title: Geography of community health information organization activity in the United States: Implications for the effectiveness of health information exchange.
abstract: The United States has invested nearly a billion dollars in creating community health information organizations (HIOs) to foster health information exchange. Community HIOs provide exchange services to health care organizations within a distinct geographic area. While geography is a key organizing principle for community HIOs, it is unclear if geography is an effective method for organization or what challenges are created by a geography-based approach to health information exchange.
  
  
  
  This study describes the extent of reported community HIO coverage in the United States and explores the practical and policy implications of overlaps and gaps in HIO service areas. Furthermore, because self-reported service areas may not accurately reflect the true extent of HIOs activities, this study maps the actual markets for health services included in each HIO.
  
  
  
  An inventory of operational community HIOs that included self-reported geographic markets and participating organizations was face-validated using a crowd-sourcing approach. Aggregation of the participating hospitals' individual health care markets provided the total geographic market served by each community HIO. Mapping and overlay analyses using geographic information system methods described the extent of community HIO activity in the United States.
  
  
  
  Evidence suggests that community HIOs may be inefficiently distributed. Parts of the United States have multiple, overlapping HIOs, while others do not have any providing health information exchange services. In markets served by multiple community HIOs, 45% of hospitals were participants of only one HIO.
  
  
  
  The current geography of community HIO activity does not provide comprehensive patient information to providers, nor community-wide information for public health agencies. The discord between the self-reported and market geography of community HIOs raises concerns about the potential effectiveness of health information exchange, illustrates the limitations of geography as an organizing principle, and indicates operational challenges facing those leading and working with community HIOs.
authors.affiliation: Joshua R. Vest, PhD, MPH, is Associate Professor, Department of Health Policy & Management, Indiana University Richard M. Fairbanks School of Public Health at IUPUI, Indianapolis, Indiana. E-mail: joshvest@iu.edu.
authors.forename: Joshua R
authors.initials: JR
authors.lastname: Vest
mesh_terms: D003153:Community Health Services / Q000379:methods / Q000458:organization & administration / Q000592:standards*; D040362:Geographic Information Systems / Q000706:statistics & numerical data*; D066275:Health Information Exchange / Q000592:standards*; D006291:Health Policy; D006761:Hospitals; D006801:Humans; D033181:Information Dissemination / Q000379:methods; D011634:Public Health; D014481:United States