HIE and patient data exchange: Driving better care
Health information exchanges (HIEs) are not new. But their role in shaping the future of healthcare has never been more important.
Far too often, critical health information is delayed following patients as they transition between care settings. After a hospital stay, an older adult may arrive home or to a facility without key details, such as being a fall risk. Without that information, falls and other complications can occur, sometimes leading to serious setbacks that are difficult to recover from, or worse, irreversible.
Many of us have heard of similar situations or experienced them firsthand. For me, it was a heartbreaking reminder that gaps in communication aren’t just administrative issues. They touch lives. And they show us why HIEs are not optional, they’re essential for protecting patients, residents, and improving outcomes for every family.
The ability to securely share patient data across providers, systems, and care settings is the foundation of interoperability in healthcare. And without it, we risk fragmented care, unnecessary costs, and potentially adverse patient outcomes.
The reality is that patients and residents don’t stay in one place. They move between specialists, hospitals, long-term care facilities, and home care. Every transition creates an opportunity for information to fall through the cracks. That’s where health information exchanges step in.
In this blog, we explore HIEs and how they’re shaping the future of patient data.
What is a health information exchange?
At its core, an HIE is the electronic movement of health-related information among organizations according to nationally recognized standards. It’s a way to make sure providers can access accurate, up-to-date patient data when and where they need it.
HIEs make interoperability real. Instead of relying on faxes, phone calls, or patient memory, providers can import preventive health medication lists (such as immunizations and boosters), allergies, preventive health information, lab results, and discharge notes directly into their workflow. That means quicker, data-driven decisions that enhance the safety and quality of patient care.
Not all HIEs look the same
HIE models vary based on governance, scope, and data-sharing rules. Broadly speaking, there are three types:
- Directed exchange: Secure, point-to-point exchange of patient data between providers. Think of it like sending an encrypted email between EHRs.
- Query-based exchange: Providers can search and retrieve information on a patient from participating organizations.
- Consumer-mediated exchange: Patients have direct control, allowing them to aggregate and share their own health data with providers.
Each model addresses different use cases. Directed exchange works well for referrals. Query-based is essential in emergency situations. Consumer-mediated empowers patients but requires more digital literacy.
Data architecture models
Beyond the exchange type, the technical backbone of an HIE matters. Different states and regions use different data architectures:
- Centralized data is stored in one central repository. Providers query against that database.
- Federated data stays with the source organizations, but a network makes it searchable and retrievable.
- Hybrid is a mix of the two, often with certain core datasets centralized.
The architecture impacts cost, scalability, and governance. Centralized data can be faster but requires heavy security investments. Federated gives more control to individual providers but can be slower to query. Hybrid often wins out as a balance.
HIE, QHIN, QHIO, and TEFCA
We know HIE is health information exchange, but how do QHIN, QHIO, and TEFCA fit into the picture?
Think of TEFCA (Trusted Exchange Framework and Common Agreement) as the national interoperability umbrella with all participants underneath facilitating “seamless data exchange” across boundaries.
The HIE, QHIN (Qualified Health Information Network), and QHIO (Qualified Health Information Organization) all reside under the umbrella, sharing patient data across the nation. California is a QHIO while QHINs and HIEs represent the remaining states.
An HIO (health information organization) can be at the regional (RHIO), local, or state level. Both HIOs and HIEs can either participate in a QHIN or act as a QHIN.
State participation and coverage
How widespread are HIEs today? According to HealthIT.gov, 78% of hospitals reported participating in a regional, local, or state HIO in 2023. That’s a huge leap from a decade ago.
- 86% of HIOs across 45 states had electronic connections to public health agencies
- 64% supported immunization registry reporting
- 63% supported electronic lab results
- 61% supported syndromic surveillance
- 4 in 5 HIOs nationwide make lab results available to participating organizations
These numbers show that HIEs aren’t just theory. They’re a real and growing part of care delivery across the country.
Opt-in vs. opt-out participation
Not every state takes the same approach to patient participation. Some require explicit consent. Others assume participation unless patients decline.
- Opt-in states: Patients must give approval before their data is shared in New York, Delaware, and Indiana.
- Opt-out states: Patient data is included by default unless they actively decline in Arizona, California, Connecticut, Colorado, Maryland, Tennessee, and Virginia.
- Mixed or undefined: Some states still have not set a clear approach.
The distinction matters. Opt-in states often see lower participation but stronger patient trust. Opt-out states see broader coverage but must invest heavily in education and transparency.
How HIEs and QHINs are funded
Of course, building and maintaining the information exchanges and networks is not free.
Historically, public investments at the federal and state levels built the foundation for many HIEs and RHIOs (HITECH and ONC grants).
Currently, there is a diverse portfolio of funding, public (state appropriations, Medicaid partnerships) investments, private (payor and provider contributions, membership fees) investments, and market-driven models (participation fees, value-added services).
Only 34% of HIOs report participant revenue covering operating expenses. That leaves a significant gap that must be filled by public funding or alternative models.
Medicaid match programs and public health grants have become essential. States that leverage these opportunities can build stronger, more sustainable HIE infrastructure. Without them, HIEs risk underfunding, even as demand grows.
Sustainability, the future of funding, is moving to market-driven models to foster value-based care, cost reduction, and improved outcomes.
Why HIEs matter for patient outcomes
The ultimate measure of success for any health information exchange is its impact on patient outcomes. By connecting the dots, HIEs improve care quality, reduce duplicative tests, and lower the risk of medication errors.
For vulnerable populations like seniors moving between acute care, post-acute care, and home health, real-time access to patient data can be lifesaving. A provider who sees allergies, lab results, and medication history in seconds can act faster and safer.
Other key benefits:
- Quicker data-driven decisions: No waiting on faxes or phone calls
- Reduced administrative burden: Less manual entry, fewer forms
- Improved coordination: Specialists, primary care, and long-term care all on the same page
- Lower costs: Less duplication of tests and procedures
- Better compliance: Alignment with federal rules like TEFCA
When information moves, patients win.
Interoperability in the regulatory landscape
The federal government has made interoperability a priority with the 21st Century Cures Act requiring that patients have seamless access to their health data. It also prohibits information blocking, when organizations intentionally make it harder to share data.
Trusted Exchange Framework and Common Agreement (TEFCA) is another critical piece. TEFCA sets the standards for nationwide health data exchange. It’s a playbook for how HIEs, HIOs, and providers can interoperate securely and consistently.
According to recent data, 63% of HIOs plan to participate in TEFCA. That signals growing alignment with the federal vision of nationwide interoperability.
HIE barriers and opportunities
HIE adoption is not without challenges. One significant barrier is information blocking. About 30% of HIOs observed potential blocking by EHR developers, with 61% saying it created moderate to significant service difficulties. That’s why our solutions are built to interoperate with HIEs and support providers across settings by increasing usage of seamless EHR interoperability.
Other challenges include:
- Lack of consistent standards
- Variation in state consent models
- The cost burden for smaller providers
- Patient awareness and trust
But the opportunities are greater:
- National interoperability through TEFCA
- Growth in value-based care, which depends on connected data
- AI and analytics powered by robust, shared datasets
- Stronger public health responses thanks to real-time surveillance
Our future with QHINs, HIEs, and QHIOs
The electronic exchange of patient data is becoming a necessity in this era of healthcare. As birth rates fall, baby boomers live longer, care grows more complex and patients move across more settings, the ability to interoperate is no longer optional.
HIEs are the bridge. They connect siloed systems and turn scattered data into meaningful insights. Our future and the future of healthcare depend on them.
At MatrixCare, we believe interoperability in healthcare should be effortless. That’s why we’ve built solutions that interoperate with HIEs and support providers across settings. By ensuring seamless EHR interoperability, we help care teams access the patient data they need, when they need it.
Ready to achieve better, safer, more connected care? Connect with us to learn how.
Request a demo today for a closer look at MatrixCare.
Michele Spadola
Michele is a Senior Product Manager in Interoperability at MatrixCare, specializing in Senior Living and Long-Term Care (SLTC). Since joining MatrixCare in 2016, she has leveraged her 17 years of experience in the healthcare industry, which began with a primary care physicians group before focusing on SLTC. With over 30 years of professional experience across various industries, Michele has developed a strong expertise in managing certification and integration projects, leading to her current role in product management.
See MatrixCare in action
Start by having a call with one of our experts to see our platform in action.
MatrixCare offers industry-leading software solutions. Thousands of facility-based and home-based care organizations trust us to help them improve efficiency and provide exceptional care.
© 2025 MatrixCare is a registered trademark of MatrixCare. All rights reserved.