Health Information Exchange as a Complex and Adaptive Construct: Scoping Review

Objective:
To understand how the concept of Health Information Exchange (HIE) has evolved over time.

Methods:
Supplementary analysis of data from a systematic scoping review of definitions of HIE from 1900 to 2014, involving temporal analysis of underpinning themes.

Results:
The search identified 268 unique definitions of HIE dating from 1957 onwards; 103 in scientific databases and 165 in Google. These contained consistent themes, representing the core concept of exchanging health information electronically, as well as fluid themes, reflecting the evolving policy, business, organisational and technological context of HIE (including the emergence of HIE as an organisational ‘entity’). These are summarised graphically to show how the concept has evolved around the world with the passage of time. The term HIE emerged in 1957 with the establishment of Occupational HIE, evolving through the 1990s with concepts such as electronic data interchange and mobile computing technology; then from 2006-10 largely aligning with the US Government’s health information technology strategy and the creation of HIEs as organisational entities, alongside the broader interoperability imperative, and continuing to evolve today as part of a broader international agenda for sustainable, information-driven health systems.

Conclusions:
The concept of HIE is an evolving and adaptive one, reflecting the ongoing quest for integrated and interoperable information to improve the efficiency and effectiveness of health systems, in a changing technological and policy environment.