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Learning from Health Information Exchange Technical Architecture and Implementation in Seven Beacon Communities

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The Issue

The federal government is offering financial and technical assistance to help health care providers adopt and use health information technology to improve patient care, reduce costs, and promote a healthier population. Doing so requires developing an infrastructure for health information exchange (HIE)—the secure, electronic movement of health-related information among different users. In this case study, a team led by Douglas McCarthy of The Commonwealth Fund looked at seven communities that participated in the Beacon Community Program—which awarded federal funds to communities to further develop their health IT to support health care delivery and payment reforms—and the choices they made in building their HIE capabilities.

What the Study Found

In addition to choosing different HIE models—decentralized, centralized, or a hybrid model—each community had to consider many common internal and external factors. These included:

  • assessing existing trust levels in the community;
  • identifying strengths and weaknesses of the health IT infrastructure;
  • considering sources of funding and timing of investments;
  • evaluating HIE vendor capabilities;
  • preparing to engage with providers to standardize data; and
  • assessing the implications of privacy regulations and expectations.


While the communities profiled in the study pursued a variety of approaches to building their HIE capabilities, the findings suggest that a robust HIE will require a centralized data repository and a method of accessing data on patient cohorts to support quality improvement, population health management, public health surveillance, and research and evaluation objectives. It seems unrealistic, the authors say, to expect that simply linking disparate electronic health record systems will allow such advanced health IT functionality. Building and leveraging trust was crucial for communities to share data, and especially for implementing central repositories. Each community must determine the best way to create this functionality based on its particular needs.

Publication Details



Mary Mahon, Former Vice President, Public Information, The Commonwealth Fund

[email protected]


D. B. McCarthy, K. Propp, A. Cohen et al., “Learning from Health Information Exchange Technical Architecture and Implementation in Seven Beacon Communities,” eGEMS, May 5, 2014 2(1).