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HIEHealth Information Exchange

In short

Health information exchange (HIE) is the process, and the infrastructure that makes it possible, through which professionals, facilities and patients access and share clinical information electronically. It can be regional, national or cross-border. It works when there are agreements on identity, permissions, formats and responsibilities, not just a technical connection.

Type
Concept
Steward
No single steward: general concept or generic technology
Reviewed
October 25, 2026

Explanation

What it is

The acronym HIE is used in two senses:

  • The process. According to HealthIT.gov, electronic health information exchange allows doctors, nurses, public health professionals, other providers and patients to access and share a person's medical information electronically.
  • The infrastructure or organization. For OpenHIE, an HIE is the shared infrastructure that makes it possible to share data across information systems: it normalizes the data and secures its transmission between databases, facilities, regions or countries.

Forms of exchange

HealthIT.gov distinguishes two:

FormHow it worksExamples
Directed (push)A provider sends information to another in an encrypted, secure waylab orders and results, referrals, discharge summaries
Query-based (pull)A provider finds or requests information on a patient from other providersunplanned care

The patient's own access is another channel: in the US TEFCA framework, for example, individual access services are one of the authorized exchange purposes.

Usual components

The OpenHIE architecture normalizes the context of each piece of data with shared registries and services:

ComponentAnswers
Client registry (MPI)Who received care?
Health worker registryBy whom?
Facility registryWhere?
Terminology serviceWhat was done?
Shared health recordNormalized person-centric record
Interoperability layerReceives communications and orchestrates the exchange

In the United States, 45 CFR 171.102 defines a "health information network or health information exchange" as whoever determines, controls or administers the requirements, policies or agreements that enable access, exchange or use of electronic health information among more than two unaffiliated individuals or entities, for treatment, payment or health care operations purposes. Whoever fits that definition is subject to the information blocking rules.

Common misconceptions

  • Thinking it is one central database. It can combine registries, a shared repository and an interoperability layer, or leave documents at each institution.
  • Connecting without a common identity. In Kenya, a 2020 evaluation cited in the Digital Public Infrastructure for Health report found that about half of facilities lacked a national client identifier format.
  • Underestimating sustainability. The same report notes that Rwanda, which has invested in its HIE since 2012, needs sustained, program-agnostic funding to move from pilot to operation.

Usage examples

  1. MyHealth@EU connects the national contact points for eHealth of EU countries to exchange patient summaries and ePrescriptions across borders.

  2. In Brazil, the RNDS integrates public and private institutions. According to the Ministry of Health, one example of the data journey is a COVID-19 result from a private lab, which becomes accessible through the network.

  3. In Rwanda, as of July 2023 there were 65 instances connected to the shared health record, which was being piloted with an interoperability layer, according to the Digital Public Infrastructure for Health report.

  4. In Kenya, the KeHMIS project's data exchange layer provides interoperability for eight systems, although a 2020 evaluation found that 183 of 213 facilities lacked the interoperability layer module.

  5. In the United States, networks that fit the definition in 45 CFR 171.102 are "actors" subject to the information blocking rules.

  6. A hospital sends the discharge summary to the family doctor through directed exchange, and an emergency department looks up the same patient's history through query-based exchange.

Relation to other terms

Relies on5

  • Consent managementStrong

    Exchanges usually need rules on who gets access and with what patient permission, although each network defines them its own way.

  • MPI / EMPIStrong

    To bring together a person's information across institutions, the HIE must resolve their identity; OpenHIE includes a client registry in its architecture.

  • FHIRMedium

    An HIE can expose FHIR APIs (OpenHIE accepts FHIR transactions as an alternative), but the concept does not depend on any one standard.

  • IHE XDS.bMedium

    A document-based HIE can use XDS.b; others use HL7 v2 messages or FHIR APIs.

  • Terminology serverMedium

    OpenHIE includes a terminology service to normalize which services were provided; not every HIE centralizes it.

Depend on this one3

  • OpenHIERequired

    OpenHIE is a reference architecture for building a health information exchange.

  • TEFCARequired

    TEFCA is an agreement among health information networks: without them it has nothing to connect.

  • DPI-HMedium

    The report presents a functioning health information exchange as a good example of DPI-H, and aligns the components of both (registries, interoperability layer).

Sources

  1. HealthIT.gov — Health Information Exchange (HIE)healthit.gov
  2. eCFR — 45 CFR 171.102 Definitions (health information network or health information exchange)ecfr.gov
  3. OpenHIE Architecture Specification 5.2 — Architectureguides.ohie.org
  4. European Commission — Electronic cross-border health services (MyHealth@EU)health.ec.europa.eu
  5. Ministério da Saúde — Rede Nacional de Dados em Saúde (RNDS)gov.br
  6. Vital Wave, PATH and Digital Square — Digital Public Infrastructure for Health (2023)media.path.org
Health interoperability glossary