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Health information exchange (HIE) has two related meanings: the appropriate, confidential electronic sharing of clinical information among authorized organizations, and the organization that enables that sharing under agreed operational and business rules. The surrounding sentence usually makes clear whether “HIE” means the activity or the network behind it.
What does health information exchange mean?
The U.S. Office of the National Coordinator for Health Information Technology (ONC) uses HIE both as a verb and as a noun. As an activity, it is the appropriate and confidential electronic exchange of clinical information among authorized organizations. As an organization, it is a group with agreed operational and business rules that provides services for secure electronic sharing of health-related information. ONC’s HIE FAQ gives both definitions.
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In practical terms, HIE allows authorized clinicians, public health professionals, other providers, and patients to access and securely share relevant patient information electronically. It does not mean that any organization can freely view any patient’s record; access is governed by authorization and applicable rules. ONC’s overview of HIE describes its intended users and purpose.
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Two common approaches are directed exchange and query-based exchange. They differ mainly in who initiates the exchange and whether the recipient is known in advance.
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| Approach | How it works | Typical use | Example |
|---|---|---|---|
| Directed exchange (“push”) | A provider sends information directly to a known recipient. | A planned handoff, referral, or delivery of results or a discharge summary. | A primary care provider sends a care summary to a specialist. |
| Query-based exchange (“pull”) | A provider searches for or requests information held by outside sources. | A clinician needs information while treating a patient, including in unplanned care. | An emergency department clinician looks for a patient’s medications or recent imaging from other providers. |
These examples and exchange types are described by ONC. They are not two names for the same workflow: one sends information to a known destination, while the other seeks information from sources that may hold it.
Is HIE the same as interoperability?
No. HIE refers to the exchange activity or to an organization or network that enables exchange. Interoperability describes a system’s ability to exchange electronic health information with other systems and use the information without special effort from the user. See ONC’s interoperability definition.
The distinction matters because finding or receiving information does not guarantee that it is integrated smoothly into a clinician’s workflow. ONC’s hospital research considers finding, sending, receiving, and integrating information as different aspects of exchange and interoperability. An HIE can support information sharing, but its existence alone does not guarantee complete records or seamless use in every system.
Does HIE mean one national database?
No. HIE is not a single national patient database, a particular EHR product, or one technical route. Organizations can exchange information through different methods and networks. ONC describes the Trusted Exchange Framework and Common Agreement (TEFCA) as supporting nationwide exchange through Qualified Health Information Networks (QHINs), participants, and subparticipants. That framework does not mean every organization participates or that all exchanges use the same route. ONC’s HIE overview describes TEFCA and its permitted purposes.
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Those purposes include treatment, payment, healthcare operations, public health, government benefits determination, and individual access services. HIE is therefore governed and purpose-bound, rather than unrestricted access to health records.
Independent reader supportYour contribution helps us test, update, and keep practical guides available for everyone.How widely did hospitals use HIE?
In ONC’s report on U.S. non-federal acute care hospitals, 61% used HIE to find patient information in 2021. This is a hospital measure for that observation year—not a current adoption rate for all healthcare organizations. The same report listed hospitals’ other reported methods for finding information: interface connections between EHRs (52%), national networks (48%), EHR vendor-based networks (46%), provider portals (37%), and access to other organizations’ EHR systems (30%). The categories are separate methods and are not mutually exclusive. ONC’s 2023 data brief provides the population, year, and measures.
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What HIE does—and does not—guarantee
HIE provides ways for authorized organizations and people to share relevant electronic health information across care settings. Whether a particular clinician can find a specific record, whether the information is complete, and how readily it can be used depend on the participating organizations and the exchange arrangements. The term describes the sharing activity and the structures that enable it; it is not a promise of a complete record or a particular patient outcome.
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