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According to Melvin (25), health information exchange refers to the process of electrically transmitting healthcare related data among health facilities and organizations. She points out that this process of sharing healthcare information is devised in a manner that enhances the confidentiality, privacy and security of information. Generally, health information exchange (HIE) is a primary component of the health information technology (HIT) that enhances a reliable transfer, easy accessibility and secure extraction of healthcare information (Melvin 25).

Melvin (26) points out that various Health Information Organizations (HIOs) deploy privacy and security policies that enable effective storage and sharing of healthcare information. For instance, she notes that these organizations implement Health Information Management (HIM) that encourages the quality and safety of the patient’s information, which, in turn, reduces the cost of healthcare services. The write up analyzes health information exchange by pointing out various aspects that are related with the practice. It highlights the process’s historic background, challenges, associated with it, the privacy and security measures that it entails. It also examines its benefits and the role, played by the information network, as well as both its financial sustainability and future.

History of Health Information Exchange

According to Morrissey (1), the evolution of health information exchange was primarily contributed by the necessity of improving the healthcare quality and that of reducing its cost. He points out that during the past two decades, various countries, especially the United States, experienced problems of patients’ healthcare information exchange as their healthcare data were typically stored in various health locations. He notes that since there were no effective and reliable healthcare information technologies, doctors and pharmacists were unable to effectively provide the patients’ health record, especially whenever patients were involved in accidents far from their personal doctors.

In 1990s, various health care technologists attempted to establish such systems as the community health management information system (CHIMS) and the community health information network (CHIN). They were meant to give the various healthcare centers a chance to benefit more from patients’ health information. Morrissey (1) notes that these approaches were not successful as the U.S. federal government did not actively participate in them. Furthermore, the programs lacked effective implementation policies. For instance, one of the executive directors of the Michigan Health Connect, an HIE network, notes that the old days were characterized by typical data storage as most of the communities health centers used papers to store patients’ health record (Morrissey1).  

However, Morrissey (1) notes that in 2004 the U.S. president Bush through his administration established and funded the regional health information organization (RHIO), which was developed to enhance HIE. He points out that the effectiveness of the organization in enhancing health information exchange enabled more investment in health information technology to improve healthcare efficiencies. This, in turn, led to the development of National Health Information Network (NHIN).

In 2009, the healthcare information exchange practice was boosted by the enactment and passage of Health Information Technology for Economic and Clinical Health Act (HITECH Act). According to Morrissey (1), this legislation encompasses the ability to exchange healthcare information between different providers. Moreover, he notes that the legislation incorporate health privacy as it encourages the privacy, security, and confidentiality of the information, concerning patients. Furthermore, in 2010, the U.S. government advanced the National Health Information Network, which bars some of the government agencies from accessing various peoples’ health information, hence, improving the efficiency of healthcare information exchange.

Challenges of Health Information Exchange

According to Vest and Gamm (288), health information exchange has encountered various challenges that are based on the ineffectiveness of securing and creating accurate health information. They point out that the isolation of health information systems within health facilities have made it difficult in sharing patients’ health information, especially during health emergencies. For instance, most of the chronic diseases require the patient’s health information before being treated. Therefore, in cases, where health information of the patient cannot be effectively accessed due to poor storage methods, such patients’ lives would be in danger. Vest and Gamm (288) point out that health information exchange has been facing various challenges, especially those, caused by natural disasters. This normally happens in cases, where the patients’ health records were recorded in paper. They note that natural disaster such as flood normally displaces people, making it difficult for the health providers in the places, where these personalities have settled to access the patients’ health status.

Lack of affordable and effective health technology has been one of the challenges that have continuously affected the health information exchange. Vest and Gamm (288) point out that most of the health centers, especially in the rural areas, lack adequate and effective health technologies due to their associated high costs and, therefore, typically store their patients’ health records. For instance, in the past, the community health information management system (CHIMS) was too costly, as it required various health organizations to intensively use network connections, health software and hardware (Vest and Gamm 288). Therefore, the patients’ health information was vulnerable as their privacy and confidentiality were at stake.

According to Vest and Gamm (289), another factor that has continued to affect health information exchange is the insufficiency of funds. For instance, they point out that the regional health information organization (RHIO) required approximately twelve billion U.S. dollars for its development and a further three billion dollars for its operations. These funds were not adequately provided and leading to the inability of RHIO to develop the effective health information exchange programs and technologies.

On the other hand, Vest and Gamm (289) point out that the low technological knowhow of medical practitioners was also another challenge that affected the health information exchange. They note that most of the doctors and pharmacists, especially in the past, lacked the basic knowledge of health information technology, hence, they found it difficult to either record or retrieve health record of patients. Due to their inadequate technological knowhow, most of the medical practitioners, especially the nurses, exposed the health information of various patients, which, in turn, affected the privacy and confidentiality of their health status.

The Privacy and Security Measures, Associated with Health Information Exchange

According to Marshall and Mitchell (6), the primary objective of health information exchange is to enhance the privacy and security of the patients’ health information. They note that various government health authorities have engaged various information technologies that not only improve the accessibility of healthcare services but also address the privacy and security measures, required by these authorities in sharing the patients’ health information. The privacy and security of health information is paramount, especially in building trust between the patient and the health care providers (Marshall and Mitchell 6).

Morrissey (1) points out that the HITECH Act incorporates rule and regulations that defines the healthcare providers’ role in protecting the privacy and security of the patients’ health. He notes that one of the principal privacy guideline in the HITECH Act is the provision that allows all the records and information about healthcare to be taken as confidential. This provision clearly indicates the legal perspective, to which the healthcare providers are bound, especially in sharing the patients’ information with others. On the other hand, the legislation addresses the illegality of taking control of patients’ health information by either altering the recorded health data or disclosing their health information to authorized people.

In implementing such privacy and security measure in the health sectors, the law had stipulated adverse penalties on those who would breach such laws and regulations. For instance, section 13410 of the HITECH Act indicated a penalty to an amount of $1.5 million for anyone found in violation of the health insurance portability and accountability (HIPAA) privacy and security rules. On the other hand, the HIPAA privacy and security rule provided a legal framework that requires both the privacy and security personnel to design policies and procedures that would effectively enable the exchange of health information without prejudicing the corresponding patients (Marshall and Mitchell 10).

Benefits of Health Information Exchange

According to Morrissey (1), the health information exchange has effectively enabled easier sharing of health records that has been beneficial in reducing the healthcare cost. He points out that the HIE involves health information network programs that enable healthcare providers to easily access and retrieve health records of patients, especially in times of emergencies. For instance, most health providers have found it efficient to use mobile phones or internet to acquire the information on the patients’ health records; this has not only reduced the operation cost but has also helped decrease the total health cost (Morrissey 1).

Another benefit of enhancing health information exchange is its ensuring effectiveness in promoting quality healthcare services. According to Vest and Gamm (289), doctors have found it easier handling patients, especially those who suffer from chronic diseases such as diabetes. This is because they can now use technology, involved in the health information exchange, to gain access to the patients’ health record, thereby, promoting their health services. They note that electronic health record system has enabled to access the current health status of patients, hence, promoting healthcare service delivery.

According to Vest and Gamm (286), various enacted legislations on health information exchange have increased the country’s revenue income. They note that the HITECH Act recommends the use of electronic technology in the health centers for the exchange of health information as it will accounts for any health incentive payment made. Moreover, they point out that the enactment of HITECH Act portrays more of business investment regulation in the health sector, which, in turn, promotes tax collection. On the other hand, they note that the regulations that are defined by the law promote trust between health providers and patients, which is essential for healthcare service delivery.

The Role of Information Network

Vest and Gamm (288) note that information networks played an important role in maintaining the independency of health providers’ database. For instance, the National Health Information Network enhances a standardized health recording procedures and regulations that enable each health provider to manage and account for the patients’ health records. This would enable them to securely exchange the patients’ health information with others through internet (Vest and Gamm 288).

According to Morrissey (1), the information network ensures inter-connectivity of various healthcare agencies. For instance, he points out that the National Health Information Network has made it possible for the inter-connection of National Cancer Institute and the Veterans Administration, which are health agencies. Towards this initiative, most of the agencies have been able to share various concerned health information of a given disease, thereby, devising appropriate medical measures to be taken.

Financial Sustainability of Health Information Exchange

As have been illustrated earlier, the financial constrain has been one of the undermining factors that posed challenges on the effectiveness on health information exchange. According to Marshall and Mitchell (10), health information exchange entails various technologies and procedures that require adequate funding for sustainability. They point out that health information exchange require enough funds for both the development and operation of its technologies. In most cases, government has been the sole financial contributor making it hard for the facilities to obtain enough financial allocations to finance the program.

On the other hand, Marshall and Mitchell (10) point out that many health technologists have invested in various health information technologies by providing funds that promotes effective health information exchange. However, apart from the U.S. government, which has continued to allocate more than half million dollars annually for the HIE, the local health organizations have also stepped in to help raise funds to help improve and sustain the HIE (Morrissey 1).

Future of HIE

According to Morrissey (1), the advancement of health information technology continues to offer brighter future for the health information exchange. He points out that these technologies continuously improve the quality and efficiency of healthcare service delivery, based on improved HIE. Furthermore, he notes that the enactment of the economic, privacy, and security legislations such as the HITECT Act offers the potentiality of HIE in promoting healthcare service delivery. However, Marshall and Mitchell (10) point out that the future of HIE is based on adequate funding that enhances both the development and operation of various programs, associated with the HIE.


Health information exchange is an important entity in enhancing quality and securing healthcare service technologies. It is particularly significant in safeguarding the patients’ health status, especially during the sharing of health information. There is, thus, a need for health related organizations to enhance and implement various HIE legislation. This will not only protect the health status of patients but will also effectively enable health providers to easily access relevant patients’ health information. There is also the need for various supporting agencies to increase the funding for HIE for its future effective healthcare service delivery.

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