Journal of Medical Systems

, 37:9987 | Cite as

Challenges, Alternatives, and Paths to Sustainability for Health Information Exchange Efforts

  • Joshua R. Vest
  • Thomas R. CampionJr.
  • Rainu Kaushal
  • for the HITEC Investigators
Original Paper


Health information exchange (HIE) is a promising approach to improving the cost and quality of healthcare. We sought to identify the strengths and weaknesses of organizational models to achieve exchange, and what can be done to ensure the sustainability and effectiveness of exchange efforts. We interviewed state and national health informatics policy experts (n = 17). Data were collected as part of an evaluation of the Health Care Efficiency and Affordability Law for New Yorkers (HEAL NY) program and included respondents from both the private and public sectors. Data were analyzed using a general inductive and comparative approach with open coding of themes. Interviewees generally viewed HIE as a public or societal good to be valued. However, they identified challenges with the regional health information organization (RHIO) model of facilitating exchange including: economics, organizational issues, and geography. RHIOs were contrasted against alternative methods of exchange such as Direct, enterprise HIE, and vendor-mediated exchange. HIE is a difficult undertaking due to political and economic reasons. Alternatives to the RHIO model have features that may be more attractive to participants, but may be of less public benefit. Using states as intermediaries and mandating exchange under public health law may avoid the challenges facing exchange efforts. Moving forward, policies will have to address the shortcomings of each HIE model to ensure information is effectively shared between providers to maximize health benefits.


Regulatory issues Governance Health information exchanges Policy Public health 



This study was supported by the New York State Department of Health (NYS contract number C023699). We also thank Lisa M. Kern, Vaishali Patel, Karen M. Murphy, C. William Schroth, Renny V. Thomas for the work in data collection efforts. The Institutional Review Board of Weill Cornell Medical College approved the study protocol.

Conflicts of Interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Joshua R. Vest
    • 1
    • 2
  • Thomas R. CampionJr.
    • 1
    • 2
    • 3
  • Rainu Kaushal
    • 1
    • 2
    • 3
    • 4
    • 5
  • for the HITEC Investigators
  1. 1.Center for Healthcare Informatics & PolicyWeill Cornell Medical CollegeNew YorkUSA
  2. 2.Department of Public HealthWeill Cornell Medical CollegeNew YorkUSA
  3. 3.Department of MedicineWeill Cornell Medical CollegeNew YorkUSA
  4. 4.Department of PediatricsWeill Cornell Medical CollegeNew YorkUSA
  5. 5.NewYork-Presbyterian HospitalNew YorkUSA

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