Health Information Exchange Lessons from Six States

Today, we released a case study from the evaluation of the HITECH-funded State Health Information Exchange (HIE) Program that shows how states play a central role in leadership, coordination, collaboration, policy development, and identifying local health IT needs and gaps.

At ONC, we are undertaking important work – along with our federal partners and private-sector stakeholders – to advance the collection, sharing, and use of interoperable information. Notably, the Federal Health IT Strategic Plan 2015-2020 released earlier this month and the Nationwide Interoperability Roadmap set for release in early 2015, sets course for how the federal government and private sector can facilitate the seamless sharing of health information among trusted entities. As we move forward with these endeavors, it is important to reflect on our previous efforts, and highlight lessons that can inform and guide future activities.

NORC at the University of Chicago is currently conducting a multi-year program evaluation of the State HIE Program to characterize states’ approaches to enable HIE, assess their progress, and identify key lessons for overcoming challenges. The case study synthesizes more than 100 interviews with a variety of stakeholders to examine the experiences of six grantees: Iowa, Mississippi, New Hampshire, Utah, Vermont, and Wyoming.

Finding 1

Given the differences among the states targeted in the study in regards to geography, population size, presence of large health systems, and prior experience with supporting HIE, it is not a surprise that context was a major factor in how these grantees organized and operationalized their respective programs. Technical approaches, services enabled, and the use of policy and legislative levers varied across the grantees. Although this finding may appear self-evident, accounting for local context is critical when designing technical, behavioral, or policy solutions to advance interoperable HIE.

Put another way, what works for Iowa may not work for New Hampshire.

Finding 2

A second key finding from this case study is the need to set tangible and achievable intermediate goals that keep stakeholders energized by ongoing progress and success.  In an environment where technology and supporting infrastructure continue to evolve, it is important to define incremental processes and goals that promote dexterity and support strategy adjustments and refinements. In some states, they migrated from relying on a single HIE developer to a best-in-class approach, working with multiple HIE developers to address different needs and gaps.

Finding 3

Another takeaway from this effort is the importance of collaboration and support among key HIE participants. As part of this program, grantees worked with a diverse set of stakeholders, including hospitals, large provider organizations, small provider offices, the public health community, electronic health record and HIE developers, state Medicaid offices, pharmacies, payers, consumer advocates, and clinical labs. States play a critical role in convening these stakeholders, identifying common needs, establishing trust, developing governance mechanisms, and fostering collaboration. NORC found that the more parties that supported, promoted, and participated in HIE, the easier the implementation path.

Finding 4

Lastly, the case study found states are leveraging a variety of policy and regulatory levers to advance the interoperable exchange of information.  Meaningful use has provided significant impetus for exchange and promoted the use of infrastructure established by grantees. States are now linking their exchange efforts to the Affordable Care Act and other payment reform efforts.

While this qualitative evaluation study provides useful insight on how State HIE Program grantees implemented their respective programs, it is only a small part of what is happening on the ground across the country. A recent systematic review conducted by the RAND Corporation concluded that there is a paucity of evaluation studies examining the usage and downstream effects of HIE.  It is important for entities that share electronic health information to study and understand how HIE effects clinical and non-clinical processes and outcomes.

At the state-level, entities that facilitate HIE need to leverage learnings from their peer successes and challenges, as well as study their own efforts. Evaluations can help inform their efforts, while disseminating their findings can help inform the efforts of others.  The more knowledge and insight shared among those in the trenches, the closer we will move to an environment where health information is accessible when and where it is needed to improve and protect people’s health and well-being.

For this report and others from the evaluation of the State HIE Program, please visit:



  1. Dave Newman says:

    Thanks folks for the update. I’d really like to see more on the use of ‘niche’ HIEs that fulfill specific functions. What comes to mind is the EDIE program in my state of WA. This technology has helped cut down on non-urgent ER visits and has cut down on narcotic prescriptions in ERs. This approach would really pay off, as it’s so focused and not as hard to implement as a full-blown HIE.

  2. Thangamani says:

    would like to participate in any of the health related electronic tool preparation

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