Systematic review••

Defining health information exchange: scoping review of published definitions

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Abstract

Objective The term health information exchange (HIE) is often used in health informatics, yet uncertainties remain about its precise meaning. This scoping review aimed to capture and analyse existing definitions in order to map variations in the use of this term and the concepts associated with it.

Methods Systematic literature search to identify published definitions of HIE and related terms. Medline, Web of Science, Library Information Science and Technology Abstracts, EMBASE and CINAHL Plus were searched to identify relevant papers, and Google to identify grey literature. Searches were not limited by language or date of publication. Both explicit and equivalent conceptual definitions were included. Included definitions were summarised and thematically analysed in order to identify and map the underpinning constructs.

Results Our searches revealed 603 scientific articles and 5981 website links. From these, a total of 268 unique definitions of HIE were identified and extracted: 103 from scientific databases and 165 from Google. Eleven constructs emerged from the thematic analysis. Contextual factors influenced the emphasis of the definitions and the overall framing of HIE as an organisational entity that facilitates and or as a process of sharing health information between diverse stakeholders.

Conclusions HIE is a complex and evolving construct, for which multiple definitions exist. In order to encourage consensus, the authors propose this broad definition, which encompasses the key attributes of HIE described in the literature: “HIE is the electronic mobilisation of clinical and administrative information within or across organisations in a region or community and, potentially, internationally between various systems according to locally and/or nationally recognised standards while maintaining the authenticity and accuracy of the information being exchanged, enabling stakeholders to make informed decisions to enhance healthcare quality of a patient and population. HIEs are multi-stakeholder organisations that oversee the business, operational and legal issues involved in the exchange of information.”

INTRODUCTION

Effectively delivering integrated patient care and business transactions within the healthcare ecosystem requires the exchange of patient-related data between stakeholders within and across organisations, in order to support clinical decision making and organisational functions such an insurer reimbursement.1 The process of transferring or sharing this information using information and communications technologies is often referred to as electronic health information exchange (HIE).2^,3

Much of the current narrative around HIE has been centred around the United States (US) policy context, arising from the Health Information Technology for Economic and Clinical Health (HITECH) Act. This aims to improve the efficiency, consistency, safety and equity of healthcare services through better information sharing between relevant stakeholders, contingent upon the ‘meaningful use’ of electronic health records (EHRs), and is backed by a programme of financial incentives and penalties to encourage change.4^,5 These developments have drawn particular attention to HIE in the US, although the same activities are being undertaken internationally. The screenshot in Figure 1 shows the number of global Google searches, since 2004, for the specific term ‘HIE’ (lower line) and the topic more generally, which is computed from several indicators (upper line).

Figure 1

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Much of the web traffic shown in Figure 1 is driven from the US and closely reflects the ‘meaningful use’ agenda, which has important but somewhat different implications for clinicians, healthcare delivery organisations, insurers and healthcare information technology providers. It also reflects the explicit use of the search term ‘HIE’, which is close-coupled with the US policy and business environment.

Although the term HIE is widely used, the way in which it is used varies in significant ways across stakeholders and contexts, including policymakers, academic institutions, professional organisations and funding bodies. Examples of diversity include ‘occupational’ HIE,4 HIE as a feature of the EHR5 and HIE as a corporate network of data warehouses serving a health organisation.6 This raises the potential for ambiguous or inconsistent definitions to hinder meaningful dialogue around health informatics policy, research and practice. For this reason, we decided to undertake a detailed scoping review in order to analyse the ways in which the term is being interpreted in the literature and how these vary across different organisations and contexts. The research therefore set out to answer the question “What is HIE?” with reference to the ways in which it has been defined and the concepts underpinning these definitions. The approach was inspired by earlier scoping reviews of eHealth7^,8 and aimed to clarify the different uses of the term to in order aid the sharing of information about HIE across stakeholders and inform emerging taxonomies in health informatics.9^,10

METHODS

Design

Systematic scoping review of the published and grey literature.11

Inclusion criteria

Definitions appearing in print or digital format were searched that explicitly refer to HIE or equivalent terms such as clinical information exchange and healthcare information exchange, as well as related concepts such as electronic data interchange (EDI). ‘Definition’ was taken to include explicit statements of the meaning of the term with reference to key concepts (e.g. ‘HIE is the movement of patient information across nodes of a health system using health information technologies and standards for data exchange’) and conceptual definitions, in the form of functional descriptions of HIE (e.g. ‘organisations exchange health information using middleware systems and interoperability standards such as HL7’).

Exclusion criteria

References to HIE not accompanied by either an explicit or an implied definition (as above) were excluded.

Search strategy

Searches were not limited by language. The searches covered the period from 1900 to February 2014.

Web searches: AA and CP first conducted a Google search using the narrative terms shown in Table 1.

Table 1

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Scientific databases

The explicit search terms and structured queries shown in Table 2 were used to interrogate Medline; Web of Science; Library Information Science and Technology Abstracts; EMBASE; and CINAHL Plus. There was no medical subject heading (MeSH) term available for HIE, clinical information exchange or healthcare information exchange and hence the reliance on key words.

Table 2

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Query strings were adapted as necessary for each academic database and for the purposes of Google searching. Titles, abstracts and text of the citations identified in the academic database were independently reviewed by two authors (AA and CP) before articles were retrieved for further analysis. Any disagreements between the investigators were resolved by a third reviewer (AS).

Reference lists of the included articles were also scrutinised for any relevant sources and cited work. Websites included reports, encyclopaedias, dictionaries, blogs, hospitals, vendors, letters, presentations, documents, white papers, articles and references. Duplicate citations and definitions were excluded from the results.

Data extraction

Data extraction tables were prepared to include details of the definition, author, source, year and country of origin. Duplicates appearing in more than one database were excluded prior to further analysis.

Analysis

As this was a scoping review of definitions, rather than a systematic review of research evidence, analysis did not involve appraisal of study quality.8^,12^–14

All potentially relevant articles identified by the search were analysed by hand in order to determine whether they contained an explicit definition of the term or an equivalent conceptual definition. Definitions were descriptively analysed according to publication date, geographical origin, provenance, and terminology used. AA undertook a high-level pass through the data to create a draft coding framework, which was refined in consultation with CP before beginning the coding process.8^,12 Definitions were then thematically analysed, with each definition coded according to its various qualitative attributes. The codes were iteratively adapted in order to achieve the best fit with the data, equivalent to qualitative research, where coding proceeds until the point of ‘saturation’ where no new codes were required to describe the data.

RESULTS

The Google search yielded 5981 Web pages referring to the term HIE, whilst the searches of scientific databases revealed 603 articles referring to HIE (see Figure 2). These were analysed in order to determine whether they contained an explicit or conceptual definition.

Figure 2

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Table 3 shows the number of definitions (see also Appendix A) extracted from Google and scientific databases.

Table 3

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Definitions dated back to the year 1957.15 Definitions ranged in length from 1116 to 146 words.17 Most of the definitions were from the US. See Table 4 for the number of definitions from various countries and regions. Other terms closely related to HIE found were ‘electronic data interchange’,18^–20 ‘clinical information exchange’,21^–26 ‘clinical document exchange’,27 ‘clinical HIE’,28^,29 ‘healthcare information exchange’,30^–35 ‘medical data exchange’ 36 and ‘information exchange.’37

Table 4

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KEY THEMES IDENTIFIED

The objective of facilitating exchange of health information among different systems or stakeholders was represented in the majority of definitions (See Appendices A and B).

The analysis of the included definitions revealed 11 main conceptual themes. In Table 5, these are arranged according to their frequency in the corpus of included definitions, while Figure 3 represents them in terms of themes and sub-themes (not in the order of frequency). A more detailed breakdown of subthemes and their frequencies may be found in Appendix B.

Table 5

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Figure 3

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(Many definitions embedded a range of concepts and were thus tagged with more than one code or theme.)

The concepts represented within each higher order theme are described below.

Usage of data and information

The theme ‘data and information’ was divided into sub-categories that included ‘healthcare information’, ‘health records’, ‘claims and administrative’ and ‘demographic data.’

Health care information

Definitions referring to the types of information that could be shared, accessed or exchanged are given in Box 1.

Box 1

Terms used to represent healthcare information

‘Health information’,2^,5^,45^,49^,54^–98 ‘clinical information’,21^,33^,37^,46^,61^,71^,88^,97^,99^–120 ‘clinical data’,23^,30^,33^,87^,110^,111^,121^–131 ‘health data’,17^,24^,43^,69^,70^,76^,100^,132-140 ‘patient data’,31^,33^,55^,107^,141^–145 ‘healthcare information’,35^,72^,84^,110^,115^,126^,146^–148 ‘clinical patient data’,1^,149 ‘patient clinical data’,150 ‘patient health information’,151^–158 ‘patient information’,16^,26^,29^,40^,41^,47^,66^,97^,116^,159^–165 ‘medical information’,21^,28^,34^,97^,107^,129^,166^–171 ‘health-related information’,16^,81^,82^,121^,163^,172^–182 ‘patient-medical information’,183^,184 ‘personal health information’,185 ‘clinical and demographic data’,186^,187 ‘healthcare-related data’, 188^–190 ‘health surveillance data’,191 ‘clinical and other patient data’,145 ‘surgical procedures’,42 ‘International Classification of Diseases’42 and ‘diagnostic codes and record episodes.’42

Health records

Healthcare information was categorised into various types of health records as given in Box 2.

Box 2

Terms used to represent types of health records

‘Paper records’,161 ‘provider health records’ and ‘state registries’,79 ‘digital medical records’,192 ‘electronic medical record’ (EMR),113^,165^,191^,193^–198 ‘EHR’,5^,57^,67^,81^,107^,136^,162^,169^,179^,199^–209 ‘health information records’,130 ‘care records’,210 ‘personal health record’ (PHR),114^,194 ‘patient health records’,211 ‘electronic patient records’212and ‘patient clinical records.’51

Further, the contents of healthcare information and health records included are given in Box 3.

Box 3

Terms used to represent ‘contents’ of healthcare information and health records

‘Problem lists’,41^,105 ‘illness’,96^,185 ‘injuries’,96 ‘procedures’,42^,105^,126^,158^,184 ‘test results’,88^,96^,105^,185^,213^,214 ‘radiology reports’,88^,207^,215^,216 ‘allergies’,88^,96^,105^,131^,185 ‘images’ and prescriptions, 41^,184 ‘medicines’,96^,185 ‘medications’ lists,41^,88^,105^,126^,131‘hospitalization summaries’88 and ‘discharge summaries.’94^,105^,195

Claims and administrative data

Other health information involved claims and administrative data (see Box 4).

Box 4

Terms used to represent claims and administrative data

Claims related to ‘health insurance and payments’,20 ‘claims information’217 and ‘health encounter claims’,79 whereas administrative data were labelled as ‘administrative health data’,69 administrative data,168 ‘administrative information’117^,198 and ‘orders.’165

Demographic data

Demographic items such as name, date of birth, address and insurance of the patients were exchanged along with the clinical information.27^,42^,88^,186^,187

Information transfer as a function

Nearly, all the included definitions referred to health information are being exchanged through electronic processes. Words and expressions used to describe this process or its direction are given in Box 5.

Box 5

Terms used to represent information transfer

‘Exchange’,55^–57^,141 ‘access’,69^,82^,138^,207^,218^–220 ‘movement’,154^,163^,172^,173^,175^–177^,221 ‘sharing’,2^,59^,99^,200^,222 ‘multi-directional transfer’,223 ‘moving’,127^,224^,225 ‘bi-directional’,47^,191^,194 ‘mobilizes’,226 ‘connectivity’,54 ‘data flow’,122 ‘transferring’,55^,61 ‘transfer’,58^,70^,109^,112^,115^,133^,160^,216 ‘feed data repositories’,109 ‘transmission’,76^,80^,186^,188^,189^,217^,227^,228 ‘transport’,49^,100^,184 ‘moves’,162 ‘access to and retrieval’87^,110^,111^,115^,121^,130^,160 and ‘link’/‘linking.’191^,229^–231

Further, health information was being exchanged and transferred through different mediums and methods such as ‘e-transfer’,55 ‘application-level communication’,49 ‘email’195^,210 and ‘secure messaging.’196

Stakeholders involved in HIE

The third theme related to the range of stakeholders engaged in HIE, as shown in Box 6:

Box 6

Terms used to represent different types of stakeholders involved in HIE

‘Doctors’67^,69^,85^,96^,142^,156^,166^,179^,184^,185^,232^–234 or ‘physicians’,21^,77^–79^,123^,144^,162^,235^–237 ‘clinicians’,1^,56^,87^,97^,99^,109^,131^,135^,161^,213^,218^,238^–240

‘nurses’,85^,166^,184^,234^,241^,242 ‘patients’,5^,38^,90^,109^,133^,138^,206 ‘pharmacists’, 66^,166^,184 ‘health educators’,66 public health officials’,133 ‘healthcare professionals’, 29^,33^,36 ‘medical professionals’,90 ‘insurers’,142 ‘payers’,69^,77^,175^,217^,243 ‘policy makers’,233 ‘social workers’,66 ‘healthcare providers’,25^,58^,90^,105^,126^,141^,152^,154^,170^,196^,197^,205^,208^,222^,230^,244 ‘customers’,44 ‘hospitals’,19^,23^,99^,101^,120^,123^,222^,245 ‘health plans’,21^,67^,78^,79^,171 ‘laboratories’,67^,77^,85^,246 ‘ radiology centres’,88 ‘pharmacies’,33^,67^,85^,131^,142^,162^,163^,183^,235^,246^,247 ‘hospitals’,21^,32^,124^,184^,195^,215^,222^,237 ‘organizations’,134^,223^,226^,248^,249 ‘institutions’,34^,36^,44^,99^,141^,250^–252 ‘emergency departments’,25^,128^,142^,213 ‘nursing homes’,101^,123 ‘clinics’ (ambulatory/community),32^,79^,114^,120^,124^,216 ‘quality assurance groups’,114 ‘government agencies’,18^,188^–190 ‘state agencies’,79 ‘public health agencies’,84^,101^,174^,175^,237^,243 ‘public health facilities’,79 ‘public health entities’,114 ‘health information organizations’,188^–190 ‘insurance companies’,18^,33 ‘research groups’,114 ‘public health departments’123 and ‘federal reporting entities.’253

Some descriptions of stakeholders were more general, as shown in Box 7:

Box 7

Other terms for stakeholders

‘Stakeholders’,52^,68^,74^,84^,106^,117^,126^,127^,181^,254 “multi-stakeholders”,69^,92^,195^,241 ‘public–private stakeholders’,91‘public health stakeholders’,254 “other or third parties”17^,143 and “other healthcare providers.”25^,154

Potential benefits of HIE

Many definitions emphasised the benefits and potential benefits of using HIE, although these were framed in different ways. The dominant benefit was being able to transfer information in a secure way (see Box 8). Other themes related to healthcare quality, timeliness, improved decision making and patient centredness.

Box 8

Terms used to represent potential benefits of HIE

Information security,25^,30^,43^,60^,70^,89^,95^,98^,100^,127^,153^,157^,164^,173^,182^,191^,198^,227^,234^,238^,255 ‘coded’,41^,195 improved capacity for informed ‘decisions’,17^,27^,38^,47^,65^,69^,83^,109^,116^,152^,229^,245^,247^,253 ‘effective’,21^,71^,103^,115^,121^,129^,160^,234^,252 ‘efficient’,33^,84^,95^,121^,148^,160^,233^–235 ‘safer’,37^,71^,87^,110^,111^,121^,233 ‘coordinated’,81^,234 ‘equitable’,37^,71^,110^,111^,115^,121^,129^,130 ‘timelier’,103^,121 patient-centred healthcare,37^,71^,84^,110^,111^,115^,121^,129^,130 ‘real-time’ information transfer,27^,99^,139^,164^,198^,256 enhance ‘quality’ of healthcare,53^,59^,106^,132^,141^,213^,257 reduce costs,2^,146^,177^,216^,250^,258 deliver ‘accurate’,97^,107^,213^,247 ‘seamless’,47^,99^,140^,255 ‘empowerment’93 and ‘complete’27^,97^,118^,144^,150^,161^,212^,222^,240^,259 health information.

Technology required for HIE

Almost all of the definitions referred to ‘electronic’ or ‘digital’ data exchange. Most referred to the information infrastructure, systems or technology platforms used to host, transfer or exchange these data. Other related terms included those in Box 9.

Box 9

Terms used to represent information technology

‘Technology platform’,43^,47^,165^,225^,260 ‘network infrastructure’,42^,102^,109^,126^,131^,219^,227^,249^,260^–269 ‘health information technology’,154^,172^,189 ‘computer-based systems’,226 ‘technology model’,126 ‘information technology’,52^,65^,81^,147^,248^,259^,270 ‘HIE systems’,271^,272 ‘document exchange system’,26^,27^,253 use of ‘online metadata registry’,242 ‘powerful technology’,273 ‘Web-based delivery systems’,215 ‘technical infrastructure’,133^,267 ‘information infrastructure’,274 ‘electronic networks’,106 ‘electronic system’,152 ‘portal’,41 ‘computer network’,187 ‘interoperable technologies’,275 ‘central information systems’,159 ‘collection of activities and technologies’,104^,276 ‘component of innovative’, 277 ‘friendly user interfaces’,278 ‘secured website’,116^,170 ‘communication based on Web services’,51 ‘health care technology’,96 ‘health information systems’,265 ‘mobile computing technology’,119 ‘hubs’,136 ‘open source’231 and ‘data formats.’249

Focus/context of use

Different definitions also considered HIE with reference to its different contexts of use (see Box 10).

Box 10

Examples of HIE in different contexts of use/focus

For instance, ‘nursing interventions’,279 ‘registered nurses’ working in home healthcare improving the quality of care through HIE,241 contributing to ‘emergency departments’24^,119^,124^,142^,161^,213^,239 and focusing on preventive and outcome-based medicines.158
HIE was also used for occupational health,15 mental health,280 HIV66^,230 cancer care31 and cardiac surgery.119
It is also referred as a ‘set of activities’ to transfer information from one place to another,201^,281 as a component of eHealth,43^,246 as a method of utilising EHR81^,144^,169^,204^,209 or electronic patient record212 and as an important requirement of Stage 1 ‘meaningful use’ for hospitals.75^,105^,203^,209^,282

HIE was seen as an entity, organisation as well as a process as described below.

HIE as an entity or organisation

In many definitions, HIE was labelled as an ‘entity’60^,70^,73^,74^,77^,83^,143^,227^,283 that was established to exchange health information in a secure manner. It has also been prefixed as ‘legal entity’60 and ‘person or governmental entity.’227 In some definitions, HIEs were conceived as ‘organisations’186^,284 or sets of organisational ‘services’ and infrastructures to support or streamline the exchange of health information.72^,149^,165^,197^,206^,285^,75^,263^,267^,130 Other organisational concepts/terms used under this theme are given in Box 11).

Box 11

Examples of HIE used as an entity or organisation

Here HIE was used as a ‘noun’, to describe an entity responsible for the exchange of health information.186^,217^,284 The term HIE was synonymously interchanged with local health information organisations,181 regional health information organisations (RHIOs)23^,45^,50^,63^,72^,102^,181^,207^,286 and sub-network organisations,181 though different names but serving the same purpose. Others perceived that HIEs were run and controlled by RHIOs,63 and were funded by healthcare delivery organisations.117
HIEs were occasionally recognised as multi-stakeholder organisations responsible for managing business and legal matters involved in the exchange of information.69 Moreover, HIEs were even regarded as the foundational part of accountable care organisations (ACOs)113 because they allowed EMRs to exchange information between various types of medical records. The other way around, HIEs were important for organisations that are transitioning into ACOs.94

HIE as a process

Here HIE was considered as the procedure involved in transferring electronic or digital health data in a protected environment among multi-stakeholders.68^,81^,145^,178^,180^,200^,223^,224^,235^,261^,283^,284 Moreover, it was the process of utilising technology and systems to capture, store, share and retrieve the data electronically.35^,48 In a few definitions, HIE was also reflected as a ‘verb’, an action, a process responsible for transmitting health information17^,186^,217^,284 and collaboration among providers.21^,32^,94^,117^,171

Data standards

Incompatibility between systems and software has presented a barrier to HIE, and for this reason, the importance of interoperability standards is emphasised in the majority of definitions. Keywords and phrases related to this are given in Box 12.

Box 12

Terms used to represent the use of data standards

‘Standards’,180^,201 ‘nationally recognized standards’,100^,121^,137^,154^,173^,175-177^,228^,283 ‘nationally recognized vocabularies’,195 ‘policies and standards’,133 ‘standardise’,149^,152^,208^,254 ‘standardized content’,49 ‘standard procedures’,129 ‘nationwide standards’,283 ‘national standards’,153^,188^–190 standards-based infrastructure’,30 ‘standard-based exchange/solution’,36^,238 ‘cross enterprise document sharing (XDS)’186 to ‘Health Insurance Portability and Accountability Act (HIPAA) standards.’ 89

Connectivity between different‘locations’

Definitions falling within this theme emphasised the exchange of information among facilities or organisations located in different areas (see Box 13).

Box 13

Terms used to represent different locations

Such as within a ‘region’,2^,21^,52^,69^,72^,76^,87^,110^,115^,145^,147^,162^,163^,171^,231^,233^,257 or at a ‘regional level’,5^,40^,44^,55^,75^,82^,83^,271^,283 ‘community’,2^,31^,69^,82^,102^,109^,124^,165^,247^,287 ‘non-clinical settings’,66 ‘metropolitan regions’,124 ‘sites of care’,150 ‘delivery settings’,54^,59 ‘city’,233 ‘state/statewide’,21^,40^,82^,131^,156^,164^,168^,191^,203^,205^,233 ‘member sites’,267 ‘geographic area’,51^,68^,72^,74^,138^,145 ‘provincial’,40 ‘local level/local health departments’,32^,75^,139^,271 ‘national level’,40^,44^,75^,271 ‘across countries’,76 ‘neighbourhood/neighbouring states’,168^,283 ‘multi-state’83 and ‘nationwide.’57^,256^,283

Public health outcomes

The uses of HIE in population health were stressed in a number of definitions.97^,127^,165^,255^,288 Relevant concepts covered the uses of HIE for supporting public and community health practices, population health monitoring and research (see Box 14).

Box 14

Terms used to represent public health functions of HIE

Concepts included connecting ‘public health departments’,122^,139 supporting ‘public health practices’,254 undertaking ‘public heath activities’,150 linking ‘public health surveillance data’,191 ‘public health reporting’,148^,253 evaluation and planning of ‘public health services’,148 ‘public health event-monitoring capability’,256 ‘public health situational awareness’,256 analysing the ‘health of the population’,110 ‘countrywide population health’,115 ‘statistics for public health’,72 assist ‘public well-being’,283 protecting ‘public interest’,91 ‘public health organizations’,32 promote ‘population health’, 65^,109^,141^,148^,243 health data on a ‘population level’,139 ‘track population health’,253 refine ‘US health care system’,56^,74 HIE for a ‘16-county region’171 and ‘community betterment’.87^,168

Business solutions/objectives of HIE

A number of definitions conceived of HIE as either a commercial solution facilitating information exchange or in terms of its business objectives.289 It was suggested that HIE will come up with their viable business plans when stimulus funding from the government will end.290 See more examples of HIE business solutions/objectives are given in Box 15.

Box 15

Examples of HIE as business solutions/objectives

One vendor represented itself as a national HIE ‘company’,291 while other definitions emphasised issues like scalability and efficiency.258
Siemens offered a four-dimensional HIE ‘solution’, organised according to ‘economics’, ‘care’, ‘service’ and ‘technology.’198
Transactions between providers or between services or suppliers often involve secure data exchange.17^,100 This may be conceived in terms of ‘data supplier and data receiver’ 17 but also ‘competitors’43 and ‘customers.’44
HIE has been spoken about in terms of exchanging health information across traditional business boundaries62 and also characterized as ‘large multi-billion dollar efforts.’252
HIE has also been characterised as an infrastructure that includes business models, technology model and the legal model to facilitate the exchange of information among various organisations.91^,126
The ‘primary business focus’ of networks involved in building HIEs was to create value for the provider community by forming ‘productive efficiencies.’102
One of the authors termed HIE as entities built on ‘bilateral legal agreements’ between proprietary information systems to be able to share different kinds of data.177 HIE is seen as an administrative as well as a clinical tool,27^,117^,168 and as a tool for exchanging insurance information.292

Sectoral or regional scope

Many definitions conceived HIE in terms of sectoral, geographic or occupational scope (see Box 16)

Box 16

Terms used to represent sectoral or regional scope of HIE

‘Public’ HIE,165 ‘private’ HIE,165 ‘local’ HIE,133^,150 ‘regional’ HIE,133^,215 ‘national’ HIE,291 ‘nationally accessible electronic record’,39 and ‘community’ HIE.214

DISCUSSION

The analysis has revealed considerable variability among existing definitions of HIE and insights into the range of concepts that are embedded within these definitions.

Many definitions included not only the exchange of patient information but also other types of information such as demographics, claims and administrative data. Definitions also described health information sharing and connectivity at the level of organisations, states or regions and nations, possibly reflecting the different ways in which care is organised in different national contexts.

While the US government has provided incentives for the adoption of HIE, securing long-term funding is a major challenge for sustainability. Implementing HIE represents an investment and not simply a cost and this is accompanied by a realisation that policy makers must find approaches to assure that all stakeholders who benefit from HIE pay to support it and specifically that efforts should be made to engage private payers.293

A wide variety of stakeholders are engaged in HIE, not only including healthcare professionals and patients but also policy makers, researchers, and insurance companies, for example. Although infrastructural, economic, technical and cultural barriers have impeded the participation of some stakeholder groups in HIE efforts, it remains the core of the vision for a connected, coordinated and learning health system.294

Not surprisingly, the majority of definitions highlighted the importance of secure information exchange and many pointed to the requirement for common data standards necessary for the quality of data content, clinical documentation, data mapping and, most importantly, interoperability between disparate systems.201 Common standards will also ensure data protection, confidentiality, interoperability and privacy.29^,129^,189^,228

The value of HIE for supporting public health is referred to in many of the definitions, with the ability to meaningfully move clinical data across disparate systems being seen as vital for effective health surveillance and management of care delivered outside health facilities.295

Strengths and limitations

This review aimed to identify, classify and map definitions of HIE and was not intended as an in-depth analysis of the challenges and opportunities presented by HIE, although such issues were inevitably reflected in many of the definitions. The search terms used to identify definitions of HIE were limited to those that we considered most relevant and it is possible that extending them to include other pertinent concepts in health informatics might have revealed further descriptions of HIE and HIE-like concepts. However, we have followed previous authors in prioritising the search for explicit definitions, as a means of generating insights into how the concepts has evolved and how it is being discussed.8^,12 Using both research databases and a general web search engine gave us greater scope to reach both academic and non-academic literature. Internet searches were restricted to Google and while it is possible that additional definitions may have been found using other search engines, the very large number of hits produced by our queries suggests that it was an effective means of identifying the majority of relevant content in the online grey literature.

The included definitions reflect the dominance of the US literature pertaining to HIE and, to some extent, the language used to describe information sharing concepts in that national context. We acknowledge this limitation, interpreting it as a consequence of the major investment in HIE in the US over recent years, with its inevitable knock-on effects on the volume of literature emerging from that part of the world. As the term gains wider international currency and other countries prioritise investments in HIE, this national balance may change. Nevertheless, a post-hoc analysis excluding the US definitions revealed similar themes as found across our entire corpus of 268 definitions, which encompasses research pre-HIPPA, suggesting that that the concept and function of HIE is similar in different parts of the world and has consistencies over time (Table 6).

Table 6

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Implications for research, practice and policy

The definitions of HIE appearing in the literature vary on a number of philosophical and conceptual attributes, and many are context specific. The ways in which different authors choose to describe concepts is inevitably influenced by their backgrounds and vested interests and it is therefore not surprising to observe the differences in emphasis. However, we were struck by the clear alignment of the HIE concept with specific technologies or business opportunities in some definitions, where HIE is used describe a service, an organisation or a technology, rather than a process or concept. Such a language was often used by businesses promoting their products or in the context of state information systems, where ‘the exchange’ is pictured as an operational entity. This creates important obstacles to communication about HIE, particularly for policymakers involved in making decisions about strategy and procurements.

We have not found a single definition that encompasses all of the key attributes of HIE identified by our thematic analysis. The one suggested by Finn69 is one of the most comprehensive and differentiates ‘HIE’ as a concept related to the processes of data transfer and sharing, and ‘HIEs’ as entities responsible for overseeing effective HIE, while also recognising the benefits, scope and stakeholders involved.69 The broad concept of HIE also describes a set of enabling technologies that support these processes, including data standards and public health objectives. The use of HIE as a noun describing organisational entities concerned with mediation and governance of information transfers is largely, although not exclusively, a US phenomenon and also qualitatively different from process-oriented definitions. It has therefore has been placed in separate sentence. Based on our review, we proposed the following integrated definition of HIE shown in Box 17, which is a heavily adapted version of the one proposed by Finn.69

While this definition may not be ideally suited to all contexts (such as HIE for specific diseases and/or community HIE), we believe it provides a good overall fit with the themes identified in the heterogeneous corpus of definitions revealed by our review and therefore propose it for possible wider adoption (see Figure 4).

Box 17

Adapted and proposed HIE definition

‘HIE is the electronic mobilisation of clinical and administrative information within or across organisations in a region or community and, potentially, internationally between various systems according to locally and/or nationally recognised standards while maintaining the authenticity and accuracy of the information being exchanged, enabling stakeholders to make informed decisions to enhance healthcare quality of a patient and population. HIEs are multi-stakeholder organisations that oversee the business, operational and legal issues involved in the exchange of information.’

Figure 4

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CONCLUSIONS

This review has shed light on the different facets of HIE. In the spirit of promoting further scholarly discussion and debate, we have proposed a definition that encompasses the key underpinning constructs. We recommend that future authors consider the findings of this review before developing new definitions of HIE, in order to avoid adding further heterogeneity. We also hope the review has value for policymakers involved in planning, procurement and evaluation of HIE.

Appendix A: Extracted Definitions

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Appendix B: Recurrent topics of HIE

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Funding: We would like to thank Higher Education Commission Pakistan and The University of Edinburgh for providing funds for this review.

Acknowledgements

We wish to record our appreciation to Professor Brian McKinstry and the anonymous reviewers for their comments on an earlier draft of this manuscript.

Wright A, Soran C, Jenter CA, et al. Physician attitudes toward health information exchange: results of a statewide survey. Journal of the American Medical Informatics Association 2010; 17:66–70.
Google Scholar
Overhage JM, Evans L, Marchibroda J, et al. Communities’ Readiness for Health Information Exchange: The National Landscape in 2004. Journal of the American Medical Informatics Association 2005; 12:107–12.
Google Scholar
Smith PC, Araya-Guerra R, Bublitz C, et al. Missing clinical information during primary care visits. Journal of the American Medical Association 2005; 293:565–71.
Google Scholar
Byers DH. Occupational-Health Information Exchange. Public Health Reports. 1957; 72:1077–8.
Google Scholar
Delfan A. Regional Health Information Exchange (RHIE). 2013;
Google Scholar
Barton MB, Gabriel GS, Frommer MS, et al. Surgical procedures for melanoma in public and private New South Wales Hospitals, 2001–2002. ANZ Journal of Surgery 2006; 76:318–24.
Google Scholar
Pagliari C, Sloan D, Gregor P, et al. What is eHealth (4): a scoping exercise to map the field. Journal of Medical Internet Research 2005; 7.
Google Scholar
Oh H, Rizo C, Enkin M, et al. What is eHealth (3): a systematic review of published definitions. Journal of Medical Internet Research 2005; 7.
Google Scholar
Boonstra A, Broekhuis M. Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions. BMC Health Services Research 2010; 10:231.
Google Scholar
Castillo VH, Martínez-García AI, Pulido J, et al. A knowledgebased taxonomy of critical factors for adopting electronic health record systems by physicians: a systematic literature review. BMC Medical Informatics and Decision Making 2010; 10:60.
Google Scholar
Arksey H, O’Malley L. Scoping studies: towards a methodological framework. International Journal of Social Research Methodology 2005; 8:19–32.
Google Scholar
Van De Belt TH, Engelen LJ, Berben SA, et al. Definition of Health 2.0 and Medicine 2.0: a systematic review. Journal of Medical Internet Research 2010; 12.
Google Scholar
Sood S, Mbarika V, Jugoo S, et al. What is telemedicine? A collection of 104 peer-reviewed perspectives and theoretical underpinnings. Telemedicine and e-Health 2007; 13:573–90.
Google Scholar
Frank JR, Mungroo R, Ahmad Y, et al. Toward a definition of competency-based education in medicine: a systematic review of published definitions. Medical Teacher 2010; 32:631–7.
Google Scholar
Byers DH. Occupational health information exchange. Public Health Reports. 1957; 72:1077.
Google Scholar
What is health information exchange?: Alaska eHealth Network.
Available: here
Google Scholar
Committee H. HIE Implications in Meaningful Use Stage 1 Requirements. Healthcare Information and Management Systems Society (HIMSS). 2010;
Available: here
Google Scholar
The federal role in setting standards for the exchange of health information, 1998 Proceedings Pacific, Medical Technology Symposium. IEEE 1998;
Google Scholar
Hasman A, Ament A, Arnou P, et al. Interinstitutional information exchange in healthcare. International Journal of Bio-Medical Computing 1992; 31:5–16.
Google Scholar
Regan B. Computerised information exchange in health care. Medical Journal of Australia 1991; 154:140.
Google Scholar
About Healthelink.
Available: here
Google Scholar
Payne TH, Detmer DE, Wyatt JC, et al. National-scale clinical information exchange in the United Kingdom: lessons for the United States. Journal of the American Medical Informatics Association 2011; 18:91–8.
Google Scholar
Grinspan ZM, Berg L, Onyile A, et al. Medical information fragmentation for people with epilepsy in new york city differs by type of visit. Epilepsy Currents 2013; 13:315.
Google Scholar
Onyile A, Shapiro JS, Kuperman G, et al. Patient crossover rates vary by disease in a health information exchange. Annals of Emergency Medicine 2011; 58:S294–S5.
Google Scholar
Onyile A, Vaidya SR, Kuperman G, et al. Geographical distribution of patients visiting a health information exchange in New York City. Journal of the American Medical Informatics Association 2013; 20:e125–e30.
Google Scholar
Hazamy PA, Haley V, Tserenpuntsag B, et al. Using remote access to audit hospital data submitted to NHSN for reporting of hospital acquired infections in New York State. American Journal of Infection Control 2013;
Google Scholar
Clinical Document Exchange.
Available: here
Google Scholar
Utah Statewide Clinical Health Information Exchange 2011. 2011;
Google Scholar
Utah Clinical Health Information Exchange. 2011;
Google Scholar
Infor Cloverleaf Hosted Healthcare Information Exchange.
Available: here
Google Scholar
Merrill M. Georgia Cancer Coalition uses HIE to share evidence-based medicine 2009.
Available: here
Google Scholar
San Diego Regional Healthcare Information Exchange.
Google Scholar
What You Need to Know About Securing Healthcare Information Exchanges. 2010;
Available: here
Google Scholar
Birkle M, Schneider B, Beck T, et al. Implementation of an open source provider organization registry service. Studies in Health Technology and Informatics 2011; 169:265–9.
Google Scholar
Cannoy SD. Consumer Empowerment in Healthcare Information Exchange: An Investigation Using the Grounded Theory Approach. Greensboro, The University of North Carolina 2008;
Google Scholar
Cisco Medical Data Exchange Solution.
Available: here
Google Scholar
Physician Information Exchang.
Available: here
Google Scholar
Bugge C, Entwistle VA, Watt IS, et al. The significance for decision- making of information that is not exchanged by patients and health professionals during consultations. Social Science and Medicine 2006; 63:2065–78.
Google Scholar
Greenhalgh T, Morris L, Wyatt JC, et al. Introducing a nationally shared electronic patient record: Case study comparison of Scotland, England, Wales and Northern Ireland. International journal of Medical Informatics 2013;
Google Scholar
Boyle T. Privacy Lessons Learned from an Operational Health Information Exchange. FairWarnings, Inc.. 2011;
Available: here
Google Scholar
One of the world’s leading Health Information Exchange (HIE) applications.
Available: here
Google Scholar
Barton MB, Gabriel GS, Frommer MS, et al. Surgical procedures for melanoma in public and private New South Wales hospitals, 2001–2002. ANZ Journal of Surgery 2006; 76:318–24.
Google Scholar
Health Information Exchange: CSC.
Available: here
Google Scholar
Software solutions for Health Information Exchanges.
Available: here
Google Scholar
Rebryna R. EHR Arithmetic: Extracting Positives from Negatives. The Santa Barbara County Care Data Exchange Project. Healthcare Quarterly 2009; 7:82–5.
Google Scholar
Sicotte C, Pare G. Success in health information exchange projects: Solving the implementation puzzle. Social Science and Medicine 2010; 70:1159–65.
Google Scholar
Denmark Selects InterSystems HealthShare for Countrywide Health Information Exchange. 2012;
Available: here
Google Scholar
Codagnone C. Benchmarking deployment of eHealth Among General Practitioners II. 2013;
Google Scholar
Health Information Exchange Architecture Building Blocks, Overview and Glossary.
Google Scholar
Frankel M, Chinitz D, Salzberg CA, et al. Sustainable health information exchanges: the role of institutional factors. Israel Journal of Health Policy Research 2013; 2:21.
Google Scholar
Alert® Health Information Exchange.
Available: here
Google Scholar
Mäenpää T, Asikainen P, Gissler M, et al. Outcomes Assessment of the Regional Health Information Exchange. Methods of Information in Medicine 2011; 50:308–18.
Google Scholar
Geissbuhler A. Lessons learned implementing a regional health information exchange in Geneva as a pilot for the Swiss national eHealth strategy. International Journal of Medical Informatics 2013;
Google Scholar
Adler-Milstein J, DesRoches CM, Jha AK, et al. Health information exchange among US hospitals. American Journal of Managed Care 2011; 17:761.
Google Scholar
Adler-Milstein J, Ronchi E, Cohen GR, et al. Benchmarking health IT among OECD countries: better data for better policy. Journal of the American Medical Informatics Association 2014; 21:111–6.
Google Scholar
Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC, National Academies Press 2001;
Google Scholar
Carter J. Electronic Health Records: a Guide for Clinicians and Administrators. Sydney, ACP Press 2008;
Google Scholar
Mental Health Information and Primary Care Integration Act of 2011. Washington, DC, DC Behavioral Health Association 2011;
Google Scholar
Dullabh P, Hovey L. Large scale health information exchange: implementation experiences from five States. Studies in Health Technology and Informatics 2012; 192:613–7.
Google Scholar
Frisse ME. Health Information Exchange in Memphis: Impact on the Physician-Patient Relationship. Journal of Law, Medicine and Ethics 2010; 38:50–7.
Google Scholar
2011 Report on Health Information Exchange: The Changing Landscape. 2011;
Google Scholar
Hersh W. A stimulus to define informatics and health information technology. BMC Medical Informatics and Decision Making 2009; 9:24.
Google Scholar
Hripcsak G, Kaushal R, Johnson KB, et al. The United Hospital Fund meeting on evaluating health information exchange. Journal of Biomedical Informatics 2007; 40:S3–S10.
Google Scholar
Kern LM, Kaushal R. Health information technology and health information exchange in New York State: new initiatives in implementation and evaluation. Journal of Biomedical Informatics 2007; 40:S17–S20.
Google Scholar
Lobach DF, Kawamoto K, Anstrom KJ, et al. Proactive population health management in the context of a regional health information exchange using standards-based decision support. AMIA Annual Symposium Proceedings, 2007;
Google Scholar
Myers JJ, Koester KA, Chakravarty D, et al. Perceptions regarding the ease of use and usefulness of health information exchange systems among medical providers, case managers and non-clinical staff members working in HIV care and community settings. International Journal of Medical Informatics 2012; 81:e21–9.
Google Scholar
Patient FAQ 2011.
Available: here
Google Scholar
Health Information Exchange - An Introduction.
Available: here
Google Scholar
Finn N. Health information exchange: a stepping stone toward continuity of care and participatory medicine. Journal of Participatory Medicine 2011; 3:e47.
Google Scholar
(20 ILCS 3860/) Illinois Health Information Exchange and Technology Act.
Available: here
Google Scholar
Afzal S. Maryland’s Health Information Exchange, SOA in Healthcare Conference, the Role of Health Information Exchange in Driving Toward Interoperability. 2011;
Google Scholar
Definition of:HIE.
Available: here
Google Scholar
Electronic Personal Health Information Exchange Health Care Entities’ Reported Disclosure Practices and Effects on Quality of Care. 2010;
Available: here
Google Scholar
Health Information Technology: American Medical Association.
Available: here
Google Scholar
Aspelin M. What is a Health Information Exchange (HIE)? An Introduction to HIEs.
Available: here
Google Scholar
Thomas J. OpenHIE Architecture. 2013;
Available: here
Google Scholar
Kongstvedt PR. Essentials of managed health care. Massachusetts, Jones & Bartlett Publishers 2012;
Google Scholar
IBM Enterprise Master Person Index (EMPI).
Available: here
Google Scholar
Meaningful Health Information Exchange. 2009;
Google Scholar
Introduction/Definitions: North Dakota Health Information Network.
Available: here
Google Scholar
L. Block P. Introduction to Health Informatics.
Available: here
Google Scholar
Health Information Exchange (HIE): Medical Society of Virginia.
Available: here
Google Scholar
332-I:1 Medical Records; Definitions. 1989;
Available: here
Google Scholar
Available: here
Google Scholar
What is the Difference between HIX and HIE?
Available: here
Google Scholar
Health Information Exchange (HIE).
Available: here
Google Scholar
What is an HIE? : One Partner HIE.
Available: here
Google Scholar
Health Information Exchange (HIE).
Available: here
Google Scholar
What is HIE? Liquid Medical Office, Inc.
Available: here
Google Scholar
Health Information Exchange (HIE) Project.
Available: here
Google Scholar
Nevada Health Information Exchange.
Available: here
Google Scholar
Southeast Michigan Health Information Exchange.
Available: here
Google Scholar
Texas Health And Human Service Commission.
Available: here
Google Scholar
Health Information Exchange Connect community. Provide access. Create collaboration.: Harris Healthcare Solutions.
Available: here
Google Scholar
Florida Health Information Exchange Overview.
Available: here
Google Scholar
Frequently Asked Questions About Health Information Exchanges Princeton Healthacre Systems.
Available: here
Google Scholar
Health Information Exchange.
Available: here
Google Scholar
Matthews T, Leroy L, Rowland T, et al. Indiana and Ohio Health Information Exchanges Connect for Nation’s First Live, Multi-Region Clinical Information Exchange. 2009;
Available: here
Google Scholar
Altman R, Shapiro JS, Moore T, et al. Notifications of hospital events to outpatient clinicians using health information exchange: a post-implementation survey. Informatics in Primary Care 2012; 20:249–55.
Google Scholar
Bouhaddou O, Bennett J, Teal J, et al. Toward a Virtual Lifetime Electronic Record: The Department of Veterans Affairs Experience with the Nationwide Health Information Network. AMIA Annual Symposium Proceedings 2012;
Google Scholar
Daurio NR, Fielding M, Cholewka PA, et al. Implementation of an enterprise-wide Electronic Health Record: a nurse-physician partnership. Studies in Health Technology and Informatics 2009; 146:263.
Google Scholar
De Brantes F, Emery D, Overhage J, et al. The potential of HIEs as infomediaries. Journal of Healthcare Information Management 2007; 21:69.
Google Scholar
Hincapie AL, Warholak TL, Murcko AC, et al. Physicians’ opinions of a health information exchange. Journal of the American Medical Informatics Association 2011; 18:60–5.
Google Scholar
AHA. 2011; 85:22–7.
Google Scholar
Jones SS, Friedberg MW, Schneider EC, et al. Health information exchange, Health Information Technology use, and hospital readmission rates. AMIA Annual Symposium Proceedings 2011;
Google Scholar
Moore J. Definition of HIE: What’s Yours? Chilmark Research,. 2011;
Available: here
Google Scholar
Health Information Exchange Definition-Defined By Experts.
Available: here
Google Scholar
Vaidya SR, Shapiro JS, Papa AV, et al. Perceptions of health information exchange in home healthcare. Computers Informatics Nursing 2012; 30:503–9.
Google Scholar
Voigt C, Torzewski S. Direct results. An HIE tests simple information exchange using the direct project. Journal of the American Health Information Management Association 2011; 82:38–41.
Google Scholar
Health information exchange.
Available: here
Google Scholar
Health Information Exchange: A Key Concept for Biosurveillance.
Available: here
Google Scholar
Healthcare Identity Management: The Foundation for a Secure and Trusted National Health Information Network: Smart Card Allaince. 2009;
Available: here
Google Scholar
ACO Glossary of Terms.
Available: here
Google Scholar
Available: here
Google Scholar
The vision, mission(s) and goal(s) of health information exchange that was, is and will remain in effect… forever. Professional Dynamic Network.
Available: here
Google Scholar
Health Information Exchange.
Available: here
Google Scholar
Health Information Exchange (HIE).
Available: here
Google Scholar
Committee on Enhancing the Internet for Health Applications: Technical Requirements and Implementation Strategies, CSaTB, National Research Council, Networking Health: Prescriptions for the Internet. Washington, DC, The National Academies Press 2000;
Google Scholar
Gassert CA. Defining information requirements using holistic models: introduction to a case study. Holistic Nursing Practice 1996; 11:64–74.
Google Scholar
Liu S. Enabling Electronic Healthcare Information Exchange. IEEE IT Professional 2007; 9:17–23.
Google Scholar
What is health information exchange? U.S. Department of Health and Human Services, Health Information Technology and Quality Improvement.
Available: here
Google Scholar
Adler-Milstein J, Bates DW, Jha AK, et al. A survey of health information exchange organizations in the United States: implications for meaningful use. Annals of Internal Medicine 2011; 154:666–71.
Google Scholar
Adler-Milstein J, Jha AK. Sharing clinical data electronically: a critical challenge for fixing the health care system. Journal of the American Medical Association 2012; 307:1695–6.
Google Scholar
Gadd CS, Ho Y-X, Cala CM, et al. User perspectives on the usability of a regional health information exchange. Journal of the American Medical Informatics Association 2011; 18:711–6.
Google Scholar
Kern LM, Dhopeshwarkar R, Barrón Y, et al. Measuring the effects of health information technology on quality of care: a novel set of proposed metrics for electronic quality reporting. Joint Commission Journal on Quality and Patient Safety 2009; 35:359–69.
Google Scholar
Lee L, Whitcomb K, Galbreth M, et al. A strong state role in the HIE. Lessons from the South Carolina Health Information Exchange. Journal of AHIMA 2010; 81:46–50.
Google Scholar
Reeder B, Revere D, Hills RA, et al. Public Health Practice within a Health Information Exchange: Information Needs and Barriers to Disease Surveillance. Online journal of public health informatics 2012; 4.
Google Scholar
Shapiro JS. Evaluating public health uses of health information exchange. Journal of Biomedical Informatics 2007; 40:S46–S9.
Google Scholar
Michigan Health Information Technology Commission 2007-2008 Report to the Michigan Legislature. 2008;
Google Scholar
HIE, the future of electronic medical records?
Available: here
Google Scholar
GE Healthcare to Grow its Health Information Exchange Services by Joining Global eHealth Leader. 2009;
Available: here
Google Scholar
Kuperman GJ. Health-information exchange: why are we doing it, and what are we doing? Journal of the American Medical Informatics Association 2011; 18:678–82.
Google Scholar
Sittig DF, Joe JC. Toward a statewide health information technology center (abbreviated version). Southern Medical Journal 2010; 103:1111–4.
Google Scholar
Unertl KM, Johnson KB, Lorenzi NM, et al. Health information exchange technology on the front lines of healthcare: workflow factors and patterns of use. Journal of the American Medical Informatics Association 2012; 19:392–400.
Google Scholar
Vreeman DJ. Keeping up with changing source system terms in a local health information infrastructure: running to stand still. Studies in Health Technology and Informatics 2007; 129:775.
Google Scholar
Rowley R. Rethinking health information exchange. 2013;
Available: here
Google Scholar
National Biosurveillance Strategy for Human Health V2.0. US Department of Health and Human Services. 2010;
Google Scholar
C. Kibbe D. Responses to ’Meaningful Use’: a pivotal definition for new-wave medical records systems. 2009;
Available: here
Google Scholar
Health Information Exchange (HIE): Kane County Health Department.
Available: here
Google Scholar
Oracle Health Information Exchange: Secure, Seamless Data Sharing. 2012;
Available: here
Google Scholar
Ancker JS, Edwards AM, Miller MC, et al. Consumer Perceptions of Electronic Health Information Exchange. American Journal of Preventive Medicine 2012; 43:76–80.
Google Scholar
Genes N, Shapiro J, Vaidya S, et al. Adoption of Health Information Exchange by Emergency Physicians at Three Urban Academic Medical Centers. Applied Clinical Informatics 2011; 2:263.
Google Scholar
Health Information Exchange (HIE).. 2014;
Available: here
Google Scholar
Health Information Exchange (HIE) Indian Health Service. Maryland, Indian Health Service
Available: here
Google Scholar
Schulte M. Healthcare Delivery in the U.S.A.: An Introduction2012.Boca Raton. Florida, CRC Press 2012;
Google Scholar
Hall C. What is a Health Information Exchange?2009. Georgia, Centers for Disease Control and Prevention
Available: here
Google Scholar
STHL HIE|Frequently Asked Questions (FAQs): Southern tier healthlink New York.
Google Scholar
Merrill JA, Deegan M, Wilson RV, et al. A system dynamics evaluation model: implementation of health information exchange for public health reporting. Journal of the American Medical Informatics Association 2013; 20:e131–e8.
Google Scholar
Mearian L. Verizon creates medical information exchange cloud. 2010;
Available: here
Google Scholar
Grossman JM, Kushner KL, November EA, et al. Creating sustainable local health information exchanges: can barriers to stakeholder participation be overcome? Research Brief. 2008;
Google Scholar
Health Information Exchange Models.
Available: here
Google Scholar
North Carolina Health Information Exchnage.
Available: here
Google Scholar
The Florida HIE.
Available: here
Google Scholar
HIE Texas.
Available: here
Google Scholar
What is OnePartner HIE? OnePartner HIE.
Available: here
Google Scholar
Current Care: Rhode Island Quality Institute.
Available: here
Google Scholar
Maine’s Health Information Exchange (HIE).
Available: here
Google Scholar
Healthcare Information Exchange (HIE).
Available: here
Google Scholar
Clemens NA. Privacy, consent, and the electronic mental health record: The person vs. the system. Journal of Psychiatric Practice 2012; 18:46–50.
Google Scholar
Gaebel H. What is an HIE? 2010;
Available: here
Google Scholar
HIPAA and Health Information Exchange. Colorado Regional Health Information Organization
Google Scholar
HIE FAQ: Greater Houston Health Connect.
Available: here
Google Scholar
Health Information Exchanges in California.
Available: here
Google Scholar
State Health Alliance for Records Exchange (SHARE).
Available: here
Google Scholar
Accenx: A rapid, cost-effective on-ramp to Health Information Exchange: Healthcare Informatics. 2009;
Available: here
Google Scholar
Health Information Exchange (HIE).
Available: here
Google Scholar
Joshi JK. Clinical Value-Add for Health Information Exchange (HIE).. The Internet Journal of Medical Informatics 2010; 6.
Google Scholar
NeHII Completes Demonstration of Statewide Health Information Exchange. 2009;
Available: here
Google Scholar
Health Information Exchange (HIE).
Available: here
Google Scholar
Routzon J. Blog.
Available: here
Google Scholar
HIXNY achieves strategic interoperability with community practices.
Available: here
Google Scholar
Defining Key Health Information Technology Terms. Washigton DC, Office of the National Coordinator for Health Information Technology. National Alliance for Health Information Technology 2008;
Google Scholar
Health Information Exchanges Part 2: Putting the HIE into Practice.
Available: here
Google Scholar
Building a Health Information Exchange for the State of Missouri. Missouri, Object Computing, Inc. 2009;
Google Scholar
Bostick R, Crayton G, Fishman E, et al. Sustaining Health Information Exchange: A State Toolkit. NGA Centre for Best Practices. 2011;
Google Scholar
HIE.
Available: here
Google Scholar
Pennsylvania eHealth Collaborative Strategic Plan for Health Information Exchange 2012. 2012;
Available: here
Google Scholar
Healthcare Information Exchange - Certified EMR Software, Leading Fully Certified EMR Software already ready for the Heathcare Information Exchange.
Available: here
Google Scholar
What is Health Information Exchange? : Health Information Network of Arizona.
Available: here
Google Scholar
What is Health Information Exchange (HIE).
Available: here
Google Scholar
Amatayakul M. HIEs: survival of the fittest: an estimated 130 health information exchange (HIE) organizations exist today-- and many of these fledgling HIEs are at risk.(INSIDE IT). 2008;
Available: here
Google Scholar
What is the Louisiana Health Information Exchange?
Available: here
Google Scholar
Suenaga G. About the State HIE. 2012;
Available: here
Google Scholar
Health Information Exchange in Oregon.
Available: here
Google Scholar
Health Information Exchange (HIE).
Available: here
Google Scholar
What is HIE? Fast Facts about Health Information Exchange.
Available: here
Google Scholar
HIE Overview.
Available: here
Google Scholar
What is HIE and HIPAA Compliance?
Available: here
Google Scholar
Health Information Exchange (HIE).
Available: here
Google Scholar
Get Connected - Provide Timely, Efficient and Effective Patient-Centered Care. Convergent’s OmniMD.
Available: here
Google Scholar
Herwehe J, Wilbright W, Abrams A, et al. Implementation of an innovative, integrated electronic medical record (EMR) and public health information exchange for HIV/AIDS. Journal of the American Medical Informatics Association 2012; 19:448–52.
Google Scholar
Kentucky selects ACS to develop health information exchange. 2009;
Available: here
Google Scholar
Luo JS. Electronic health information exchange: Key trends to watch. Primary Psychiatry 2006; 13:19.
Google Scholar
McIlwain J, Lassetter K. HIE: decision support. Building sustainable HIEs. In the aftermath of Hurricane Katrina, the need for a true health information exchange in Mississippi cannot be denied. Health Management Technology 2009; 30:8.
Google Scholar
Loonsk JW. Not All Health Information Exchange Is Created Equal. 2010;
Available: here
Google Scholar
MobileMD Health Information Exchange.
Available: here
Google Scholar
Health Information ExchangeBetter care. Everywhere. Palmetto Health.
Available: here
Google Scholar
MobileMD HIE.
Available: here
Google Scholar
HITECH Act 2009. Washington, DC, Hitech 2009;
Google Scholar
Chaudhary O. Developing the Foundation for Syndromic Surveillance and Health Information Exchange for Yolo County, California. Online Journal of Public Health Informatics 2012; 4.
Google Scholar
Morrissey J. HIE: Which Way Will You Go? Hospital and Health Networks.. 2013;
Available: here
Google Scholar
Shapiro JS, Genes N, Kuperman G, et al. Health information exchange, biosurveillance efforts, and emergency department crowding during the spring 2009 H1N1 outbreak in New York City. Annals of Emergency Medicine 2010; 55:274–9.
Google Scholar
Illinois HIE Strategic and Operational Plan 2010. Illinois, ILHIE 2010;
Google Scholar
Better Outcomes Start With Better Information.
Available: here
Google Scholar
Public Perception and Utah’s Clinical Health Information Exchange 2011–2012.
Available: here
Google Scholar
Electronic Health Information Exchange.
Available: here
Google Scholar
Stoten S. Health Policy Issue with the Electronic Health Record. Online Journal of Nursing Informatics 2009; 13:2.
Google Scholar
Healthcare Information Exchange (HIE): Considerations for Engaging North Carolina Consumers. North California, NCHICA 2009;
Google Scholar
Electronic Health Records National Association for Health Professionals. 2011;
Google Scholar
Reeder G. Meaningful Use Roadmap for HIE 2011–2012.
Available: here
Google Scholar
Kijsanayotin B, Speedie SM, Connelly DP, et al. Linking patients’ records across organizations while maintaining anonymity. AMIA Annual Symposium Proceedings 2007; 11:1008.
Google Scholar
Bresnick J. Does HIE cause more confusion than it prevents? 2013;
Available: here
Google Scholar
Halamka JD. Health information exchange for emergency department care is on the right trajectory. Annals of Emergency Medicine 2013; 62:25–7.
Google Scholar
Ross SE, Schilling LM, Fernald DH, et al. Health information exchange in small-to-medium sized family medicine practices: Motivators, barriers, and potential facilitators of adoption. International Journal of Medical Informatics 2010; 79:123–9.
Google Scholar
Abhyankar S, Lloyd-Puryear MA, Goodwin R, et al. Standardizing newborn screening results for health information exchange. AMIA Annual Symposium Proceedings 2010;
Google Scholar
Bredfeldt C. PS2-10: Economic Impact of Electronic Health Information Exchange. Clinical Medicine and Research 2013; 11:152.
Google Scholar
Smith LB. HIE 101: Definition. 2012;
Available: here
Google Scholar
Ozkaynak M, Brennan PF. Revisiting sociotechnical systems in a case of unreported use of health information exchange system in three hospital emergency departments. . Journal of Evaluation in Clinical Practice 2013; 19:370–3.
Google Scholar
Munoz RT, Fox MD, Gomez MR, et al. Presumed Consent Models and Health Information Exchanges: Hard Nudges and Ambiguous Benefits. The American Journal of Bioethics 2013; 13:14–5.
Google Scholar
California Medical Privacy Fact Sheet C2: How Is Your Medical Information Used and Disclosed -With and Without Consent? 2012;
Available: here
Google Scholar
Lori H. What is HIE? a Federal and State Perspective. California, Object Health LLC
Available: here
Google Scholar
Furukawa MF, Patel V, Charles D, et al. Hospital Electronic Health Information Exchange Grew Substantially In 2008–12. Health Affairs. 2013; 32:1346–54.
Google Scholar
Shade SB, Chakravarty D, Koester KA, et al. Health information exchange interventions can enhance quality and continuity of HIV care. International Journal of Medical Informatics 2012; 81:e1–e9.
Google Scholar
Vest JR. Health Information Exchange: National and International Approaches. Advances in Health Care Management 2012; 12:3–24.
Google Scholar
Health Information Exchange (HIE): Inteli Chart.
Available: here
Google Scholar
Warholak TL, Murcko A, McKee M, et al. Results of the Arizona Medicaid Health Information Technology Pharmacy Focus Groups. Research in Social and Administrative Pharmacy 2011; 7:438–43.
Google Scholar
HIE O. Summary of Law on Health Information Exchanges.
Available: here
Google Scholar
Health Information Exchange (HIE) Minnesota Department of Health.
Available: here
Google Scholar
Linking patients’ records across organizations while maintaining anonymity. AMIA Annual Symposium Proceedings 2007;
Google Scholar
HIV Health Information Exchange (HIE).
Available: here
Google Scholar
Hartford Hospital:Open Source Health Information Exchange (HIE): eHealth Open Source.
Available: here
Google Scholar
Murphy K. Health Information Exchange. 2012;
Available: here
Google Scholar
Walker J, Pan E, Johnston D, et al. The value of health care information exchange and interoperability. Health Affairs-Millwood 2005; 24:W5.
Google Scholar
Williams C, Mostashari F, Mertz K, et al. From the office of the national coordinator: the strategy for advancing the exchange of health information. Health Affairs 2012; 31:527–36.
Google Scholar
Health Information Exchange.
Available: here
Google Scholar
Frequently Asked Questions: Health Information Newtwork of Arizona.
Available: here
Google Scholar
Kralewski JE, Zink T, Boyle R, et al. Factors influencing electronic clinical information exchange in small medical group practices. Journal of Rural Health 2012; 28:28–33.
Google Scholar
Clinical Exchange Platform.
Available: here
Google Scholar
Shapiro JS, Kannry J, Kushniruk AW, et al. Emergency physicians’ perceptions of health information exchange. Journal of the American Medical Informatics Association 2007; 14:700–5.
Google Scholar
Vest JR. Health Information Exchange and Healthcare Utilization. Journal of Medical Systems 2009; 33:223–31.
Google Scholar
Vaidya SR, Shapiro JS, Papa AV, et al. Perceptions of health information exchange in home healthcare. Computers Informatics Nursing 2012; 30:503–9.
Google Scholar
Whittenburg L. Nursing point of care documentation for the evaluation of human quality. Studies in Health Technology and Informatics 2008; 146:713–4.
Google Scholar
Health Information Exchange: PRISM Health Consulting.
Available: here
Google Scholar
What is HIE?
Available: here
Google Scholar
Health Information Exchange Projects. What Hospitals and Health Systems Need to Know.
Available: here
Google Scholar
Marchibroda JM. Health Literacy, eHealth, and Communication: Putting the Consumer First: Workshop Summary. Washington, DC, National Academies Press 2009;
Google Scholar
Health HIE Neveda.
Available: here
Google Scholar
Sicotte C, Paré G. Success in health information exchange projects: Solving the implementation puzzle. Social Science and Medicine 2010; 70:1159–65.
Google Scholar
Steward WT, Koester KA, Collins SP, et al. The essential role of reconfiguration capabilities in the implementation of HIV-related health information exchanges. International Journal of Medical Informatics 2012; 81:e10–20.
Google Scholar
C. Livingood W, Coughlin S, Remo R, et al. Public Health & Electronic Health Information Exchange: A Guide to Local Agency Leadership. Florida, Duval County Health Department, Institute for Public Health Informatics and Research
Google Scholar
Haggstrom DA, Doebbeling BN. Quality Measurement and System Change of Cancer Care Delivery. Medical Care 2011; 49:S21–S7.
Google Scholar
Johnson KB, Gadd C. Playing smallball: approaches to evaluating pilot health information exchange systems. Journal of Biomedical Informatics 2007; 40:S21–S6.
Google Scholar
Health Information Exchange | HIE Reporting - Overview.
Available: here
Google Scholar
Grannis SJ, Stevens KC, Merriwether R, et al. Leveraging health information exchange to support public health situational awareness: the Indiana experience. Online Journal of Public Health Informatics 2010; 2.
Google Scholar
Solutions/Statewide HIE.
Available: here
Google Scholar
Revere D, Stevens KC. Accelerating Public Health Situational Awareness through Health Information Exchanges: An Annotated Bibliography. Online Journal of Public Health Informatics 2010; 2.
Google Scholar
ClinicalConnect: A secure health information exchange.
Available: here
Google Scholar
Vest JR, Campion TR, Kaushal R, et al. Challenges, alternatives, and paths to sustainability for health information exchange efforts. Journal of Medical Systems 2013; 37:1–8.
Google Scholar
Kaelber DC, Bates DW. Health information exchange and patient safety. Journal of Biomedical Informatics 2007; 40:S40–S5.
Google Scholar
Health Information Exchange Definition-Defined By Experts.
Available: here
Google Scholar
Tang PC, Lee TH. Your doctor’s office or the Internet? Two paths to personal health records. New England Journal of Medicine 2009; 360:1276–8.
Google Scholar
Gordon P, Camhi E, Hesse R, et al. Processes and outcomes of developing a continuity of care document for use as a personal health record by people living with HIV/AIDS in New York City. International Journal of Medical Informatics 2012; 81:e63–73.
Google Scholar
Deas TM, Solomon MR. Health information exchange: foundation for better care. Gastrointestinal Endoscopy 2012; 76:163–8.
Google Scholar
Thornewill J, Dowling AF, Cox BA, et al. Information infrastructure for consumer health: a health information exchange stakeholder study. American Journal of Preventive Medicine 2011; 40:S123–S33.
Google Scholar
Overhage JM. Health information exchange:‘lex parsimoniae.’. Health Affairs 2007; 26:w595–w7.
Google Scholar
Emergency medical services: the frontier in health information exchange. AMIA Annual Symposium Proceedings 2010;
Google Scholar
Shapiro JS, Johnson SA, Angiollilo J, et al. Health Information Exchange Improves Identification Of Frequent Emergency Department Users. Health Affairs 2013; 32:2193–8.
Google Scholar
Moore J. Definition of HIE: What’s Yours?
Available: here
Google Scholar
Rowley R. Rethinking health information exchange.
Available: here
Google Scholar
Information technology and knowledge exchange in health-care organizations. Proceedings of the AMIA Symposium 1999;
Google Scholar
Lloyd-Puryear MA, Brower A. Long-term follow-up in newborn screening: a systems approach for improving health outcomes. Genetics in Medicine 2010; 12:S256–S60.
Google Scholar
Shapiro JS, Kannry J, Kushniruk AW, et al. Emergency Physicians’ Perceptions of Health Information Exchange. Journal of the American Medical Informatics Association 2007; 14:700–5.
Google Scholar
Lee S-i, Park H, Kim J-W, et al. Physicians’ Perceptions and Use of a Health Information Exchange: A Pilot Program in South Korea. Telemedicine and e-Health 2012; 18:604–12.
Google Scholar
Ben-Assuli O, Shabtai I, Leshno M, et al. The influence of EHR components on admission decisions. Health and Technology 2012;
Google Scholar
Joshi J. Clinical Value-Add for Health Information Exchange (HIE). The Internet Journal of Medical Informatics 2011; 6.
Google Scholar
Hub HI. OnePartner and MobileMD Collaborate for Health Information Exchange.
Available: here
Google Scholar
What is a HIE? 2014;
Available: here
Google Scholar
2009;
Google Scholar
Dimitropoulos L, Rizk S. A state-based approach to privacy and security for interoperable health information exchange. Health Affairs 2009; 28:428–34.
Google Scholar
Health Information Exchange: From Start Up to Sustainability. Foundation for eHealth Initiative. Connecticut, Health Care Incentives Improvement Institute 2007;
Google Scholar
Vest JR, Jasperson JS. How are health professionals using health information exchange systems? Measuring usage for evaluation and system improvement. Journal of Medical Systems 2012; 36:3195–204.
Google Scholar
2011;
Available: here
Google Scholar
Karl ES. What’s in a name? Breaking down health information exchange, one definition at a time. Journal of AHIMA 2012; 83:62–3.
Google Scholar
Frisse ME, Johnson KB, Nian H, et al. The financial impact of health information exchange on emergency department care. . Journal of the American Medical Informatics Association 2012; 19:328–33.
Google Scholar
McDonald C. Protecting patients in health information exchange: a defense of the hipaa privacy rule. Health Affairs 2009; 28:447–9.
Google Scholar
Carter P, Chrisann L, Debra M, et al. Privacy and Security in Health Information Exchange. Journal of AHIMA 2006; 77.
Google Scholar
Murphy K. Maine HIE puts focus on population health. 2012;
Available: here
Google Scholar
Nationwide Health Information Network (NHIN) Trial Implementations. Indiana, Indiana Health Information Exchange 2009;
Google Scholar
Kruse CS, Regier V, Rheinboldt KT, et al. Barriers Over Time to Full Implementation of Health Information Exchange in the United States. JMIR Medical Informatics 2014; 2:e26.
Google Scholar
ICA and AlliedHIE Launch National Health Information Exchange ICA. 2012;
Available: here
Google Scholar
NaviNet HealthCare Communication Network - Transactional Portal Information Exchange.
Available: here
Google Scholar
Adler-Milstein J, Bates DW, Jha AK, et al. Operational health information exchanges show substantial growth, but long-term funding remains a concern. Health Affairs 2013; 32:1486–92.
Google Scholar
Health IT and Patient Safety: Building Safer Systems for Better Care. Institite of Medicine, Washington, DC, National Academies Press 2012;
Google Scholar
Lobach D. Proactive population health management within an HIE network: Duke Center for Health Informatics.
Available: here
Google Scholar
Ancker JS, Edwards AM, Miller MC, et al. Consumer perceptions of electronic health information exchange. American Journal of Preventive Medicine 2012; 43:76–80.
Google Scholar
Cisco Medical Data Exchange Solution.
Available: here
Google Scholar
Dobbs D, Trebatoski M, Revere D, et al. The Northwest Public Health Information Exchange’s accomplishments in connecting a health information exchange with public health. Online Journal of Public Health Informatics 2010; 2.
Google Scholar
Enhancing the quality and efficiency of newborn screening programs through the use of health information technology. Seminars in Perinatology 2010; 34:156–62.
Google Scholar
L. Block P. Introduction to Health Informatics.
Available: here
Google Scholar
Physician Information Exchange.
Available: here
Google Scholar
A Practical Guide to Understanding HIE, Assessing Your Readiness and Selecting HIE Options in Minnesota. Minnesota, Minnesota Department of Health
Available: here
Google Scholar
Moore T, Shapiro JS, Doles L, et al. Event detection: a clinical notification service on a health information exchange platform. AMIA Annual Symposium Proceedings 2012;
Google Scholar
Mount Sinai Health Information Exchange (HIE).
Available: here
Google Scholar
Magnus M, Herwehe J, Andrews L, et al. Evaluating health information technology: provider satisfaction with an HIV-specific, electronic clinical management and reporting system. AIDS Patient Care and STDs 2009; 23:85–91.
Google Scholar
Nakamura MM, Ferris TG, DesRoches CM, et al. Electronic health record adoption by children’s hospitals in the United States. Archives of pediatrics and Adolescent Medicine 2010; 164:1145.
Google Scholar
Ozkaynak M, Brennan PF. Revisiting sociotechnical systems in a case of unreported use of health information exchange system in three hospital emergency departments. Journal of Evaluation in Clinical Practice 2013; 19:370–3.
Google Scholar
Tripathi M, Delano D, Lund B, et al. Engaging patients for health information exchange. Health Affairs 2009; 28:435–43.
Google Scholar
Virginia C. Welcome to Virginia’s Statewide Health Information Exchange (HIE).
Available: here
Google Scholar
Healthcare Information Exchange (HIE).
Available: here
Google Scholar

Received: 1 November 2016
First published: 1 October 2016

Defining health information exchange: scoping review of published definitions

Abstract

INTRODUCTION

METHODS

Design

Inclusion criteria

Exclusion criteria

Search strategy

Scientific databases

Data extraction

Analysis

RESULTS

KEY THEMES IDENTIFIED

Usage of data and information

Health care information

Terms used to represent healthcare information

Health records

Terms used to represent types of health records

Terms used to represent ‘contents’ of healthcare information and health records

Claims and administrative data

Terms used to represent claims and administrative data

Demographic data

Information transfer as a function

Terms used to represent information transfer

Stakeholders involved in HIE

Terms used to represent different types of stakeholders involved in HIE

Other terms for stakeholders

Potential benefits of HIE

Terms used to represent potential benefits of HIE

Technology required for HIE

Terms used to represent information technology

Focus/context of use

Examples of HIE in different contexts of use/focus

HIE as an entity or organisation

Examples of HIE used as an entity or organisation

HIE as a process

Data standards

Terms used to represent the use of data standards

Connectivity between different‘locations’

Terms used to represent different locations

Public health outcomes

Terms used to represent public health functions of HIE

Business solutions/objectives of HIE

Examples of HIE as business solutions/objectives

Sectoral or regional scope

Terms used to represent sectoral or regional scope of HIE

DISCUSSION

Strengths and limitations

Implications for research, practice and policy

Adapted and proposed HIE definition

CONCLUSIONS

Appendix A: Extracted Definitions

Appendix B: Recurrent topics of HIE

Footnotes

References

Publication history

Responses