Health information exchange: national and international approaches.
OBJECTIVE
Health information exchange (HIE), the process of electronically moving patient-level information between different organizations, is viewed as a solution to the fragmentation of data in health care. This review provides a description of the current state of HIE in seven nations, as well was three international HIE efforts, with a particular focus on the relation of exchange efforts to national health care systems, common challenges, and the implications of cross-border information sharing.


METHODS
National and international efforts highlighted in English language informatics journals, professional associations, and government reports are described.


RESULTS
Fully functioning HIE is not yet a common phenomenon worldwide. However, multiple nations see the potential benefits of HIE and that has led to national and international efforts of varying scope, scale, and purview. National efforts continue to work to overcome the challenges of interoperability, record linking, insufficient infrastructures, governance, and interorganizational relationships, but have created architectural strategies, oversight agencies, and incentives to foster exchange. The three international HIE efforts reviewed represent very different approaches to the same problem of ensuring the availability of health information across borders.


CONCLUSIONS
The potential of HIE to address many cost and quality issues will ensure HIE remains on many national agendas. In many instances, health care executives and leaders have opportunities to work within national programs to help shape local exchange governance and decide technology partners. Furthermore, HIE raises policy questions concerning the role of centralized planning, national identifiers, standards, and types of information exchanged, each of which are vital issues to individual health organizations and worthy of their attention.
Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA.
Joshua R
JR
Vest
D001208:Asia; D044362:Australasia; D057286:Electronic Health Records; D005060:Europe; D006291:Health Policy; D033181:Information Dissemination; D007391:International Cooperation; D008490:Medical Informatics; D009656:North America; D013673:Technology Assessment, Biomedical