# Health information exchange

Health Information Exchange (HIE) refers to the electronic mobilization of health care information across organizations within a region, community, or hospital system. Participants in data exchange are collectively called Health Information Networks (HIN). In practice, HIE may also refer to the Health Information Organization (HIO) that facilitates the exchange. The primary goal of HIE is to facilitate access to and retrieval of clinical data to provide to public health authorities in analyses of the health of the population.
In the United States, formal organizations support financial statewide health information exchange grants from the Office of the National Coordinator for Health Information Technology. These grants were legislated into the HITECH components of the American Recovery and Reinvestment Act of 2009. The Regional Health Information Organizations, or RHIOs, are ordinarily geographically defined entities that develop and manage a set of contractual conventions and terms, arrange for the means of electronic exchange of information, and develop and maintain HIE standards. Federal and state regulations regarding HIEs and health information technology (HIT) are still being defined. Federal regulations and incentive programs such as "Meaningful Use", which is formally known as the EHR Incentive Program, are changing. The vast majority of HIEs and RHIOs remain tied to federal, state, or independent grant funding to remain operational. Some exceptions exist, such as the Indiana HIE.

## Storage and gathering of information
### Data architecture models

In a centralized model of HIE, there is a central (or master) database that holds a copy of all of the records of every patient. In a federated model of HIE, there is no master database.
In a centralized model, patient information is uploaded to a single database from which any provider in the HIE can download. In a federated model, records are exchanged electronically among providers when they need them.

### Patient consent

Exchanges in the US must operate with patient consent to comply with not only the Health Insurance Portability and Accountability Act (HIPAA) but also a variety of state and federal laws and regulations. This was clarified by the Office of Civil Rights in the January 2013 Final Omnibus Rule Update to HIPAA.
There are two methods for gaining patient consent. One is explicit consent and is termed opt-in. With this method, a patient is not automatically enrolled into the HIE by default and generally must submit a written request to join the exchange.
The other method is implicit patient consent, which is termed opt-out. In this method, patients give implicit consent to join an HIE when they agree to use the services of a healthcare provider submitting data into an HIE and sign the provider's Notice Of Privacy Practices. Patients can request to opt out of the HIE, generally with a written form.

## Notable European health information exchanges
### Netherlands
#### Frysian Health Information Exchange

    Connects Medical Centre Leeuwarden and Academic Center in Groningen with community hospitals like Nij Smellinghe Hospital in Drachten.
    The Friesland Regional Cardiology Network reduces hospital stays for patients by one or two days..Once records are uploaded to the cardiology network, they remain available for consultation at any time, allowing healthcare providers to review a patient's previous episodes of care.

#### North of the Netherlands – XDS Network

Hospitals in the Dutch provinces Groningen, Friesland, and Drenthe have created a (diagnostic) image exchange network to phase out CD/DVD-based exchanges using an IHE (XDS) platform. St. Gerrit, the local HIE organization, has gradually expanded the network since 2014, spanning 10 hospitals to date.

#### Other

* ZorgNetOost
* Radboud University Medical Center
* Image Exchange South East-Brabant – Maxima Medical Center, Elkerliek Hospital, Catharina Hospital Eindhoven, St. Anna Hospital
* Regional Exchange Network West-Brabant
* Image Exchange Network Breda – Amphia Hospital, BVI, Elisabeth-TweeSteden Hospital
* Rotterdam Exchange Network RijnmondNet
* TRIJN
* Zorgring Noord-Holland Noord

### United Kingdom

* Sussex and Surrey
* Bristol
* Great Ormond Street Hospital

### Ireland

* NIMIS

### Finland

* Helsinki-Uusimaa Health district

## Notable United States Health Information Exchanges
### Individual exchanges
#### 1. (CRISP)

CRISP serves as the state-designated HIE for Maryland and the District of Columbia. It is a nonprofit organization that connects healthcare providers and patients through its platform to enhance care coordination and patient outcomes. CRISP integrates health information from hospitals, laboratories, pharmacies, and other healthcare entities, enabling providers to access real-time patient data. It focuses on ensuring that providers have access to the information they need to make informed clinical decisions.
Key Features:
* Real-time health data sharing.
* Analytics services to support public health initiatives.
* Broad provider participation, including small practices and large hospital systems.

#### 2. HealthInfoNet

HealthInfoNet operates as the state-designated HIE in Maine, offering a centralized repository of health data for its users. It connects hospitals, clinics, and other healthcare providers, creating a comprehensive view of patients' medical histories. By reducing redundant testing and improving clinical decision-making, HealthInfoNet aims to enhance the quality and efficiency of healthcare delivery.
Key Features:
* Advanced analytics to support population health management.
* A strong emphasis on privacy and security.
* A patient-centric approach that empowers individuals with access to their data.

#### 3. Arizona Health Information Exchange

Arizona's Health Information Exchange, led by the state's Medicaid agency, provides a web-based platform to facilitate the exchange of health information among providers. This system helps bridge the gap between healthcare organizations and ensures that patients' medical records are accessible regardless of the provider they visit. The Arizona HIE has been instrumental in improving care coordination and reducing costs associated with fragmented care.
Key Features:
* Statewide data sharing among healthcare providers.
* Emphasis on Medicaid integration to improve care for under-served populations.
* Tools to enhance care quality and reduce redundancies.

#### 4. Indiana Health Information Exchange (IHIE)

The Indiana Health Information Exchange is a nonprofit organization recognized as one of the largest and most comprehensive HIEs in the United States. IHIE connects hospitals, physician practices, laboratories, and other healthcare entities across Indiana, facilitating a seamless flow of information. Its services are designed to provide healthcare providers with complete and timely data to support better decision-making and patient care.
Key Features:
* Robust data analytics for quality improvement initiatives.
* Supports clinical research and healthcare innovation.
* Collaboration with public health agencies to enhance statewide healthcare efforts.

#### 5. Manifest MedEx

Manifest MedEx is a nonprofit HIE based in California, focusing on real-time health information exchange to improve care coordination and patient outcomes. It collaborates with hospitals, health plans, and healthcare providers to deliver a comprehensive view of patient data. Manifest MedEx emphasizes the importance of actionable insights to drive better healthcare outcomes.
Key Features:
* Real-time alerts for critical health events.
* Integration of claims data with clinical records for a holistic view of patient health.
* Strong partnerships with health plans and accountable care organizations.

#### 6. Colorado Regional Health Information Organization (CORHIO)

The Colorado Regional Health Information Organization serves as the state-designated HIE for Colorado. CORHIO connects healthcare providers, including hospitals, clinics, long-term care facilities, and laboratories, to ensure seamless access to patient data. Its mission is to improve the quality, safety, and cost-effectiveness of healthcare delivery through technology and collaboration.
Key Features:
* Comprehensive network of healthcare providers across Colorado.
* Focus on public health reporting and disease tracking.
* Support for rural healthcare providers through specialized programs.