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Being able to access and share patient information without breaking confidentiality or compromising patient privacy is an ongoing challenge in today’s increasingly digitized world. Electronic health information exchanges (HIEs) facilitate the secure transmission of and access to patient data.

What is a Health Information Exchange?

An HIE is a tool that allows access to healthcare data, including patient information, between different providers.

The role of HIEs in Clicinal Integrated Networks

A clinical integrated network (CIN) is a platform formed by a collective health network of providers or practices. The CIN uses data analytics, quality measures, and patient care protocols to improve quality of care (QOC), lower internal patient care costs, and provide market value in the form of improved revenues. CINs can leverage HIEs to streamline access to patient data, drive telehealth adoption, and improve interoperability.

CIN Solutions

The role of HIEs in ACOs

Accountable care organizations (ACOs) can be built on a CIN for the specific purpose of supporting contracts with organizations like the Centers for Medicare & Medicaid Services (CMS), which manage reimbursement for healthcare services provided to their members. HIEs can provide access to all patient data so that reimbursable services get properly coded.

The role of EHRs in HIEs

Electronic Health Record systems (EHRs) are the foundation of any HIE. Without the collection and storage of patient data, providers cannot share patient data such as lab results, diagnoses, and care plans, through the HIE.

HIE Types and Functions

There are three primary ways HIEs are used to transmit information.

1. Directed exchange

Directed exchanges let a healthcare provider or organization send patient information or data directly to another health care professional or organization to enable coordinated care or report on quality measures.

  • A primary care provider (PCP) might send a summary to a specialist for a patient referral
  • A lab might send lab results to a PCP
  • A clinic might send immunization data to a public health organization
  • An ACO might send a report on quality measures to CMS

Directed exchanges are typically a part of planned care, which is care that is being deliberately coordinated by health care providers. A distributed HIE comprises multiple pathways going directly between different parties. It facilitates direct exchanges and doesn’t rely on a consolidated repository of patient data, but sends information back and forth between different data silos.

2. Query-based exchange

Query-based exchanges let providers search and discover accessible clinical data sources for a patient to deliver the best possible care.

  • An urgent care center might query a database using an HIE to access vital patient information for a walk-in patient
  • A hospital might look for information on a pregnant patient who has arrived in the ER and requires immediate care

Query-based exchanges often get used when delivering unplanned care. Information such as current medications, recent radiology images, allergies or present care plans can help providers avoid redundant testing or adverse reactions to medication.  

3. Centralized exchange

Centralized exchanges have a design like a wheel. They let providers submit a query or send a file electronically from the end of a spoke, into the central hub, and out along another spoke to the receiving party.

  • A specialist can send a test request to a laboratory and later receive back the results
  • A doctor can send a prescription to a pharmacy, and the pharmacy can follow up

Centralized exchange architecture also facilitates consumer-mediated exchange. Patients can access their own records, which can be convenient when working with patients who want to take an active part in their own care.

The seven spokes of a centralized HIE

The hub of a centralized HIE has seven spokes extending out to seven different points on the wheel. These spokes connect the following parties to each other through the HIE hub:

  • Hospital
  • Laboratory
  • Physician practice
  • Outpatient facility
  • Public health
  • Pharmacy
  • Patient (optional)

The hub center may also serve as a central data repository, with data kept securely for faster response to queries. A hybrid HIE model may use a record locating service (RLS) as a buffer between the repository and querying parties. A RLS receives the request, and can ping different repositories or a centralized database to find the information requested.

Benefits of an HIE

Using a HIE can provide multiple benefits, including aligning with CMS initiatives to support data access. Other advantages of health information exchange include:


HIEs help minimize errors and safeguard patient health by reducing medical and medication errors and coordinating patient care.


Health information saved in a digital format eliminates the need for paperwork and reduces risk of lost information with backed-up storage. Simplifying the data exchange process in healthcare improves health monitoring and reporting.


HIE systems act as support tools for all types of healthcare providers. They can eliminate unnecessary or redundant testing, and provide insights and clinical decision support for better treatment and outcomes.


Effective HIE systems will reduce health-related costs, making it easy and inexpensive to deliver up-to-date healthcare data to other providers as well as to patients and third party agencies. 

Challenges of an HIE

There are some challenges associated with using HIEs, but the benefits of HIE typically outweigh the work that is involved to overcome these challenges.

Patient data privacy

Lack of clarity for rule variances across digital HIEs can lead to some privacy and compliance concerns, especially when patient information is being transmitted across state lines. Strict EHR standards can often overcome this issue. 

Patient ID matching

Providers may find it difficult to match patients with the health records and exchange information when multiple patients living in the same area also share a birthdate or name. Creating a separate identifier can help resolve this problem.

Incomplete records

Some HIEs with centralized depositories contain summary (continuity of care) documents only, which can leave out important context and compromise patient treatment in emergency situations. Mandating critical information to be included can bypass this risk.

Connect Data Systems for Improved Continuity of Care

Tangible can help you achieve better patient outcomes with our integration platform as a service (iPaaS), and fill in the gaps data can fall through when your systems do not fully connect. We have the experience to address the challenges presented by HIEs, so the road to success is smoother. Contact us for more information today.

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