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Cited by 80Electronic Health Records SystemsHealthcare Systems and TechnologyHealthcare Policy and Management

Differing Strategies to Meet Information-Sharing Needs: Publicly Supported Community Health Information Exchanges Versus Health Systems’ Enterprise Health Information Exchanges

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VEST, JOSHUA R., KASH, BITA A.·2016·The Milbank Quarterly
DOI 10.1111/1468-0009.12180PMC PMC4941963
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Abstract

POLICY POINTS: Community health information exchanges have the characteristics of a public good, and they support population health initiatives at the state and national levels. However, current policy equally incentivizes health systems to create their own information exchanges covering more narrowly defined populations. Noninteroperable electronic health records and vendors' expensive custom interfaces are hindering health information exchanges. Moreover, vendors are imposing the costs of interoperability on health systems and community health information exchanges. Health systems are creating networks of targeted physicians and facilities by funding connections to their own enterprise health information exchanges. These private networks may change referral patterns and foster more integration with outpatient providers. CONTEXT: The United States has invested billions of dollars to encourage the adoption of and implement the information technologies necessary for health information exchange (HIE), enabling providers to efficiently and effectively share patient information with other providers. Health care providers now have multiple options for obtaining and sharing patient information. Community HIEs facilitate information sharing for a broad group of providers within a region. Enterprise HIEs are operated by health systems and share information among affiliated hospitals and providers. We sought to identify why hospitals and health systems choose either to participate in community HIEs or to establish enterprise HIEs. METHODS: We conducted semistructured interviews with 40 policymakers, community and enterprise HIE leaders, and health care executives from 19 different organizations. Our qualitative analysis used a general inductive and comparative approach to identify factors influencing participation in, and the success of, each approach to HIE. FINDINGS: Enterprise HIEs support health systems' strategic goals through the control of an information technology network consisting of desired trading partners. Community HIEs support obtaining patient information from the broadest set of providers, but with more dispersed benefits to all participants, the community, and patients. Although not an either/or decision, community and enterprise HIEs compete for finite organizational resources like time, skilled staff, and money. Both approaches face challenges due to vendor costs and less-than-interoperable technology. CONCLUSIONS: Both community and enterprise HIEs support aggregating clinical data and following patients across settings. Although they can be complementary, community and enterprise HIEs nonetheless compete for providers' attention and organizational resources. Health policymakers might try to encourage the type of widespread information exchange pursued by community HIEs, but the business case for enterprise HIEs clearly is stronger. The sustainability of a community HIE, potentially a public good, may necessitate ongoing public funding and supportive regulation.

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  • Maintaining and advancing HIE infrastructure and engagement, and aligning policy with those efforts, remains necessary for expanding the reach and impact of community HIEs.

    “Maintaining and advancing HIE infrastructure and engagement, and aligning policy with those efforts, remains necessary for expanding the reach and impact of community HIEs [4, 7, 8, 46].”

    From Evolution of clinical Health Information Exchanges to population health resources: a case study of the Indiana network for patient care (2025) · cites this paper as [4]

    The Discussion (Policy Implications; page not provided) recommends policy that could fund and require provider connectivity to community HIEs, supporting the claim’s focus on engagement and policy alignment. The Conclusions say community HIEs *may require* public funding and regulation for sustainability; they do not establish the stronger claim that maintaining and advancing infrastructure and engagement is necessary to expand their reach and impact. (LLM, conf=0.78)

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  • Vendor-based and proprietary HIEs have the potential to advance the use of non-clinical data, but their capabilities to address local community priorities are likely limited.

    “While vendor-based and proprietary HIEs have the potential to advance the use of non-clinical data [4], their capabilities to address local community priorities are likely to be limited.”

    From Evolution of clinical Health Information Exchanges to population health resources: a case study of the Indiana network for patient care (2025) · cites this paper as [4]

    The citation is attached to the claim that vendor-based and proprietary HIEs could advance use of non-clinical data. The Results describe vendor-mediated exchange and enterprise HIEs’ use of aggregated clinical information, but the passages found do not address their potential to use non-clinical data (searched: non-clinical data, nonclinical data, and social determinants). The statement about local community priorities appears after the citation and is not the point attributed to this source. (LLM, conf=0.74)

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Sorted by citations

Authors
VEST, J. R., & KASH, B. A.
Affiliations
  • Indiana University – Purdue University Indianapolis (US)
  • Texas A&M Health Science Center (US)
Corresponding author
VEST, JOSHUA R.
ORCID
Venue
The Milbank Quarterly
Publisher
Wiley
Published
2016-03
Volume
94
Issue
1
Pages
77-108
ISSN
0887-378X (ISSN-L)
DOI
10.1111/1468-0009.12180
PMC
PMC4941963
OpenAlex
W2293737936
Cited by
80
References
2
Citations by year
2026: 9 · 2025: 8 · 2024: 3 · 2023: 5 · 2022: 8 · 2021: 9 · 2020: 7 · 2019: 3 · 2018: 10 · 2017: 16 · 2016: 2
FWCI
17.60
Type
journal article
Language
en
Open access
Licence
doi.wiley.com/10.1002/tdm_license_1.1 (tdm)
Locations
  • Milbank Quarterly (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • IUScholarWorks (Indiana University) (submittedVersion)
Funders
Agency for Healthcare Research and Quality (IR03HS020304‐01A1)
Topics
  • Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
  • Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Healthcare Systems and Technology
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
Keywords
health information exchange, health care system, interoperability, electronic health records, health IT policy, public goods, population health, referral patterns, hospital networks, integrated care
MeSH terms
Attitude of Health Personnel, Community Health Services, Health Policy, Humans, Interviews as Topic, Medical Informatics, United States, Observer Variation, Information Dissemination, Qualitative Research, Electronic Health Records, Health Information Exchange

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