Evidence base for health information exchange

Widespread adoption and use of health information exchange (HIE) continues to be a national objective to boost efficiency, reduce costs, and improve outcomes in health systems in alignment with many nations’ digital health strategies. In this chapter, we examine HIE literature spanning four decades—from 1980 to 2021—to examine the evidence base for the benefits of HIE to healthcare outcomes. In these 40 years, the landscape of HIE has undergone significant changes. We examine the major changes in the HIE market (e.g., diversity in HIE types, technologies used, mechanism of HIE, mode of access, and care settings) and changing trends over time, framing our findings in three time periods associated with the passing of landmark policies, including the Health Information Technology for Economic and Clinical Health Act and its Meaningful Use Program, Medicare’s Merit-based Incentive Payment System, and the Promoting Interoperability program. At the end of this chapter, the reader will be able to describe the breadth and depth of existing studies that provide evidence on effects of HIE on healthcare and how various HIE characteristics affect the relationship between information exchange and health outcomes.