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Cited by 7Electronic Health Records SystemsMedical Coding and Health InformationHealthcare Systems and Technology

Evolution of clinical Health Information Exchanges to population health resources: a case study of the Indiana network for patient care

Open access
Williams, Karmen S., Rahurkar, Saurabh, Grannis, Shaun J., Schleyer, Titus K., Dixon, Brian E.·2025·BMC Medical Informatics and Decision Making
DOI 10.1186/s12911-025-02933-9PMC PMC11849299
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Abstract

BACKGROUND: Motivated by the Triple Aim, US health care policy is expanding its focus from individual patient care to include population health management. Health Information Exchanges are positioned to play an important role in that expansion. OBJECTIVE: The objective is to describe the evolution of the Indiana Network for Patient Care (INPC) and discuss examples of its innovations that support both population health and clinical applications. METHODS: A descriptive analytical approach was used to gather information on the INPC. This included a literature review of recent systematic and scoping reviews, collection of research that used INPC data as a resource, and data abstracted by Regenstrief Data Services to understand the breadth of uses for the INPC as a data resource. RESULTS: Although INPC data are primarily gathered from and used in healthcare settings, their use for population health management and research has increased. By December 2023, the INPC contained nearly 25 million patients, a significant growth from 3.5 million in 2004. This growth was a result of the use of INPC data for population health surveillance, clinical applications for data, disease registries, Patient-Centered Data Homes, non-clinical population health advancements, and accountable care organization connections with Health Information Exchanges. CONCLUSION: By structuring services on the fundamental building blocks, expanding the focus to population health, and ensuring value in the services provided to the stakeholders, Health Information Exchanges are uniquely positioned to support both population health and clinical applications.

AI snapshot

Written from the paper’s full text.

TL;DR

This case study describes how the Indiana Network for Patient Care (INPC) evolved from a clinical health information exchange into a population health data resource. It reports growth to nearly 25 million patients by December 2023 and highlights innovations in surveillance, registries, data commons, EHR integration, and accountable care organization support.

Key findings

  • The INPC grew from 3,554,480 total patients in 2004 to 25,449,906 in 2023, with Indiana county coverage expanding from 9 to 92 and clinical data elements increasing from about 53,055,000 to 16,000,000,000 (Table 1).
  • By December 2023, the INPC contained at least one patient encounter for nearly two-thirds of Indiana’s population across its 92 counties; total Indiana patients in the INPC rose from 2,562,836 in 2004 to 13,336,671 in 2023.
  • The Health Dart FHIR app, integrated with Cerner EHR, was piloted with 111 clinicians at IU Health Methodist ED from September 2017 through March 2018; intervention ED clinicians used HIE significantly more (10.55%) than other EDs (3.2%, p < 0.001), with increased odds of HIE usage (OR 1.15; CI 1.02–1.30; p = 0.026), and a laboratory experiment reduced clicks from 50 to 6 and search time from 3 minutes to 10 seconds.
  • Disease registries and data commons included cancer registry linkage matching approximately 89% of patients with longitudinal records and identifying an additional 746,311 patients by June 2020; CoRDaCo contained data for 1,858,220 COVID-19 patients by February 2023; and the Patient-Centered Data Home pilot exchanged nearly 8,500,000 ADT messages among Heartland Region HIEs over one year.

Methods

  • A descriptive analytical case study was used: a limited review of recent systematic and scoping HIE literature, collection of published studies and Regenstrief Institute working documents, and data abstractions by Regenstrief Data Services to understand the INPC’s growth and breadth of uses.
  • The authors iteratively developed a narrative of the INPC’s evolution, validated working documents with HIE leadership, and reached consensus among authors; the study was deemed non-human subjects research with IRB approval waived and adhered to the Declaration of Helsinki.
  • The theoretical framework drew on fundamental HIE building blocks and core services, layered over time, as described in the book *Health Information Exchange*.

Limitations

  • The paper does not present a formal limitations section; it states that the Indiana Network for Population Health is still in its early stages and that creating and sustaining HIE remains a challenge, with many implementations relying on proprietary terminologies, suboptimal messaging standards, and health systems treating data as an asset to protect rather than a shared resource.
  • The paper also states that many places lack HIEs with population health capabilities like the INPC and that more investment is needed by the US and other nations to develop and sustain HIE for population health.
  • Evident from the text: this is a single-case descriptive study of one mature HIE, which limits generalizability; the methods rely on available publications, reports, and Regenstrief Data Services abstractions rather than a systematic, independent outcome evaluation.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/s12911-025-02933-9

Cites

47 of 47 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

25 of 58 cited sources checked · 10 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    ELR provides a robust foundation upon which HIEs can offer electronic case reporting (eCR).

    “Moreover, ELR provides a robust foundation upon which HIEs can offer electronic case reporting (eCR) [24].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [24] Dixon BE, Zhang Z, Arno JN, Revere D, Joseph Gibson P, Grannis SJ. Improving notifiable Disease Case Reporting through Electronic Information Exchange-facilitated decision support: a controlled before-and-after Trial. Public Health Rep. 2020;135(3):401–10. source

      The Methods (page unavailable) describe electronic laboratory results triggering an HIE system that generates and electronically delivers prepopulated case-reporting forms. This supports laboratory reporting as a basis for HIE-facilitated reporting, but the forms were usually submitted to the health department by fax; the trial does not establish fully electronic case reporting. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
  • Findingcitation

    INPC data are aggregated from providers, payers, and public health agencies in real-time.

    “INPC data are aggregated from providers, payers, and public health agencies in real-time, which was a recommended practice in Dixon et al.’s systematic review [16], enabling online functions such as clinical alerts that can influence patient care decisions at the point of care.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [16] Dixon BE, Whipple EC, Lajiness JM, Murray MD. Utilizing an integrated infrastructure for outcomes research: a systematic review. Health Info Libr J. 2016;33(1):7–32. source

      The Discussion (page unavailable) describes the INPC as an integrated resource for clinical and administrative data collected across clinical facilities, supporting the general point that it brings data together. It does not establish that data come from payers and public health agencies, are aggregated in real time, or that such aggregation was a recommended practice of the review. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
  • Findingcitation

    The INPC provides population-level messages from public health departments to clinicians during localized outbreak events.

    “Building upon its Docs4Docs service, the INPC provides population-level messages from public health departments to clinicians during localized outbreak events [26, 27].”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [26] Bender DSK, editor. HL7 FHIR: an agile and RESTful approach to healthcare information exchange. 26th IEEE International Symposium on Computer-Based Medical Systems; 2013. source
    • cites [27] Gamache R, Stevens KC, Merriwether R, Dixon BE, Grannis S. Development and Assessment of a Public Health Alert Delivered through a Community Health Information Exchange. Online J Public Health Inf. 2010;2(2). source

      The Methods (Public Health Alerting and Alerting Workflow) describe public-health agencies sending alerts through DOCS4DOCS to physicians across a jurisdiction or in targeted areas. The Results describe alerts about local outbreaks. Our copy identifies DOCS4DOCS as an Indiana Health Information Exchange service, but does not identify the alerting service as part of the INPC. (LLM, conf=0.83)

      Experimental — accuracy not yet measured
  • Findingcitation

    The INPC electronically notified infection preventionists in hospitals about a patient's prior infection with a multi-drug resistant organism, enabling rapid identification and isolation of patients who may carry "super-bugs."

    “Moreover, the INPC electronically notified infection preventionists in hospitals about a patient’s prior infection with a multi-drug resistant organism [28], enabling rapid identification and isolation of patients who may carry “super-bugs.””
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [28] Kho AN, Doebbeling BN, Cashy JP, Rosenman MB, Dexter PR, Shepherd DC, et al. A regional informatics platform for coordinated antibiotic-resistant infection tracking, alerting, and prevention. Clin Infect Dis. 2013;57(2):254–62. source
  • Premisecitation

    ELR improves the completeness and timeliness of reporting in support of public health surveillance.

    “Additional studies from Regenstrief investigators showed that ELR improves the completeness and timeliness of reporting in support of public health surveillance [22, 23].”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [22] Overhage JM, Grannis S, McDonald CJ. A comparison of the completeness and timeliness of automated electronic laboratory reporting and spontaneous reporting of notifiable conditions. Am J Public Health. 2008;98(2):344–50. source
    • cites [23] Dixon BE, Zhang Z, Lai PTS, Kirbiyik U, Williams J, Hills R, et al. Completeness and timeliness of notifiable disease reporting: a comparison of laboratory and provider reports submitted to a large county health department. BMC Med Inf Decis Mak. 2017;17(1):87. source

      In Results > Timeliness (page not provided), electronic laboratory reports arrived sooner than faxed laboratory or provider reports. But Results > Completeness shows mixed field-level findings and lower average completeness for HIE-ELR reports than for either faxed laboratory or provider reports. This baseline comparison does not establish that ELR improves completeness. (LLM, conf=0.89)

      Experimental — accuracy not yet measured
  • Classified as probably not a substantial claim. 35
  • May combine two claims. 24
  • The quote only partly states this claim. 1

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Studies have found that HIEs make patient information more available and accessible across organizations and have reduced duplicate testing and imaging and diagnostic discrepancies, lowered costs, and improved patient safety.

    “Studies have found that HIEs make patient information more available and accessible across organizations and have reduced duplicate testing and imaging and diagnostic discrepancies, lowered costs, and improved patient safety [5–8].”
    Quote in the paperNot a substantial claim2 of 4 sources checked
    • cites [5] Everson J, Cross DA. Mind the gap: the potential of alternative health information exchange. Am J Manag Care. 2019;25(1):32–8.
    • cites [6] Menachemi N, Rahurkar S, Harle CA, Vest JR. The benefits of health information exchange: an updated systematic review. J Am Med Inf Assoc. 2018;25(9):1259–65. source

      The Abstract reports fewer duplicated procedures, reduced imaging, lower costs, and improved patient safety; the Discussion describes HIE as providing access to patient information across organizations. The Healthcare Quality section reports improved medication reconciliation, but our copy does not report a reduction in diagnostic discrepancies. That part of the claim is unsupported. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [7] Jung HY, Vest JR, Unruh MA, Kern LM, Kaushal R. Use of Health Information Exchange and repeat imaging costs. J Am Coll Radiol. 2015;12(12 Pt B):1364–70. source

      The HIE Intervention section describes access to patient information contributed by multiple organizations. The Results report an association between HIE access and less repeat imaging, with estimated imaging cost savings. The paper does not establish reductions in duplicate testing generally or diagnostic discrepancies, nor does it report improved patient safety; the sentence also states the imaging and cost findings more causally than the paper does. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [8] Michael Hochman JG, Edmondo J, Robinson. Health Affairs. 2019. Available from: https://www.healthaffairs.org/do/10.1377/hblog20190807.475758/full/.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    HIEs have the potential to gather health information for entire populations, presenting opportunities for improving health at a broader level.

    “In addition to supporting individual patient care, HIEs have the potential to gather health information for entire populations, presenting opportunities for improving health at a broader level [6, 9].”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [6] Menachemi N, Rahurkar S, Harle CA, Vest JR. The benefits of health information exchange: an updated systematic review. J Am Med Inf Assoc. 2018;25(9):1259–65. source
    • cites [9] Beland D, Katapally TR. Shaping Policy Change in Population Health: Policy entrepreneurs, ideas, and institutions. Int J Health Policy Manag. 2018;7(5):369–73. source

      The Introduction discusses improving population health through policy, and “Population Health and Policy Entrepreneurs” discusses using research evidence for policy change. Neither addresses whether health information exchanges (HIEs) can gather information for entire populations; searches for HIEs and population-level electronic health information found no relevant passage. (LLM, conf=0.74)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In March 2020, health system partners and public health agencies were concerned that a surge in COVID-19 patients might overburden the health system, as had been seen in China and New York City.

    “In March 2020, there were concerns among health system partners and public health agencies that a surge in COVID-19 patients might overburden the health system, as seen in China and New York City [50, 51].”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [50] Sun SXZ, Yu K, Jiang B, Zheng S, Pan X. COVID-19 and healthcare system in China: challenges and progression for a sustainable future. Global Health. 2021;17(1):14. source
    • cites [51] Tangcharoensathien VBM, Meng Q, Mills A. Are overwhelmed health systems an inevitable consequence of COVID-19? Experiences from China, Thailand, and New York State. BMJ. 2021;372. source

      The ‘Mobilising resources’ section (page unavailable) reports that COVID-19 demand exceeded capacity in New York City and that China rapidly added staff and hospital beds in Wuhan. The ‘Effect of covid-19 on health services’ section (page unavailable) says New York’s health delivery systems were overwhelmed. The paper does not document concerns held by the citing document’s health system partners or public health agencies in March 2020, nor does it explicitly say China’s health system was overwhelmed. (LLM, conf=0.85)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingcitation

    This traumatic brain injury, spinal cord injury, and stroke registry has been used to examine the risk of stroke and the utilization of health services following traumatic brain injury.

    “This registry has been used to examine the risk of stroke [37] and the utilization of health services following traumatic brain injury [38].”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [37] McFarlane TD, Love J, Hanley S, Dixon BE, Hammond FM. Increased risk of Stroke among Young adults with Serious Traumatic Brain Injury. J Head Trauma Rehabil. 2020;35(3):E310–9. source
    • cites [38] Eliacin J, Yang Z, Kean J, Dixon BE. Characterizing health care utilization following hospitalization for a traumatic brain injury: a retrospective cohort study. Brain Inj. 2021;35(1):119–29. source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Sparse data often limit algorithm performance, and more complete data can help improve analytical accuracy.

    “Sparse data often limit algorithm performance, and more complete data can help improve analytical accuracy [34, 45, 60].”
    Quote in the paperNot a substantial claim3 of 3 sources checked
    • cites [34] Wei WQ, Leibson CL, Ransom JE, Kho AN, Caraballo PJ, Chai HS, et al. Impact of data fragmentation across healthcare centers on the accuracy of a high-throughput clinical phenotyping algorithm for specifying subjects with type 2 diabetes mellitus. J Am Med Inf Assoc. 2012;19(2):219–24. source
    • cites [45] Tarumi S, Takeuchi W, Qi R, et al. Predicting pharmacotherapeutic outcomes for type 2 diabetes: an evaluation of three approaches to leveraging electronic health record data from multiple sources. J Biomed Inform. 2022;129:104001. https://doi.org/10.1016/j.jbi.2022.104001. source
    • cites [60] Wang LOJ, Bielinski SJ, St Sauver JL, Fu S, He H, Cicek MS, Hathcock MA, Cerhan JR, Liu H. Impact of Diverse Data sources on computational phenotyping. Front Genet. 2020;3(11):556. source

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationcitation

    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].”
    Quote in the paperNot a substantial claim3 of 4 sources checked
    • cites [4] Vest JR, Kash BA. Differing strategies to meet information-sharing needs: Publicly Supported Community Health Information Exchanges Versus Health Systems’ Enterprise Health Information exchanges. Milbank Q. 2016;94(1):77–108. source

      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)

      Experimental — accuracy not yet measured
    • cites [7] Jung HY, Vest JR, Unruh MA, Kern LM, Kaushal R. Use of Health Information Exchange and repeat imaging costs. J Am Coll Radiol. 2015;12(12 Pt B):1364–70. source

      The Discussion (page unavailable) supports investment in HIE and says further study is warranted as HIE becomes more widely implemented and providers gain experience. It does not establish that continued infrastructure development, engagement, and policy alignment are necessary to expand community HIEs’ reach and impact; that wording turns a tentative possibility into a requirement. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites [8] Michael Hochman JG, Edmondo J, Robinson. Health Affairs. 2019. Available from: https://www.healthaffairs.org/do/10.1377/hblog20190807.475758/full/.

      Not checked in the free run.

    • cites [46] Williams KS, Grannis SJ. Patient-centered data homes: a path towards national interoperability. Front Digit Health. 2022;4. source

  • May combine two claims.

    Interpretationcitation

    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.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [4] Vest JR, Kash BA. Differing strategies to meet information-sharing needs: Publicly Supported Community Health Information Exchanges Versus Health Systems’ Enterprise Health Information exchanges. Milbank Q. 2016;94(1):77–108. source

      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)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingown data

    By December 2023, the INPC contained nearly 25 million patients, a significant growth from 3.5 million in 2004.

    “By December 2023, the INPC contained nearly 25 million patients, a significant growth from 3.5 million in 2004.”
    • Also stated in: § Growth of the Indiana network for patient care · plain
      “By the end of December 2023, the network had grown to contain information on nearly 25 million patients”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingcitation

    During the pilot project phase from September 2017 through March 2018, clinicians at the intervention ED site used HIE significantly more (10.55%) than at other EDs (3.2%) during the study period (p < 0.001).

    “The study found that clinicians at the intervention ED site used HIE significantly more (10.55%) than at other EDs (3.2%) during the study period (p < 0.001) [ [30, 32]].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [30] Halamka JD, Osterland C, Safran C. CareWeb, a web-based medical record for an integrated health care delivery system. Int J Med Inf. 1999;54(1):1–8. source
    • cites [32] Schleyer TKL, Rahurkar S, Baublet AM, Kochmann M, Ning X, Martin DK et al. Preliminary evaluation of the Chest Pain Dashboard, a FHIR-based approach for integrating health information exchange information directly into the clinical workflow. AMIA Jt Summits Transl Sci Proc. 2019;2019:656– 64.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Findingown data

    In qualitative interviews, clinicians rated the usefulness of the Health Dart application as very high but identified several opportunities for improvement.

    “In qualitative interviews, clinicians rated the usefulness of the application as very high but identified several opportunities for improvement.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    INPC data are primarily gathered from and used in healthcare settings, but their use for population health management and research is increasing.

    “INPC data are primarily gathered from and used in healthcare settings, but their use for population health management and research is increasing [11, 17].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [11] Overhage J. The Indiana Health Information Exchange. Health Information Exchange: navigating and managing a Network of Health Information Systems. Waltham, MA: Academic; 2016. pp. 267–79. source
    • cites [17] Institute ICaTS. Data Sources 2019. [Available from: http://indianactsi.org/researchers/services-tools/translational-informatics/data-core/data-sources/]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    IHIE offers a 17-year-old clinical messaging service (Docs4Docs) that delivers laboratory and imaging results to primary care providers and specialists.

    “IHIE further offers a 17-year-old clinical messaging service (Docs4Docs) that delivers laboratory and imaging results to primary care providers and specialists.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    Additional records from the INPC strengthened the sickle cell disease registry and enabled the state health department to secure additional funding for sickle cell disease surveillance.

    “The additional records strengthened the registry and enabled the state health department to secure additional funding for sickle cell disease surveillance, which significantly impacts the African American population living in Indiana.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    In 2015, linking INPC patients to the Indiana State Cancer Registry using probabilistic matching found that approximately 89% of patients with longitudinal records in the registry were matched, and additional cancer patients present in the INPC but not in the registry were identified.

    “For example, in 2015, researchers linked INPC patients to the Indiana State Cancer Registry using probabilistic matching to determine the completeness of the registry [35]. Approximately 89% of the patients with longitudinal records in the registry were matched, and additional cancer patients present in the INPC but not in the registry were identified.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [35] Ruppert LP, He J, Martin J, Eckert G, Ouyang F, Church A, et al. Linkage of Indiana State Cancer Registry and Indiana Network for Patient Care Data. J Registry Manag. 2016;43(4):174–8.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    IHIE supports a web-based application (INPC CareWeb) to view integrated medical records from providers across the state.

    “For example, IHIE supports a web-based application (INPC CareWeb) to view integrated medical records from providers across the state.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    IHIE, through the INPC, supports broad data types as well as longitudinal records to track disease progression, treatment, and outcomes, reducing data fragmentation that is common in retrospective data-based studies.

    “For example, IHIE, through the INPC, and like other HIEs supports broad data types as well as longitudinal records to track disease progression, treatment, and outcomes, reducing data fragmentation that is common in retrospective data-based studies as mentioned above [33–[35].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [33–[35]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim.

    Findingnone given

    There is no comprehensive synthesis on the capabilities of the INPC.

    “Although there are several manuscripts that describe services and individual research studies supported by the INPC, there is no comprehensive synthesis on the capabilities of the INPC.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Findingnone given

    There is no recent review of the population health services developed and implemented by the INPC over the past two decades.

    “Moreover, there is no recent review of the population health services developed and implemented by the INPC over the past two decades.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Community HIEs typically do not integrate work and data flows directly with EHRs in health care practices and other organizations, resulting in workflow inefficiencies, increased information retrieval effort, and cognitive friction.

    “Community HIEs typically do not integrate work and data flows directly with electronic health records (EHRs) in health care practices and other organizations. This lack of integration forces clinicians to access HIE data using a system separate from their EHR, resulting in workflow inefficiencies, increased information retrieval effort, and cognitive friction [30].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [30] Halamka JD, Osterland C, Safran C. CareWeb, a web-based medical record for an integrated health care delivery system. Int J Med Inf. 1999;54(1):1–8. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The study adhered to the guidelines of the Declaration of Helsinki.

    “This study also adhered to the guidelines of the Declaration of Helsinki.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    The study was deemed non-human subjects research; ethics approval and informed consent were deemed unnecessary, not applicable, and waived according to national regulations by Indiana University's Institutional Review Board.

    “This study was deemed non-human subjects research; therefore ethics approval and informed consent were deemed unnecessary, not applicable, and waived according to national regulations by Indiana University’s Institutional Review Board.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationnone given

    Automated identification of COVID-19-positive patients is an essential function necessary to establish CoRDaCo.

    “An essential function necessary to establish CoRDaCo is the automated identification of COVID-19-positive patients.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The PCDH process allows comprehensive medical histories to follow patients wherever they seek care.

    “The PCDH process allows comprehensive medical histories to follow patients wherever they seek care.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationreasoning

    The example of the INPC can increase understanding of the benefits of these new directions and serve as a model for other HIEs making similar transitions.

    “The example of the INPC can increase understanding of the benefits of these new directions and serve as a model for other HIEs making similar transitions.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given

    HIEs can play an important role in expanding focus from individual patient care to population health management by expanding their focus on decision-making during individual patient encounters to include understanding population health and using population health data to guide clinical care.

    “Health Information Exchanges (HIEs) can play an important role in this process by expanding their focus on decision-making during individual patient encounters to include understanding population health and using population health data to guide clinical care.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Integrating HIE data directly with the EHR is feasible and has several benefits.

    “The app successfully demonstrated that integrating HIE data directly with the EHR is feasible and has several benefits.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Working documents were shared with leadership of the HIE for validation, and edits were made based on feedback following further discussion and consensus among the authors.

    “Working documents were shared with leadership of the HIE for validation, and edits were made based on feedback following further discussion and consensus among the authors.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Community HIEs have positive effects on cost savings and care decisions.

    “Community HIEs have a particular role in this process since positive effects on cost savings and care decisions have been associated with the community HIEs [10].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Rahurkar S, Vest JR, Menachemi N. Despite the spread of health information exchange, there is little evidence of its impact on cost, use, and quality of care. Health Aff (Millwood). 2015;34(3):477–83. source

  • May combine two claims.

    Interpretationreasoning

    For ACOs in Indiana, INPC information supports coordinating care, reducing duplication of services, and calculating quality metrics.

    “For ACOs in Indiana, INPC information supports coordinating care, reducing the duplication of services, and calculating quality metrics.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Coordinated care can help ensure patients receive the right care at the right time while avoiding unnecessary duplication of services and preventing medical errors.

    “Coordinated care can help ensure that patients receive the right care at the right time while avoiding unnecessary duplication of services and preventing medical errors [ [56]].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [56] International HLS. HL7 FHIR Release 4 2020. [Available from: https://www.hl7.org/fhir/].

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationnone given

    Many health systems continue to see data as an asset to be protected rather than a shared resource needed by all organizations caring for the patient.

    “In addition, many health systems continue to see data as an asset that needs to be protected rather than an important shared resource that is needed by all of the organizations taking care of the patient.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationreasoning

    Creating and sustaining HIE remains a challenge.

    “Creating and sustaining HIE remains a challenge.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    HIE offers a more diverse set of patients and can help support less biased algorithms.

    “HIE offers a more diverse set of patients and can help support less biased algorithms.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Implementation of messaging standards is often suboptimal, with real-world messages failing to adhere to standards even though vendor products pass certification tests.

    “Moreover, implementation of messaging standards is often suboptimal, where real-world messages fail to adhere to standards even though vendor products pass certification tests.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given

    Health Information Exchanges are essential components for national health data exchange.

    “Health Information Exchanges are essential components for national health data exchange and must continue to evolve to remain relevant and sustainable.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Community HIEs can be excellent partners for healthcare delivery systems to advance health and healthcare, which ultimately advances population health.

    “Given the continued pressure of the regulatory environment on healthcare providers, community HIEs can be excellent partners for healthcare delivery systems to advance health and healthcare, which ultimately advances population health.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.

    Interpretationnone given

    For HIEs to evolve, there must be dedication to building fundamental services, expanding beyond a clinical-care-only focus, and investing in services valuable to stakeholders.

    “In order for HIEs to evolve, there has to be a dedication to building the fundamental services, expanding beyond the clinical care only focus, and investing in the services that are valuable to its stakeholders.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationreasoning

    A network of community HIEs could make the vision of transparent and accessible patient information throughout the country (and potentially worldwide) a reality, as the Patient-Centered Data Home initiative has demonstrated.

    “As the Patient-Centered Data Home initiative has demonstrated, a network of community HIEs could make the vision of transparent and accessible patient information throughout the country (and, potentially, worldwide) a reality.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationreasoning

    HIEs in a community are more in tune with that community's health priorities and needs.

    “Moreover, HIEs in a community are more in tune with that community's health priorities and needs.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Policy in the US is moving towards a national HIE with strong subnational units such as states and districts, and the INPC is trending in the same direction as policy.

    “Policy in the US is moving towards national HIE with strong subnational units, such as states and districts, while INPC is advanced it is trending in the same direction as policy [58].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [58] National strategy to advance privacy-preserving data sharing and analytics a report by the fast-track action committee on advance privacy-preserving data sharing and analytics networking and information technology research and development subcommittee of the National Science and Technology Council. 2023. https://www.whitehouse.gov/wp-content/uploads/2023/03/National-Strategy-to-Advance-Privacy-Preserving-Data-Sharing-and-Analytics.pdf.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    Vendor-based models leave out latency due to standards and have a non-population focus.

    “The vendor-based models leave out latency due to standards and have a non-population focus.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    More complete and comprehensive information allows ACOs to achieve the Triple Aim objectives more efficiently and effectively than previously possible.

    “More complete and comprehensive information allows ACOs to achieve the Triple Aim objectives of delivering the right care at the right time, reducing unnecessary duplication, and preventing medical errors more efficiently and effectively than previously possible.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationnone given

    Many places lack HIEs with population health capabilities like the INPC.

    “Many places lack HIEs with population health capabilities like the INPC.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    HIEs are agnostic to the type of data they include and the organizations providing the data.

    “HIEs have the advantage of being agnostic to the type of data they include and the organizations providing the data.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    HIEs can combine health-related with non-health-related data, for instance connecting patient populations with their sociodemographic or environmental context.

    “Thus, HIEs can combine health-related with non-health-related data, for instance, to connect patient populations with their sociodemographic or environmental context.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationnone given

    HIEs can support sophisticated clinical decision support interventions that may be difficult or impossible to implement in traditional EHR frameworks.

    “HIEs can also support sophisticated clinical decision support interventions that may be difficult or impossible to implement in traditional EHR frameworks.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Algorithms developed within a single hospital or health system may be overfitted to that population or biased towards unique characteristics of the patient population seeking care in that health system.

    “Additionally, algorithms developed within a single hospital or health system may potentially be overfitted to that population or biased towards unique characteristics of the patient population seeking care in that health system.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationreasoning

    The example of the INPC can increase understanding of the benefits of these new directions and serve as a model for other HIEs evolving along similar trajectories.

    “The example of the INPC can increase understanding of the benefits of these new directions and serve as a model for other HIEs evolving along similar trajectories.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    In the US, many implementations continue to rely on proprietary terminologies with limited translation to international standards, despite policies encouraging standards and interoperability.

    “In the US, policies encourage the use of standards and interoperability, yet many implementations continue to rely on proprietary terminologies with limited translation to international standards.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    HIEs have a model that allows for non-standardized health information exchange compared with vendor-based standards-based exchange.

    “HIEs have a model that allows for non-standardized health information exchange compared with that of the standard-based health information exchange of vendors.”
    Quote in the paperNot a substantial claim
50 of 50

  • The paper relies on this without support.

    The COVID-19 dashboard's data accurately reflect population-level hospitalization rates and disparities across Indiana.

    “It further supported community-level discussions about resource sharing and disparities and identified major differences in hospitalization rates among non-white populations in specific counties and zip codes.”
1 of 1

Cites

Flagged first, then by citations

Research works printed but not linked: 2

  1. Michael Hochman JG, Edmondo J, Robinson. Health Affairs. 2019. Available from: https://www.healthaffairs.org/do/10.1377/hblog20190807.475758/full/. · DOI
  2. Dixon B. Health Information Exchange: navigating and managing a Network of Health Information Systems. 2nd ed. San Diego: Elsevier Science & Technology; 2022.

Cited by

Sorted by citations

Related

Authors
Williams, K. S., Rahurkar, S., Grannis, S. J., Schleyer, T. K., & Dixon, B. E.
Affiliations
  • City University of New York (US)
  • Regenstrief Institute (US)
Corresponding author
Williams, Karmen S.
ORCID
Venue
BMC Medical Informatics and Decision Making
Publisher
Springer Science and Business Media LLC
Published
2025-02-24
Volume
25
Issue
1
Pages
97-97
ISSN
1472-6947 (ISSN-L)
DOI
10.1186/s12911-025-02933-9
PMC
PMC11849299
OpenAlex
W4407880394
Semantic Scholar
cf6de8b64c6fc97724f03a3fa3ed4e2a0f9e861c
Cited by
7
References
47
Citations by year
2026: 3 · 2025: 4
FWCI
5.20
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Medical Informatics and Decision Making (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion, cc-by-nc-nd)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • U.S. National Library of Medicine (T15LM012502)
  • Agency for Healthcare Research and Quality (R21HS025502)
  • National Center for Advancing Translational Sciences (ULI TR002529)
Topics
  • Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
  • Health Sciences › Health Professions › Health Information Management › Medical Coding and Health Information
  • Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Healthcare Systems and Technology
Keywords
health information exchange, population health management, Triple Aim, health data sources, population health surveillance, disease registries, accountable care organizations
MeSH terms
Population Health, Population Health Management, Patient Care, Humans, Indiana, Organizational Case Studies, Health Information Exchange

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-19.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-19.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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