange
usi
ng a
n on
line
met
adat
a re
gist
ry a
llow
s nur
ses,
heal
th p
rofe
ssio
nals
, hos
pita
l adm
inis
trato
rs, a
nd d
iver
se in
form
atio
n sy
stem
s
683
S.N
o.
Aut
hor
Sour
ce
Yea
r of
Publ
icat
ion
Cou
ntry
D
efin
ition
to m
ake
sign
ifica
nt st
rides
tow
ards
impr
ovin
g he
alth
out
com
es a
nd h
uman
qu
ality
of c
are
264.
Wik
iped
ia (2
83)
Web
page
: arti
cle
on H
IE
Unk
now
n U
nkno
wn
Hea
lth in
form
atio
n ex
chan
ge (H
IE) i
s the
mob
iliza
tion
of h
ealth
care
in
form
atio
n el
ectro
nica
lly a
cros
s org
aniz
atio
ns w
ithin
a re
gion
, com
mun
ity o
r ho
spita
l sys
tem
. HIE
pro
vide
s the
cap
abili
ty to
ele
ctro
nica
lly m
ove
clin
ical
in
form
atio
n am
ong
disp
arat
e he
alth
car
e in
form
atio
n sy
stem
s whi
le
mai
ntai
ning
the
mea
ning
of t
he in
form
atio
n be
ing
exch
ange
d. T
he g
oal o
f HIE
is
to fa
cilit
ate
acce
ss to
and
retri
eval
of c
linic
al d
ata
to p
rovi
de sa
fer a
nd m
ore
timel
y, e
ffic
ient
, eff
ectiv
e, a
nd e
quita
ble
patie
nt-c
ente
red
care
. HIE
is a
lso
usef
ul to
pub
lic h
ealth
aut
horit
ies t
o as
sist
in a
naly
ses o
f the
hea
lth o
f the
po
pula
tion.
265.
Will
iam
s et a
l. (2
84)
Scie
ntifi
c 20
12
US
The
goal
of h
ealth
info
rmat
ion
exch
ange
is fo
r inf
orm
atio
n to
follo
w p
atie
nts,
whe
reve
r and
whe
neve
r the
y se
ek c
are,
in a
priv
ate
and
secu
re m
anne
r so
that
te
ams o
f doc
tors
, nur
ses,
and
care
man
ager
s can
pro
vide
coo
rdin
ated
, ef
fect
ive,
and
eff
icie
nt c
are.
26
6.
W
PF (2
85)
Web
pag
e: H
IE in
C
alifo
rnia
. Wor
ld
Priv
acy
Foru
m, p
ublic
in
tere
st re
sear
ch g
roup
.
Unk
now
n U
S A
Hea
lth In
form
atio
n Ex
chan
ge, o
r HIE
, is t
echn
olog
y th
at e
nabl
es th
e el
ectro
nic
mov
emen
t of h
ealth
-rel
ated
info
rmat
ion
amon
g he
alth
car
e pr
ovid
ers a
nd o
ther
s. H
IEs a
re a
n in
crea
sing
ly p
opul
ar w
ay fo
r hos
pita
ls,
phar
mac
ies,
labs
, and
em
erge
ncy
room
phy
sici
ans t
o sh
are
patie
nt
info
rmat
ion.
Som
e H
IEs j
ust s
hare
info
rmat
ion
with
in o
ne h
ospi
tal n
etw
ork,
so
me
shar
e in
form
atio
n ac
ross
man
y ho
spita
ls o
r phy
sici
ans i
n a
regi
on, a
nd
som
e H
IEs s
hare
info
rmat
ion
acro
ss th
e st
ate.
26
7.
W
right
et a
l (28
6)
Scie
ntifi
c 20
10
US
HIE
is th
e ab
ility
for c
linic
ians
to sh
are
a co
re se
t of c
linic
al p
atie
nt d
ata
acro
ss p
ract
ices
and
ent
ities
26
8.
X
erox
HIE
(287
) W
eb p
age:
Xer
ox
heal
thca
re IT
solu
tion
Unk
now
n U
S Fo
cusi
ng o
n pr
even
tive
and
outc
omes
-bas
ed m
edic
ine,
the
HIE
solu
tion
mak
es c
ompr
ehen
sive
pat
ient
hea
lth in
form
atio
n av
aila
ble,
eve
n at
the
poin
t of
care
. Thi
s exc
hang
e of
info
rmat
ion
help
s red
uce
med
ical
err
ors a
nd re
dund
ant
med
ical
pro
cedu
res a
s wel
l as i
mpr
oves
pat
ient
safe
ty a
nd w
ell-b
eing
.