What is a Health Information Exchange?

Beth Plumptre
April 4, 2023

Only a decade ago, the health sector’s access to clinical data was powered by the sounds of printers, fax machines, and physical mail exchanging patient information. The current ecosystem is on a fast track away from the paper trail, as technology continues to enhance digital health information transfer. Our health systems are now deliberately built to be interoperable — with data leading the push for connected care delivery. The Health Information Exchange (HIE) supports coordinated care by positioning medical information as a collaborative resource. In the United States, this exchange unifies the highly fragmented health systems by integrating with Electronic Healthcare Records (EHRs) that collect health data across medical facilities. 

The HIE functions as a cornerstone of healthcare systems across the world, and is the primary system of accessing health information. In recent years, HIE adoption among hospitals soared from 53% in 2019 to 88% in 2021. This guide will explore HIEs and their impact on care delivery across clinical communities. We’ll look at the benefits that support its use throughout health systems, and the challenges to interoperability in healthcare.

What Can Health Information Exchanges Do?

HIEs operate on the simple premise that patient data generated by hospitals, payers, pharmacies, and related health organizations be readily accessible to patients and health professionals alike. The Office of the National Coordinator for Health Information Technology (ONC) explains this function saying: “HIE allows doctors, nurses, pharmacists, other health care providers and patients to appropriately access and securely share a patient’s vital medical information electronically — improving the speed, quality, safety, and cost of patient care.”

Traditionally, vital information on patient charts, lab reports, clinical notes, immunization records, etc, are stored in filing cabinets, or secured at home by the patient. Health information is then shared using mailing and fax systems, or delivered manually by the patient concerned. This splintered approach to information access and storage often results in missing patient records, or duplicate testing to remedy incomplete data. In 2018, 32% of American patient visits to doctors reported at least one gap in health information. HIE networks simplify information sharing across different health IT systems, protocols, and formats. By consolidating patient information records, one healthcare provider can electronically request and retrieve relevant health records from another provider, promoting care continuity.

What are the Forms of Health Information Exchange?

HIEs and EHRs coordinate data storage and exchange for health systems aiming for interoperable care delivery. HIEs support this goal by accommodating organization size, data formats, and the health entity’s capacity to send and receive information. Health players can participate in three forms of Health Information Exchanges. These are:

Directed Exchange

This exchange supports secure data sharing between healthcare providers. Organizations that adopt this method of exchange can provide and securely access medical records, lab results, allergy information, insurance records, and other clinical data in an encrypted format.

Query-Based Exchange

Providers can search for and find specific patient information using a query-based exchange. This exchange is a common resource in emergency or unplanned medical situations. For instance, an emergency physician may require immediate information on a patient’s existing medical conditions or allergies before administering treatment. Likewise, different providers involved in a patient’s care can use this exchange to stay up-to-date on lab results, X-ray scans, and other relevant information.

Consumer-Mediated Exchange

A consumer-mediated exchange grants patients secure access to their health data. This exchange empowers direct patient control over the course of their health journey. Patients can keep track of their health information, correct inaccurate entries, and may even plug in missing health records using this exchange. While this form of exchange remains a hopeful promise for HIEs, many do not support this use case currently.

Benefits of Health Information Exchanges

HIEs provide an extension ladder over the technical and systemic barriers to health information exchange. For example, Carequality — one of Metriport's data sharing partners — supports the nationwide exchange of over 300 million health-related documents every month.

These players have transformed the healthcare landscape, producing many benefits for coordinated care. These include:

  1. Streamlining communication across clinical departments and health players by ensuring each organization operates from the same information.
  2. Reducing administrative costs by removing the need for paper, printer ink, and other office supplies.
  3. Minimizing errors in care operations by reducing duplicate record entries, lab tests, or medication mistakes.
  4. HIEs encourage efficiency and prevent duplicate processes in care delivery by housing vital records of a patient’s medical history.
  5. Specific exchanges encourage health autonomy in patients by granting direct access to medical records.

Challenges of Health Information Exchanges

HIEs form the foundation for data exchange across health systems. However, several barriers stand in the way of its complete adoption by health systems. In 2018, HIE participation supported data exchange for 64% of shared patients in hospitals. The following obstacles interrupt the free flow of data between organizations:

Lack of standardization

Organizations may generate health data in uncoordinated image, text, or digital formats without standard practices available. If a health IT system is denied access to vital patient information in an unsupported format, this can break the free flow of health data. HIEs require similar record systems across health providers to support data exchange.


HIEs require considerable investment to support the high cost of purchasing, building, navigating, and maintaining the exchange infrastructure — not to mention massive platform fees. Health organizations may avoid HIE participation due to this expense.

Conflicting legal regulations 

Data exchange can be confusing, especially across state lines. In addition, when security laws and legal requirements may for exchange conflict, this can muddle the health information process.

Privacy concerns

Health information contains a treasure trove of valuable patient data. With payer records stating card payment details, and hospital records containing prized health information, HIE members have valid reasons to fear for data safety.

Lack of interoperability 

Poor standardization also restricts data exchange across EHR systems. For example, primary care settings, specialist offices, telehealth services, or wearable technology systems may operate on incompatible EHR networks. This difference can block easy patient data exchange.

Thankfully, Metriport is working to solve some of the most pressing interoperability challenges. Through a single open-source API, Metriport abstracts away these challenges from the end user, providing a trusted connection to HIEs for medical players looking to access and retrieve valuable health records and information. Visit here to learn more about Metriport's unique solution.


A Health Information Exchange is a unifier connecting primary care settings, doctors, nurses, pharmacies, public health registries, and other related health systems to promote patient-centric care. But while beneficial and widely adopted across health organizations, HIEs networks must demonstrate its value proposition of interoperability. This can be achieved using data normalization, standardization, and universal APIs.

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