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How Do You Define Regional? The Geography of Health Information Exchange

Project Final Report (PDF, 482.38 KB) Disclaimer

Project Details -
Completed

Multiple organizations facilitate health information exchange (HIE) activity in the United States. Community health information organizations (HIOs) historically have provided exchange services for a geographically defined community, such as a region or a State. Estimates suggest that there are 200 national community HIOs, but their potential benefits are generally unknown. Through a series of related studies, this project sought to clarify the concept of geographical area that is fundamental to HIE activity, and explored the practical and policy implications of how exchange service areas are defined and measured.

The specific aims of the project were as follows:

  • Describe the extent of community HIO activity in the U.S. 
  • Use healthcare markets to better define community HIO exchange activity. 
  • Examine the implications of how leaders of HIE organizations and healthcare organizations define exchange service areas. 
  • Contrast the benefits and challenges of community HIOs with those of enterprise HIE, a non-geographically defined approach to exchange activity organization. 

The researchers conducted three distinct but related geographical and qualitative investigations. First, geographical information systems (GIS) analyses were utilized to identify and quantify the extent of community HIO activity. Next, a qualitative GIS analysis built on these findings to explore how healthcare organizations and policymakers defined community HIO market areas. Finally, a qualitative analysis compared the barriers and enablers of a community HIO strategy with a non-geographically based HIE strategy.

The mapping analyses indicated gaps in community HIO activity and overlapping community HIO efforts. Findings showed that geography is not an effective organizing principle. Qualitative interviews and data suggested that the role of geography is changing. Specifically, organizing HIE activities along defined geographies is becoming less important and less practical.