Status of Health Information Exchange: A Comparison of Six Countries

Background Health information exchange (HIE) is frequently cited as
an important objective of health information technology investment because
of its potential to improve quality, reduce cost, and increase patient
satisfaction. In this paper we examine the status and practices of HIE in
six countries, drawn from a range of higher and lower income regions.
Methods For each of the countries represented – China, England, India,
Scotland, Switzerland, and the United States – we describe the state of
current practice of HIE with reference to two scenarios: transfer of care
and referral. For each country we discuss national objectives, barriers and
plans for further advancing clinical information exchange.
Results The countries vary widely in levels of adoption of EHRs, availability
of health information in electronic form suitable for HIE, and in
the information technology infrastructure to be used for transmission.
Common themes emerged, however, including an expectation that information
will be exchanged rather than gathered anew, the need for incentives
to promote information exchange, and concerns about data security
and patient confidentiality.
Conclusions Although the ability to transfer health information to where
it is most needed is nearly always mentioned as an advantage of HIE
adoption, there are wide differences in the degree to which this has been
achieved to support the scenarios used in this study. Nevertheless, these
differences indicate varying stages of progress along a comparable pathway,
with similar barriers being identified in the countries described. In
some cases, these have been partially surmounted while elsewhere work
is needed. We reflect on contextual factors influencing the status and direction
of HIE efforts in different global regions and their implications
for progress.