The Business Case for Public Health and HIE

Go or No Go?

Putting Together the Business Case

By following the guidance provided in this Toolkit, public health programs and departments will have answered the following questions:

  1. Who provides what types of HIE services in our jurisdiction?
  2. How do our priorities match local HIE capabilities?
  3. What could place our potential HIE projects at risk?

At this point for any project that appears worth pursuing, the public health entity and HIE service provider both need to assess the feasibility, benefit, cost and risk of the project(s) to both parties.

The business case is a document frequently used to spell out assumptions and describe the benefits, costs and risks of specific projects. Business case documents may range from simple overviews to extensive and highly quantitative analyses.

In HIE, some project costs and benefits may be readily quantifiable - such as the cost of transmitting a lab result by two different methods - but others are not. Quantitative analysis may be straightforward when replacing one standardized software solution with another. However, some benefits and costs elude clear-cut quantification.

For example:

  • How does one "value" benefits like improvements to overall community capability, or the resilience of having one HIO providing many exchange services to many users?
  • How does one apportion that value to the health department's participation in the effort?

Even if they are difficult to quantify, such value elements should also be explicitly described in the business case and considered in decision-making.


Health departments should feel free to start with one or more specific, high-value, low-risk HIE projects, and build incrementally on the trust and knowledge gained.

If you completed the tools in this Toolkit, you already have most of the information to answer the questions in the HIE Project Business Case Tool (below). However, there will be additional information that needs to be addressed in active discussion with a potential HIE partner.

The Public Health & HIE Project Risk Appraisal Tool helps you to generate a list of potential risks that may confront your project. Risks are rarely absolute, and can be mitigated in various ways. For example:

  • Hold-harmless clauses, service level agreements and limits on maximum cost exposure can be negotiated in contracts.
  • Policies, procedures, technology and training can mitigate security and privacy risks.
  • Redundancy can mitigate risks to continuity of operation.
  • Guaranteed participation in governance can mitigate the risk that an HIE organization's mission and business plan will veer away from health department needs.


Focus on the most important risks identified using the Public Health & HIE Project Risk Appraisal Tool. Risk mitigation strategies should be identified for each of these in the business case.

Almost anything is potentially negotiable, particularly for a highly valued HIE partner. Thus items like fees and governance structure should not be considered written in stone.

Health departments are unique organizations within the community and can bring many types of value to an HIE organization. These values may include, among others:

  • neutral convening
  • population-level data
  • access to public health funding

HIE grant funding opportunities, for instance, may depend on health department participation. Public health participation is also needed to ensure that healthcare providers can earn Meaningful Use incentives.

This is a good point for the health department to assess if it wants to purchase HIE services, invest in exchange or join an exchange organization as a strategic partner - or all three. Public health investment or commitment might be reciprocated by a prominent role in governance, and/or discounted participation fees or costs for interface and interoperability services.


The health department and HIE service provider should assess the many ways in which each party can provide value to the other, and use that information to establish a division of costs and benefits that will be appropriate and sustainable to both.

The commitment to implement a relationship will typically involve several documents:

  1. Exchange Membership Agreement - The public health entity commits fees, data and possibly other elements of value to the exchange. This may include an understanding about the role of the public health entity in the governance of the project and/or of the exchange.
  2. Data Use Agreement - This details whether and how exchange information may be used and shared by the health department, and vice versa.
  3. Service Level Agreement - In this document, the HIO (and sometimes the public health entity as well) accepts responsibility for things like peak volume capabilities, minimum network speeds and recovery time for network failures.

Reviewing such agreements is part of the risk assessment process, and risk mitigation strategies may include specific changes to these documents.


These documents may be executed separately or combined. It is important to identify and understand each part fully, for all potential HIE partners.

With the above information in mind, a health department can work through the following set of questions and, when obstacles appear, potentially negotiate to a reasonably safe and affordable project. With each successful project, the trust, understanding and skill of the partners are enhanced so that each additional project is often more successful and lower risk than the ones that came before.

Many government organizations and businesses have a prescribed format for business case documents, and these will need to be completed as locally prescribed. A simple HIE Project Business Case Tool is provided below, in the form of a slide presentation to management. The slide deck will assist project leaders to help raise, organize and discuss important business case elements before they are finalized in a text document.

DOWNLOAD: HIE Business Case Template