Public Health Data Exchange Through Health Information Exchange Organizations: National Survey Study

The COVID-19 pandemic revealed major gaps in public health agencies' (PHAs') data and reporting infrastructure, which limited the ability of public health officials to conduct disease surveillance, particularly among racial or ethnic minorities disproportionally affected by the pandemic. Leveraging existing health information exchange organizations (HIOs) is one possible mechanism to close these technical gaps, as HIOs facilitate health information sharing across organizational boundaries.

The aim of the study is to survey all HIOs that are currently operational in the United States to assess HIO connectivity with PHAs and HIOs' capabilities to support public health data exchange.

Drawing on multiple sources, we identified all potential local, regional, and state HIOs that were operational in the United States as of March 1, 2022. We defined operational as HIOs that facilitated exchange between at least 2 independent entities. We fielded a survey among our census list of 135 HIOs in January-July 2023. The survey confirmed HIO status as well as captured organizational demographics and current and potential support for PHAs. We report descriptive statistics on HIO demographics and connectivity with PHAs. We also include results on services and data available to support PHAs, funding sources to support public health reporting, and barriers to public health reporting. Of the 135 potential HIOs that received the survey, 90 met our definition of an HIO, and 77 completed the survey, yielding an 86% response rate.

We found that 66 (86%) of HIOs in 45 states were electronically connected to at least 1 PHA, yielding 187 HIO-PHA connections across all HIOs. Among HIOs connected to PHAs, the most common type of public health reporting supported by HIOs was immunization registry (n=39, 64%), electronic laboratory result (n=37, 63%), and syndromic surveillance (n=34, 61%). In total, 58% (n=38) of HIOs connected to PHAs provided data to address COVID-19 information gaps, and an additional 30% (n=20) could do so. The most common types of data provided to PHAs were hospitalization information (n=54, 93%), other demographic data (n=53, 91%), health information (eg, chronic health conditions; n=51, 88%), and hospital laboratory results (n=51, 88%). A total of 64% (n=42) of HIOs provided at least 1 type of data analytic service to PHAs to support COVID-19 pandemic response efforts. Top HIO reported barriers to support PHA activities included limited PHA funding (n=21, 32%) and PHAs' competing priorities (n=15, 23%).

Our results show that many HIOs are already connected to PHAs and that they are assuming an emerging role to facilitate public health reporting. HIOs are well-positioned to provide value-added support for public health data exchange and address PHAs' information gaps, as ongoing federal efforts to modernize public health data infrastructure and interoperability continue.