Interstate health-information exchange: understanding value propositions and challenges

Abstract: Regional intrastate and statewide health-information exchanges help to connect patients' disparate intrastate electronic health records. Intrastate electronic health-information exchange is necessary, yet it does not sufficiently serve the needs of a mobile population, expanding health systems, or a concentration of specialized providers in urban centers serving geographically distant patients. The purpose of this multicase study, consisting of interview data collected from seven states and an intrastate health-information exchange literature review, is to explore the value propositions and challenges for connecting states through interstate exchange. Findings show that attention must be placed on expanding the interstate exchange of patient health data, as 1) many health systems cross state lines, 2) many providers serve patients in different states, and 3) patients are increasingly willing to travel long distances to receive specialized medical attention. An extended discussion contextualizes the findings in consideration of national health-information exchange. Keywords: direct exchange, query-based exchange, electronic health record