Mapping the Landscape of Health Information Exchange (HIE) Networks in the United States

Since the 1990s, there has been ongoing investment in the development of health information exchanges (HIES) in the United States. However, HIE innovation has diffused throughout the health provider organizations in the country at a disappointingly slow manner. The fact that multiple stakeholder domains (that have often conflicting different policy, technical and social positions) affect HIE innovation constitutes one possible reason for this slow diffusion. Therefore, to understand the diffusion pace, one must account for structural differences in different kinds of HIE networks. However, we lack existing research on this dilemma. In the information systems (IS) discipline, research has focused on individual HIE instantiations. In the health policy domain, research has summarized different forms of HIE networks without applying theoretical lenses to explore structural differences among them. Further, HIE value research lacks consensus on measurement criteria due to these divergent motivations for HIE instantiations. To that end, in this paper, we 1) describe the current HIE network landscape in the United States from an organizational perspective, 2) propose a framework for future research to address structural differences among HIE networks, and 3) demonstrate how network type acts as a boundary condition for measuring exchange behaviors and outcomes.