Perceptions of Community and Enterprise Health Information Exchanges

What are your perceptions about the different types of health information exchange (HIE) organizations? Have you ever wondered how these perceptions might play a role in the market of health information exchange?

When we launched the HIMSS HIE Measures and Enterprise Survey in collaboration with Dr. Joshua Vest of Weill Cornell Medical College, Indiana University Richard M Fairbanks School of Public Health and Center for Health Policy in spring 2016, these were among the questions we set out to answer.

Now, the major findings of this survey appear in a report, Diverging Views on Health Information Exchange Organizations, in the Learning Health Systems (LHS) Journal as a part of a special-themed issue on Patient Empowerment and the Learning Health System.

“There are a lot of organizations working to move health information, and clearly they don’t all share a common view of each other’s roles,” Dr. Vest explained. “However, a common denominator is the broad interest in improving health. A key challenge for policy makers, providers, and IT professionals is to leverage the different approaches to health information exchange in a complementary and comprehensive manner."

Establishing definitions for Community and Enterprise HIEs

As a part of this survey process, we asked respondents to use the following definitions of community health information organizations (cHIO) and enterprise health information exchange (eHIE) while completing the survey. This allowed us to ensure responses were comparable by eliminating variability due to a difference in understanding of these terms:

  • Community Health Information Organization (cHIO) is an independent, collaborative organization with a mission to facilitate information exchange for any willing providers in an area (e.g. city, country, region, state); often a non-profit; also known as "public HIEs”; includes: regional health information organizations (RHIOs), state health information exchange, and state designated entities (SDE).
  • Enterprise Health Information Exchange (eHIE) is an information-sharing network and technology service operated by a health system, hospital, or medical group that connects the EHRs of affiliated practices and medical trading partners; also called "private HIEs.”

It is also important to note that cHIOs and eHIEs are different from DIRECT Secure Messaging (DSM) and vendor-mediated exchange (defined as HIE “convened by an EHR vendor that offers technical and networking support to establish connections between their customers”).

Our findings show that differences persist in the perception of HIEs.

From May through July 2016, we collected responses from 68 stakeholders from both types of HIEs (cHIEs and eHIEs), as well as other stakeholders, including government agency employees and healthcare practitioners. From this data, we were able to draw two major conclusions:

  • There is broad consensus about the importance of HIE, and these needs can be met through community and enterprise HIEs.
  • There are key differences in perceptions of community and enterprise HIE in terms of societal benefit, which is more associated with cHIE, and strategic advantage, which is more associated with eHIE.

Responses did not significantly differ between cHIE and eHIE for many qualities, including ease of EHR integration and indispensability to healthcare organizations.
Additionally, because our sample size was small and our sampling strategy was limited to those knowledgeable in health IT, we cannot draw conclusions about what the perceptions of those less knowledgeable or of the wider public might be.

Read the full study and learn more:

The full results of this paper are now available online.

For more information and additional analysis on the data collected, Dr. Joshua Vest joined the Interoperability & HIE Community on our May 2017 HIE Non-profit partner Roundtable. The slides from this presentation are available for download.

Let us know if you agree or disagree with the findings of this study – we want to hear from you! Email us at with any feedback or comments.