By Eric Andrew Kristof, RN, CAHIMS | Healthcare IT Professional | HIMSS Arkansas Chapter Member
About This Series: The HIMSS Word of the Day is a running blog series drawing from the HIMSS Dictionary of Health Information and Technology Terms, Acronyms, and Organizations, 6th Edition (2025) — the authoritative reference for healthcare IT professionals and the primary study resource for CAHIMS and CPHIMS certification. Each post paraphrases the term in plain language, grounds it in real-world healthcare IT context, and adds a bedside nursing perspective you won’t find in a textbook.
📖 The Term: Health Information Exchange (HIE)
Source: HIMSS Dictionary of Health Information and Technology Terms, Acronyms, and Organizations, 6th Edition (2025)
🔍 Plain-Language Definition
Health information exchange (HIE) is the electronic sharing of clinical information between organizations, such as hospitals, clinics, labs, pharmacies, and public health agencies, so that the information arrives where it is needed and still means what it meant at the source.
The HIMSS Dictionary gives HIE three related senses. First, it is the act of sharing health data between two or more organizations that have a business and legal agreement, common technology, and agreed-upon standards. Second, it is an umbrella label for the many kinds of exchange organizations, including regional health information organizations (RHIOs) and private exchanges. Third, it is a concept that grew out of the community health information networks of the mid-1990s. In every sense, the aim is to move clinical information among different systems without losing its meaning, so that care can be safer, more timely, more efficient, more effective, more equitable, and more patient-centered. Public health agencies also use HIE to understand the health of populations.
Those six aims echo the Institute of Medicine’s well-known dimensions of quality, which is a useful memory hook.
ONC describes three main forms of exchange:
| Form of HIE | How It Works | Example |
|---|---|---|
| Directed Exchange (Push) | One provider sends information securely to another known recipient | A hospital sends a discharge summary to the patient’s primary care practice |
| Query-Based Exchange (Pull) | A provider searches for and retrieves information about a patient from other sources | An emergency physician looks up recent medications and imaging from other hospitals |
| Consumer-Mediated Exchange | Patients gather and control their own information and share it with providers | A patient uses an app to download records and share them with a new specialist |
⚠️ Exam Alert: Distinguish HIE the verb (the act of exchanging information) from an HIE organization or HIO (an entity that facilitates exchange, such as a state or regional HIE). Interoperability is the broader capability of systems to exchange and use information; TEFCA is the national framework connecting networks; C-CDA and FHIR are standards used to carry the data. Know the three forms of exchange by their push, pull, and patient-controlled descriptions.
🌐 Why It Matters: Real-World Healthcare IT Context
Patients do not stay inside one health system. They see specialists across town, visit urgent care while traveling, move to skilled nursing after a hospital stay, and fill prescriptions at retail pharmacies. HIE is how their information keeps up with them.
Exchange happens through several layers. State and regional HIE organizations connect local hospitals, practices, labs, and public health agencies. National networks and vendor-based networks connect organizations across state lines. TEFCA, which went live in December 2023, links qualified networks into a single framework with common rules. Most health systems participate in more than one of these at the same time.
HIE also carries public health traffic, including immunization registry submissions, electronic lab reporting, case reporting, and syndromic surveillance, and it powers event notifications that alert care teams when their patients are admitted or discharged elsewhere.
Common barriers to useful exchange:
- Patient matching errors that link the wrong records or miss the right ones
- Data that arrives as long documents nobody has time to read
- Inconsistent coding and data quality from source systems
- Gaps where small practices, behavioral health, or long-term care providers are not connected
- Unclear workflows for who reviews incoming information and when
- Sustainability challenges for HIE organizations that depend on grants or fees
Characteristics of effective exchange:
- Accurate patient identity management at registration and across networks
- Standards-based, coded data that can be reconciled into the chart
- Event notifications routed to care managers who can act on them
- Integration that shows outside information inside the clinician’s normal workflow
- Clear governance, consent policies, and data use agreements among participants
🏥 The Nurse’s Perspective: Clinical, Bedside, & Workflow
Nurses experience HIE as the difference between a complete picture of the patient and a blank page.
At the Bedside
In the emergency department, query-based exchange can surface recent discharge summaries, medication lists, allergies, and imaging from other hospitals during triage. For a patient who is confused, unconscious, or unsure of their own history, that outside information can change care in minutes.
On inpatient units, outside records help nurses confirm home medications and understand recent hospitalizations. The information is only as useful as the time available to review it, which is why concise summaries and good display matter as much as connectivity.
In Clinical Workflow
Directed exchange shows up at every transition. Discharge summaries, transfer summaries, and care plans sent to nursing facilities, home health agencies, and primary care practices give the next team what it needs on the first day. Nursing documentation, including functional status, wound care, and patient education, is a large part of what those receiving teams rely on.
Immunization documentation is another everyday example. Vaccines that nurses administer and document are often sent automatically to the state immunization registry, and registry history can be retrieved when a patient’s records are incomplete.
In EHR Implementation (Go-Live Perspective)
During an Epic implementation, HIE connectivity is configured through the organization’s chosen networks and its state or regional HIE. Teams decide how outside records display, which documents are sent automatically at discharge, and which public health interfaces are required. Some connections are validated after Go-Live, once the core system is stable.
End-user support analysts often hear questions about missing outside records, documents that did not reach a facility, or immunizations that did not appear in the registry. Many of those trace back to patient demographics, encounter types, or interface routing rather than the clinician’s actions, and knowing that helps route issues correctly.
🎓 CAHIMS / CPHIMS & HIMSS Perspective
CAHIMS Exam Domain Mapping
HIE is one of the most heavily tested interoperability concepts on the CAHIMS exam:
| CAHIMS Domain | How HIE Appears |
|---|---|
| Healthcare & Technology Environments | ONC’s role; TEFCA; state and regional HIE organizations; information blocking; public health reporting |
| Clinical Informatics | Use of outside records in care; transitions of care; medication reconciliation; event notifications |
| Healthcare Information & Systems Management | Directed, query-based, and consumer-mediated exchange; patient matching; standards such as C-CDA and FHIR |
| Management & Leadership | Governance and data use agreements; HIE sustainability; interoperability strategy |
Key Terms to Know Alongside HIE
- Interoperability — the ability of systems to exchange information and use it meaningfully
- HIO (Health Information Organization) — an organization that oversees and facilitates exchange among participants
- RHIO (Regional Health Information Organization) — a regional organization that facilitates exchange within a geographic area
- TEFCA — the national framework and common agreement connecting health information networks
- Directed Exchange — secure sending of information from one provider to another known recipient
- Query-Based Exchange — searching for and retrieving patient information from other organizations
HIMSS Organizational Position
HIMSS treats health information exchange and interoperability as core policy priorities, engaging with federal agencies on TEFCA, information blocking, and public health data modernization. Its Public Health Digital Transformation Community focuses on the data exchange public health depends on, and members can find related guidance through the HIMSS Resource Center.
🔗 Explore Further: External References
- ONC — What Is HIE? https://healthit.gov/health-it-basics/hie/
- ONC — Trusted Exchange Framework and Common Agreement (TEFCA) https://healthit.gov/policy/tefca/
- ONC — Interoperability https://healthit.gov/interoperability/
- eHealth Exchange https://ehealthexchange.org/
- CommonWell Health Alliance https://www.commonwellalliance.org/
- HIMSS — Public Health Digital Transformation Community https://www.himss.org/networking/communities/himss-public-health-digital-transformation-community/
Term source: HIMSS Dictionary of Health Information and Technology Terms, Acronyms, and Organizations, 6th Edition (2025). All definitions in this series are paraphrased for editorial purposes. Readers are encouraged to consult the primary source for exact language.
Eric Andrew Kristof, RN, CAHIMS is a Healthcare IT professional and HIMSS Arkansas Chapter member based in Hot Springs Village, AR, with hands-on Epic Go-Live experience and a diverse healthcare and IT background. He writes at kristof.org at the intersection of clinical care and healthcare technology.
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