What’s in a Name? Breaking Down Health Information Exchange, One Definition at a Time

By Ellen Shakespeare Karl, MBA, RHIA

Most of us are just now getting used to the sea of acronyms associated with the initiatives enacted by the Office of the National Coordinator (ONC). But HIE is a difficult one. Is it a noun or a verb? This question has created some confusion in the industry, especially for those on the outside of the program development, looking in.

ONC has named the health information exchange program the State Health Information Exchange Cooperative Agreement Program. The term "HIE," acronym for health information exchange, is being used interchangeably to define both the organization that is responsible for managing the exchange of the data (the noun) and the process by which the data can be exchanged (the verb).

But what about the health insurance exchanges required under the Patient Protection and Affordable Care Act of 2010 (PPACA)? The logical acronym would be HIE, but they have instead been labeled HIXs. With multiple potential definitions currently available for an entity that fills a role within the realm of health information exchange, this article takes a closer look at the individual elements that work together to make HIE a reality.

HIE, the Noun

Health information exchanges (as a noun) have been an industry hot topic of late. ONC has already set the stage with their programs. The regional extension centers have made tremendous strides in moving physician practices to meaningful use. States are determining the best method for operational ease within the HIEs for their constituency. As ONC was being established in 2004 by President George W. Bush, Regional Health Information Organizations (RHIOs) began to pop up around the country.

Early members of the RHIO field included Utah and Massachusetts. Intermountain Healthcare in northern Utah and southeastern Idaho serves 22 hospitals, and a full range of medical services, multi-specialty clinics, and physician offices, as well as 32,000 patients.1 Kaiser Permanente, Geisinger, Cerner, McKesson, the Mayo Clinic, Massachusetts General Hospital, and the Cleveland Clinic have developed medical networks together in order to share health-related information. In response to ONC's Cooperative Agreement Program, these early RHIOs have generally changed in name to HIEs. According to the ONC web site, HIEs are located in a variety of state offices.2 They vary from the Medicaid office in Alabama to the Enterprise HIT Coordinator, Office of the CIO, in the state of Wyoming. In New Jersey, these entities are now being referred to as HIOs to avoid confusion.

Those in the health information management profession can expect to be involved, and may even find employment in these HIE organizations where their expertise is a valuable resource. A recent HIE job posting lists the following attributes: "This individual will plan, organize, and direct the overall design, development, and operation for implementation of the HIE. In addition, the individual will oversee operations, strategy, financing, physician relationship related to HIE, and regulatory compliance." HIM professionals are uniquely qualified for such a position. Understanding the landscape of the HIE/HIO organizations in your state will assist you in determining how the involvement of HIM professionals can make an impact.

HIE, the Verb

What is the process (the verb form), then, of health information exchange? There is wide variety, from organization to organization and from state to state. However, ONC has clearly designated that all states must establish a plan to enable the following priority HIE capabilities:

  • e-prescribing, receipt of structured lab results
  • sharing of patient care summaries across unaffiliated organizations

The process is the more technical aspect of how information will be exchanged. Such an exchange requires a tremendous amount of collaboration between stakeholders to ensure that all information is exchanged in accordance with standards established by the ONC and adheres to the privacy and security framework outlined by the Department of Health and Human Services (HHS). These are the folks who make the exchange of information happen.

HIE, Known as HIX

The third acronym that could be confused for HIE is "HIX," or health insurance exchange. These exchanges are newly created entities that have evolved as a result of the PPACA. Simply said, these entities will offer patients the ability to choose a health plan based on price. HIXs have longer term goals, including assistance in health insurance market reform. With implementation due to occur in 2014, more than $49 million has been distributed to 48 states. The early HIE innovators in Massachusetts and Utah will be utilizing their already existing exchanges to implement their HIXs. There are many different platforms being developed to implement statewide HIXs. HHS is developing a federal HIX for those states electing not to develop their own. The federal HIX will be operational on January 1, 2014.

The Whole Story

Between the noun, the verb, and the HIX, we've broken down the lexicon of health information exchange and identified the key components that work together to ensure that HIE goals are met. With these organizations and processes in development, the industry is prepared to increase connectivity and enable patient-centric information flow, improving the quality and efficiency of care with the aim of nationwide interoperability.


  1. Intermountain Healthcare. "About Intermountain Healthcare." www.intermountainhealthcare.org.
  2. The Office of the National Coordinator for Health Information Technology. "State Health Information Exchange Cooperative Agreement Program Key Contacts." U.S. Department of Health and Human Services. www.statehieresources.org/contacts.


Friedman, Allan et al. "Health Information Exchanges and Megachange." Brookings. February 8, 2012. http://www.brookings.edu/papers/2012/0208_health_info_exchange_friedman_west.aspx.

The Henry J. Kaiser Family Foundation. "Explaining Healthcare Reform: What Are Health Insurance Exchanges?" May 2009. http://www.kff.org/healthreform/upload/7908.pdf.

The Office of the National Coordinator for Health Information Technology. "State Health Information Exchange Cooperative Agreement Program." US Department of Health and Human Services. http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__state_health_information_exchange_program/1488.

The White House. "2012 Progress Report: States Are Implementing Health Reform." http://www.whitehouse.gov/sites/default/files/01-18-12_exchange_report.pdf.

Ellen Shakespeare Karl (eshakesp@raritanval.edu) is coordinator for HIT, medical coding, and EHR programs at Raritan Valley Community College. She is president of NJHIMA and serves on AHIMA's Council for Excellence in Education and AHIMA's Health Information Exchange Practice Council.

Article citation:
Karl, Ellen Shakespeare. "What’s in a Name? Breaking Down Health Information Exchange, One Definition at a Time" Journal of AHIMA 83, no.6 (June 2012): 62-63.