HIE Healthcare and Why It Matters

HIE healthcare means health information exchange (HIE). An HIE is the secure electronic sharing of patient health information between healthcare organizations, providers, and systems. And it’s possible even when they use different electronic health record (EHR) platforms or operate in different locations.

Through an HIE, hospitals, physician practices, laboratories, pharmacies, public health agencies, and other care participants can access relevant patient information. That way, everyone involved in a patient’s care has timely, accurate data when it matters most.

The Value of HIE Healthcare

HIEs play an important role in improving access to current, accurate data. When providers have access to data, it strengthens care coordination, reduces gaps in treatment, and creates a more seamless patient experience. Combined, it provides enhanced patient care.

Examples of data exchanged by an HIE includes:

• Clinical results
• Clinical information, notes and documentation (transcription and care summary notes, ED notes, discharge summaries, referrals, consulting, etc.)
• Medication history
• Immunizations, syndromic surveillance, and public health data
• Electronic prescribing and refill information
• EMT/first responder notes

By sharing information between providers and locations, providers and patients benefit from: 

• Better care coordination — Providers can see lab results, medications, allergies, and visit histories from other organizations.
• Improved patient safety — Access to provider data reduces medication errors, duplicate tests, and risks resulting from missing information.
• Faster, more informed decisions —Clinicians don’t have to rely only on the patient’s memory or faxed records.
• Lower costs — Shared information avoids unnecessarily repeating lab work, imaging, and admissions offers a comparative baseline for future care.
  Support for value-based care by supporting population health initiatives, quality measurement, and coordinated transitions of care.

How an HIE in Healthcare Works

To better understand how HIEs operate, imagine the following scenario. 

Sarah lives in rural Arkansas and travels to New York City for a weekend visit. While in New York she develops severe abdominal pain and goes to a local emergency department. The clinicians evaluate her, perform lab tests and imaging, prescribe medication, and discharge her with follow-up instructions. All of this information is documented in the hospital’s electronic health record (EHR).

A few days later, Sarah returns home and schedules an appointment with her primary care provider (PCP). Because the NYC hospital and her local provider participate in the same HIE, Sarah’s visit record is securely shared through the network. During her visit with her PCP, her PCP accesses available exchange records through their EHR’s connected health information networks — lab results, imaging reports, discharge notes, and prescribed medications — directly within her own EHR or EMR workflow.

This seamless exchange means Sarah’s PCP doesn’t have to rely on Sarah’s memory or wait days for her records to be faxed. She avoids ordering duplicate testing, ensures Sarah’s medications are appropriate, and provides informed follow-up care.

Behind the scenes, the HIE uses national interoperability standards and secure data-sharing protocols to move Sarah’s information safely and securely. What once took days or weeks now happens almost instantly. This is the power of health information exchange — ensuring the right information follows the patient wherever they receive care.

The History of HIEs in Healthcare

Early health information exchange efforts in the U.S. began in the 1990s. It was then that healthcare organizations explored ways to share patient information electronically across hospitals, physician practices, laboratories, and other care settings.

Many early initiatives were called regional health information organizations (RHIOs). These regional collaborations enabled providers using different EHR systems to exchange information through shared infrastructure. Over time, regional exchanges evolved into what are now commonly known as health information exchanges (HIEs).

Today, HIE participation often occurs through broader health information networks, which provide the governance, technical infrastructure, and policies needed to securely exchange data between organizations.

The HITECH Act

The HITECH Act of 2009 sped up adoption of electronic health records and interoperability initiatives. It established the EHR Incentive Programs, such as Meaningful Use, which is now the Medicare Promoting Interoperability Program (PI).

These programs significantly increased EHR adoption and helped drive participation in electronic data exchange nationwide.

The 21st Century Cures Act

The 21st Century Cures Act was passed in 2016 and advanced nationwide data sharing. While the Office of the National Coordinator for Health IT (ONC) already existed, the Act expanded its authority. It also tasked the agency with improving interoperability across healthcare.

As part of the effort, ONC was directed to create a nationwide trusted exchange framework to enable secure, standardized data exchange. And in 2018, ONC released draft 1 (TEF draft 1) of a proposal for a national interoperability framework for health information sharing called Trusted Exchange Framework and Common Agreement (TEFCA).

Any authorized healthcare entity or authorized individual can use TEFCA to securely exchange health information. ONC also certifies that EHRs meet the Promoting Interoperability Program criteria for either eligible provider or hospital technology. Azalea EHRs are ONC certified. An ONC certified EHR doesn’t guarantee that it’s interoperable with TEFCA though.

TEFCA and Nationwide Interoperability

TEFCA became operational in 2023. It was designed to simplify nationwide health information exchange by letting organizations connect once and exchange data broadly across participating networks. Under TEFCA, exchange occurs through designated Qualified Health Information Networks (QHINs), which follow standardized technical, security, and governance requirements. Organizations connected to one QHIN can securely exchange information with participants across all TEFCA-connected networks.

The TEFCA website states, “…stakeholders often must join multiple networks to get the information they need to support patient care. In contrast, joining a HIN that participates in the network created by the Common Agreement enables access to and exchange of information from varied sources.”

Those sources include:

• Health information networks (HINs)
• Federal agencies
• Public health organizations
• Individuals
• Payers
• Providers
• Technology developers

(Note: ONC released Version 2.0 of the Common Agreement on April 22, 2024. It mandates support for HL7 FHIR-based transactions, which underscores the commitment to seamless and secure interoperability across the healthcare sector.)

Two types of entities facilitate and administer TEFCA.

• QHINs – Qualified Health Information Networks (QHINs) standardize methodology for HIE interconnectivity nationwide.
• RCE – The Recognized Coordinating Entity (RCE) administers TEFCA and acts as the governing body that operationalizes the Trusted Exchange Framework.The RCE is currently operated by The Sequoia Project.

HINs that meet strict technical, security, and governance requirements can apply to become QHINs

According to the ONC’s Recognized Coordinating Entity (The Sequoia Project), as of November 2025, more than 60,000 locations participated in TEFCA through 10 QHINs. 

TEFCA vs Regional HIEs

While TEFCA supports nationwide interoperability, many regional and statewide HIEs continue to operate independently. And they remain an important part of the healthcare data exchange ecosystem. Health information networks that agree to connect nationally can become QHINs under TEFCA.

• HIEs operate locally or regionally to connect providers within a community, state, or other network
• QHINs operate nationally and connect multiple HIEs across the whole country

HIEs enable local and/or limited exchange. QHINs support nationwide interoperability, ensuring patient data follows them wherever they go.

HIE Healthcare Today

Today’s health information exchange ecosystem includes multiple types of exchange networks that can include:

• Regional and statewide health information exchanges
• Government-operated or public/private collaborative exchanges
• Accountable care organization (ACO) exchange networks
• Nationwide interoperability frameworks such as TEFCA
• National vendor-supported exchange networks

Together, these systems enable healthcare organizations to securely share patient information across care settings and geographic regions.

For example, in Georgia, there are several RHIOs and a statewide HIE, Georgia Health Information Network (GaHIN). GaHIN connects state government departments (behavioral health, Medicaid, and more), the Veterans Administration (VA), the Department of Defense (DOD), several large healthcare systems, and state RHIOs.

Why and How to Get Started with an HIE

Reasons to join an HIE include to:

• Improve quality of care through real-time access to patient data
• Reduce costs by eliminating duplicate tests and imaging
• Support population health and value-based care initiatives

Healthcare organizations have several ways to participate in health information exchanges, depending on their size, location, and technology infrastructure.

Many providers historically connected to exchange networks through regional or statewide HIE organizations. These networks continue to play an important role in supporting local care coordination and public health reporting.

As interoperability requirements and patient mobility have increased, many organizations now prioritize connectivity through their electronic health record (EHR) platform. Modern EHR-integrated exchange solutions let providers securely access patient information across multiple regional and national networks directly within their clinical workflow — without managing separate exchange portals or contracts.

Organizations can connect to an HIE through:

• EHR integration — Find an EHR that’s integrated within a nationwide HIE or QHIN. Azalea Hospital or Ambulatory EHR offer an integrated HIE through AzaleaConnect. 
• Regional HIE — A regional HIE in your area may offer a high level of support and connection to other providers across a broader area.
• State HIE — Many states have a State-Designated Entity (SDE) that provides some or all of the data exchange services listed above. SDEs are usually state agencies or government-affiliated organizations (like a state department of health or governor’s office). If your statewide HIE doesn’t serve individual practices, they can put you in touch with the networks in your area that can. See the State of Nevada’s HIE Landscape by State to find your state’s HIE or contact your state health department.
• TEFCA QHIN participation where you join an HIN connected to a QHIN for nationwide exchange.

For many providers, the most efficient approach is selecting an EHR with built-in interoperability capabilities that support participation across multiple exchange networks simultaneously.

This approach reduces administrative burden, simplifies onboarding, and helps ensure clinicians can access patient information wherever care occurs.

Get an HIE Built into Your EHR with Azalea

Azalea offers built-in nationwide interoperability HIE capabilities with AzaleaConnect. This lets providers securely share and access patient information directly within their EHR workflow. AzaleaConnect leverages the nationwide interoperability infrastructure of Surescripts Interconnect, which connects participating healthcare organizations to multiple trusted exchange networks through a single integration point.

Through this architecture, Azalea clients can exchange clinical information across both:

• Trusted Exchange Framework and Common Agreement (TEFCA) — the federal nationwide trusted exchange framework designed to support standardized interoperability across healthcare.
• Carequality — one of the largest existing nationwide interoperability networks connecting hospitals, health systems, ambulatory practices, and technology vendors.

This lets providers access patient records across care settings and geographic regions without managing multiple exchange connections, contracts, or portals.

With Azalea, organizations can:

• Retrieve external clinical records directly within their EHR workflow
• Support referrals, transitions of care, and emergency treatment decisions
• Improve care coordination across independent health systems
• Participate in both regional and nationwide interoperability initiatives
• Reduce administrative overhead associated with managing multiple exchange connections

By embedding nationwide exchange connectivity directly into the EHR, AzaleaConnect helps ensure patient information follows the patient. That supports safer, more informed care wherever treatment occurs.