Health IT Research & Analysis
Data Briefs

Health Information Exchange Organization Capabilities to Support Public Health Data Exchange

No. 86 | June 2026
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State, local, and regional health information organizations (HIOs), some of which are considered health data utilities (HDUs), provide health information exchange services to member organizations that range from hospitals and doctor’s offices to behavioral health clinics and nursing facilities.(1) Past analyses indicate that HIOs can play an important role in promoting public health data exchange by facilitating the flow of information between health care providers and public health agencies (PHAs) and providing specific services to support PHAs such as filling data-related gaps, assisting with patient de-duplication efforts, data analysis, and data quality support.(2) This brief uses data on 76 HIOs from the 2025 National Survey of Health Information Organizations, a near census of state, regional, and local HIOs, to describe the current state of HIO connectivity to state, local, and tribal PHAs, and the types of services offered to support public health reporting and other core PHA responsibilities. This brief also provides information on PHAs’ utilization of these services, as observed by HIOs, and HIO-reported barriers to PHA connectivity that may hinder their ability to support routine PHA functions as well as critical data needs for a future public health emergency.

Highlights

  • In 2025, 67 of 76 surveyed HIOs (88%) reported being connected to at least one state, local, or tribal PHA.
  • A majority of connected HIOs offer public health reporting services (e.g., syndromic surveillance reporting) to participating health care providers to facilitate the flow of data to PHAs.  
  • In addition to facilitating the flow of information to PHAs, more than three-quarters of connected HIOs (78%) also receive data from PHAs (e.g., immunizations, COVID data).
  • Nearly two-thirds of connected HIOs (64%) provide data to PHAs to fill data-related gaps and about half report enabling frequent, real-time access to data for PHAs. 
  • While a majority of connected HIOs report feeling prepared to support PHA data needs for a future public health emergency, they also report various technical and capacity related barriers to PHA connectivity.

In 2025, about 9 in 10 HIOs were connected to a state, local, or tribal PHA.

Findings

  • In 2025, 67 of 76 surveyed HIOs (88%) reported being connected to at least one state, local, or tribal PHA.
  • Three-quarters of HIOs had at least 1 state connection, 58% had at least one local connection, and 16% had at least one tribal connection.

Figure 1: Percent of HIOs with at least one state, local, or tribal PHA connection.

Figure 1 contains a vertical column chart indicating the percentage of HIOs in 2025 that had at least one connection to a state, local, or tribal PHA. The chart shows that 88 percent of HIOs had any type of connection, 74 percent had at least one state connection, 58 percent had at least one local connection, and 16 percent had at least one tribal connection. Rates are shown in descending order.
Source: 2025 National Health Information Organization (HIO) Survey.
Notes: Denominator includes all HIO respondents to the public health question set in the 2025 HIO Survey (N = 76). See Data Sources and Methods for more details. Items come from the survey question: “Is your HIO connected to any state, tribal, local, or territorial public health agencies (PHAs)?”

A majority of connected HIOs offer services to their participants to facilitate public health reporting to PHAs.

Findings

  • Sixty percent (60%) of connected HIOs offer syndromic surveillance and immunization registry reporting services to participating healthcare providers to facilitate the flow of data to PHAs.
  • About half of connected HIOs offer electronic laboratory result reporting (54%) and other types of reporting services (e.g., COVID) (49%), while just under half offer services to support reporting to public health (40%) and clinical data registries (43%). Only one-third (36%) of connected HIOs currently support electronic case reporting, but 22% are in the testing or planning for this service.
  • In addition to facilitating the flow of information to PHAs, more than three-quarters of connected HIOs also receive data from PHAs (Appendix Figure A1).

Figure 2: Percent of connected HIOs that offer services to participating healthcare providers to facilitate public health reporting to PHAs, 2025.

Figure 2 contains a horizontal stacked bar chart illustrating the percentage of connected HIOs in 2025 that offer services to participating healthcare providers to facilitate 9 different types of public health reporting. Each bar uses shading to indicate the share of HIOs that are in production, in testing, or in planning for each reporting type. The chart shows that 60 percent of HIOs are in production for syndromic surveillance and immunization registry reporting. Fifty four percent are in production for electronic reportable laboratory result reporting, and 49 percent for other types such as COVID 19 reporting. Forty percent of HIOs are in production for public health registry reporting and 43 percent for clinical or specialized registry reporting. Thirty six percent of HIOs are in production for electronic case reporting, with an additional 22 percent in testing or planning. Smaller shares support bed capacity and resource utilization reporting and vital records reporting. Fifteen percent of HIOs offer none of the listed services.
Source: 2025 National Health Information Organization (HIO) Survey.
Notes: Denominator includes HIOs with at least one PHA connection (N = 67). Items come from the survey question: “Which of the following reporting services do you offer to your participating healthcare providers or PHAs?” Missing, “Not available,” and “Don’t know” responses not shown. * This item comes from a separate survey question: “What are your current capabilities to electronically receive hospital data on bed capacity and resource utilization?” Missing data (N = 3) not shown.

Findings

  • Nearly two-thirds of HIOs (64%) reported providing data to PHAs to fill data-related gaps.
  • Other common services offered by HIOs to connected PHAs include dashboarding and data visualization assistance (45%) and analytic and data quality support (45%) and bidirectional data sharing (43%).
  • While less commonly available, other important services offered to PHAs include use of a HIO’s Master Patient Index (MPI) for patient de-duplication (28%) and outbreak monitoring (27%).

Figure 3: Percent of connected HIOs that offer services to participating PHAs, 2025.

Figure 3 contains a horizontal bar chart showing the percentage of connected HIOs in 2025 that offer services to PHAs across 9 different service categories. The chart shows that the most common service is providing data to fill data related gaps, offered by 64 percent of connected HIOs. Dashboarding and data visualization assistance and analytic or data quality support are each offered by 45 percent of HIOs. Forty three percent support bidirectional data sharing or receiving data from PHAs. Less common services include using a Master Patient Index for patient de duplication (28 percent), outbreak monitoring and alerting (27 percent), and situational awareness (21 percent). Smaller shares report providing process automation, public health policy impact monitoring, or other services, while 12 percent report offering none of the listed services.
Source: 2025 National Health Information Organization (HIO) Survey.
Notes: Denominator includes HIOs with at least one PHA connection (N = 67). Items come from the survey question, “What other services does your HIO provide to PHA(s)?” Missing data (N = 2) not shown. *The item comes from a separate survey question: “Does or could your HIO currently provide data to PHA(s) to fill data-related gaps (e.g., missing demographic information)?” Missing data (N = 3) not shown.

Findings

  • While 64% of connected HIOs indicate they currently provide data to PHAs to fill data-related gaps, 24% report they could provide this information but do not currently do so.
  • The most common types of data currently provided—or could be provided—included lab results, admission discharge dates and locations, reason for hospitalization, and race/ethnicity data.
  • A greater proportion of HIOs indicated they could provide data on individuals’ health-related social needs, newborn screening, and substance use disorder diagnoses compared to the share that currently do so.  

Table 1: Percent of connected HIOs that currently provide, or could provide, data to PHAs to fill data-related gaps, overall and by data type.

Data TypeCurrently provideCould provide, but do not currently do so
Overall64%24%
Clinical Information
Problems54%33%
Prescribed Medications49%34%
Immunizations58%24%
Laboratory-Related Information
Laboratory Values/Results64%22%
Encounter-Related Information
Procedures52%33%
Admission and Discharge Dates and Locations60%27%
Encounters58%27%
Reason for Hospitalization60%27%
Newborn Screenings28%43%
Home Address or other contact information55%31%
Race/Ethnicity60%25%
Preferred Language49%30%
Health-related Social Needs33%39%
Substance Use Disorder Diagnosis18%39%
Source: 2025 National Health Information Organization (HIO) Survey.
Notes: Denominator includes HIOs with at least one PHA connection (N = 67).

Findings

  • Fifty-two percent of HIOs report that PHAs often (39%) or sometimes (13%) electronically receive or query data from the HIO (Panel A).
  • Over one-third of HIOs report that a majority of these data are accessed in real-time, while 22% report that access is a mix of real-time and lagged (Panel B).
  • A quarter of HIOs report both that PHAs often access the data provided to them and a majority of that access is in real time.

Figure 4: Frequency of PHA access to data from connected HIOs and extent to which access is real-time, as reported by HIOs that currently provide data to PHAs to fill data-related gaps.

Figure 4 has two panels summarizing how often PHAs access data provided by connected HIOs that fill data related gaps, and the extent to which this access occurs in real time. Panel A contains a single stacked column chart showing that HIOs report PHAs access data often (39 percent), sometimes (13 percent), rarely (3 percent), or never (3 percent), with an additional 3 percent indicating they do not know. Panel B contains a single stacked column chart showing that 37 percent of HIOs report most PHA access occurs in real time, 22 percent report a mix of real time and lagged access, and only 1 percent report that most access is lagged.
Source: 2025 National Health Information Organization (HIO) Survey.
Notes: Denominator includes HIOs with at least one PHA connection (N = 67); questions were only asked of respondents who indicated they currently provide data to PHAs to fill data-related gaps (N = 43). Panel A: Items come from the survey question: “How often do PHA(s) electronically receive or query these types of data from your HIO?” Panel B: Items come from the survey question: “To what extent is access to these types of data in real-time?” Missing and not applicable responses not shown.  

PHAs access data provided by connected HIOs through a range of different methods.

Findings

  • The most common method used by PHAs to access HIO-provided data is through single patient lookup through a portal, as reported by 54% of HIOs.
  • Nearly a quarter of HIOs (24%) reported that PHAs access these data through a Secure File Transfer Protocol (SFTP) or aggregate data/statistics.
  • The least common methods used by PHAs to access HIO-provided data is through batch query and response or HL7® Fast Healthcare Interoperability Resource® (FHIR®) application programming interface (API) query and response, as reported by 13% and 7% of HIOs, respectively.

Figure 5: Methods PHAs use to access data provided by connected HIOs, as reported by HIOs that currently provide data to PHAs to fill data-related gaps.

Figure 5 contains a horizontal bar chart showing five different methods PHAs use to access data provided by HIOs that fill data-related gaps. The most common method used by PHAs is single patient lookup through a portal, reported by 54 percent of HIOs. About 24 percent report that PHAs access data through Secure File Transfer Protocol (SFTP) or by receiving aggregate statistics. Thirteen percent report batch query and response, while 7 percent report use of FHIR API–based query and response. Seven percent report other methods.
Source: 2025 National Health Information Organization (HIO) Survey.
Notes: Denominator includes HIOs with at least one PHA connection (N = 67); questions were only asked of respondents who indicated they currently provide data to PHAs to fill data-related gaps (N = 43). Items come from the survey question: “How are PHA(s) accessing these types of data?” Missing and not applicable responses not shown.

Findings

  • While a majority of HIOs report feeling prepared to support PHA data needs for a future public health emergency (Appendix Figure A2), HIOs report various barriers to PHA connectivity.
  • The most reported major barriers to PHA connectivity were HIOs’ perception that PHAs had other priorities (31%), limited funding from PHAs (25%), and that PHAs lack the capability to receive or process messages (19% and 18%, respectively).
  • The most reported minor barriers to PHA connectivity were HIOs’ perception that PHAs lacked staffing (36%), need for data use agreements (33%), and technical limitations of PHAs (39%).

Figure 6: Percent of connected HIOs reporting major and minor barriers to PHA connectivity.

Figure 6 contains a horizontal stacked bar chart illustrating 12 different major and minor barriers experienced by connected HIOs in 2025 when trying to maintain connectivity with PHAs. Each bar uses shading to indicate the share of HIOs that reported “major” versus “minor” barriers. The most frequently reported major barriers include PHAs having other priorities (31 percent), limited PHA funding (25 percent), and PHAs lacking the capability to receive (19 percent) or process (18 percent) electronic messages. Common minor barriers include technical limitations on the part of PHAs (39 percent), PHA staffing shortages (36 percent), the need for data use agreements (33 percent), and limited funding from HIO participants or statutory restrictions. Smaller shares report other technical, financial, or consent related barriers.
Source: 2025 National Health Information Organization (HIO) Survey.
Notes: Denominator includes HIOs with at least one PHA connection (N = 67). Items come from the survey question: “To what extent have you experienced the following barriers within the last year to PHA connectivity?” Responses indicating “To a great extent” or “Somewhat” were labeled as ‘Major’ and ‘Minor’ barriers. Missing, “Very little,” “Not at all,” and “N/A” responses not shown.

Summary

Data from the 2025 National Health Information Organization (HIO) Survey demonstrates that HIOs are deeply engaged in supporting public health data exchange. In 2025, 88% of HIOs (67 of 76) reported being connected to at least one state, local, or tribal PHA. Three-quarters of HIOs had state-level connections, 58% had local connections, and 16% had tribal connections. These findings suggest that early federal investments in local, regional, and state HIOs and pandemic-era funding to strengthen HIO support for PHAs’ public health emergency response efforts may have contributed to a broadly established connectivity baseline.(3-5)

Prior work has also shown that connected HIOs support public health data exchange by facilitating electronic public health reporting from health care providers to PHAs.(6) Over 60% of connected HIOs offer syndromic surveillance and immunization registry reporting services to participating healthcare providers to facilitate reporting to PHAs, while 54% support electronic laboratory reporting and 49% support other reporting (e.g., COVID-19). While less than half of connected HIOs currently support registry reporting, vital records reporting, or electronic case reporting, several HIOs are in testing or planning for these reporting types. In addition to facilitating reporting to PHAs, more than three-quarters of connected HIOs reported receiving public health data from PHAs in 2025. The most common types of data received were immunizations (45%), data related to COVID-19 (36%), and laboratory orders and/or results (34%), while less than a quarter of connected HIOs received registry data, vital records, or reportability responses to initial case reports. Overall, rates of data received mirror patterns observed in the availability of HIO services to support reporting as well as observed rates of electronic public health reporting among non-federal acute care hospitals (7), where rates are consistently higher for reporting types required or incentivized by the Centers for Medicare & Medicaid Services Promoting Interoperability programs.(8)

Beyond facilitating the flow of information between health care and public health, HIO services have increasingly evolved to support PHAs directly by filling data-related gaps, providing data analytics and data visualization support, facilitating bi-directional exchange, and assisting with patient de-duplication. Some HIOs also offer services for outbreak monitoring, situational awareness, and process automation. In 2025, nearly two-thirds (64%) of connected HIOs indicated they currently provide data to PHAs to fill data-related gaps such as for clinical, laboratory, and encounter-related information (e.g., race/ethnicity, home address). Additionally, 24% of connected HIOs indicated they could, but don’t currently provide this information, which suggests nearly a quarter of connected HIOs have untapped potential to fill data-related gaps for PHAs. The ability of HIOs to supplement missing demographic and encounter data supports ongoing efforts to improve data quality and completeness and increase standardized data capture.

About half of HIOs nationally report that PHAs electronically receive or query these data often (39%) or sometimes (13%), and 37% report that most access occurs in real-time. Real-time access strengthens preparedness and response capacity, reinforcing the importance of continued commitment to building scalable exchange infrastructure. However, most PHAs access HIO data through single patient portal lookup (54%). Only 7% of HIOs report that PHAs use FHIR® API-based query and response, and 13% report batch query and response. This reliance on portal-based access rather than standards-based APIs highlights a potential barrier to interoperable exchange. While federal policy has prioritized FHIR adoption, our findings here and elsewhere indicate uptake is limited among HIOs.(9) Accelerating FHIR-based public health use cases, increased participation in the Trusted Exchange Framework and Common AgreementTM (TEFCATM) for public health exchange purposes, and targeted implementation funding could improve scalability and automation.(10)

Overall, a majority of HIOs report feeling at least somewhat prepared to support PHA data needs for a future public health emergency. However, HIOs report numerous perceived barriers to PHA connectivity— including PHA staffing challenges, limited funding, or technical limitations—that may hinder their ability to effectively support PHAs in future public health emergencies. Efforts to identify barriers to connectivity and data exchange from the perspective of PHAs would help shed light on the extent to which HIOs and PHAs experience common barriers and can inform solutions to improve access and exchange. Together, our findings indicate the value of HIOs in supporting public health data exchange and the importance of continued investment in public health workforce and infrastructure that will help enable PHAs to access the data they need to support critical public health activities.(11) 

Data Sources and Methods

Data are from the 2025 National Health Information Organization (HIO) Survey. Since 2020, the Office of the National Coordinator for Health Information Technology (ONC) has partnered with Civitas Networks for Health (Civitas) to assess the HIO landscape in the U.S. and provide a comprehensive picture of current HIE coverage, efforts, and capabilities, including HIO support for public health data exchange. ONC funded the 2025 HIO Survey, led by Julia Adler-Milstein, PhD, Professor and Director of the Division of Clinical Informatics and Digital Transformation at University of California San Francisco (UCSF).

The 2025 National HIO Survey was fielded November 2024 to July 2025. Leadership from 99 HIOs were invited to participate in the survey with the option of completing it via the online survey tool Qualtrics© or over the phone. Non-respondents received follow-up reminders to encourage response. Respondents were offered a $50 gift card for completing the survey or a $10 gift card if they were screened out. 12 HIOs were determined to be ineligible for the survey. Of the 87 HIOs that were determined to be eligible for the survey, there were 77 respondents (89% response rate), two of which were partial respondents. One of the partial respondents did not complete any of the questions in the public health question set and was therefore excluded from the denominator for this analysis, resulting in a sub-sample of 76 HIOs. The other partial respondent to the survey completed most, but not all, of the public health question set and was therefore included in the denominator for questions that were completed and was treated as missing for questions that were left unanswered.

Data Availability

Data are available upon request. Please contact ONC_Data@hhs.gov.

References

  1. Consortium of State and Regional Interoperability. The CSRI Health Data Utility Capability Model. Accessed: February 25, 2026. Available from: https://thecsri.org/the-csri-health-data-utility-capability-model/.         
  2. Rosenthal S, Adler-Milstein J, Patel V. Public Health Data Exchange Through Health Information Exchange Organizations: National Survey Study. JMIR Public Health Surveill. 2024 Nov 15;10:e64969
  3. Office of the Assistant Secretary for Technology Policy. HITECH Act. Washington (DC): Office of the Assistant Secretary for Technology Policy. Accessed February 17, 2026. Available from: https://healthit.gov/legislation/#hitech-act.          
  4. Centers for Disease Control and Prevention. How CDC is Supporting Jurisdictional Public Health Departments. Atlanta (GA): Centers for Disease Control and Prevention. Accessed February 17, 2026. Available from: https://www.cdc.gov/csels/dmi-support/supporting-jurisdictional-public-health-departments.html.
  5. Program Evaluation for the Strengthening the Technical Advancement and Readiness of Public Health via Health Information Exchange (STAR HIE) – Cooperative Agreement Program. August 30, 2023. Available from: https://healthit.gov/wp-content/uploads/2024/03/STAR-HIE-Program-Evaluation_Final-Report_508.pdf.
  6. Richwine C, Strawley C, Chang W, Everson J. Assessing the value of health information exchange organizations to hospital interoperability. Health Aff Sch. 2025 Jun 27;3(7). Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC12247827/#qxaf133-B10.           
  7. Owusu-Mensah P, Richwine C. Electronic Public Health Reporting Among Non-Federal Acute Care Hospitals. Office of the Assistant Secretary for Technology Policy. Data Brief: 78. July 2025. Available from: https://healthit.gov/data/data-briefs/electronic-public-health-reporting-among-non-federal-acute-care-hospitals-2024/.
  8. Centers for Medicare & Medicaid Services. 2025 Medicare Promoting Interoperability Program Requirements. Baltimore (MD): Centers for Medicare & Medicaid Services. Available from: https://www.qualityreportingcenter.com/globalassets/2025/01/iqr/pi_infographic_cy-2025-requirements_jan2025_vfinal_508.pdf.      
  9. Chang W, Larson J, Strawley C. Standards Adoption among Health Information Exchange Organizations. Office of the Assistant Secretary for Technology Policy. Data Brief: 75. September 2024.
  10. Office of the Assistant Secretary for Technology Policy. TEFCA. Washington (DC): Office of the Assistant Secretary for Technology Policy. Accessed February 17, 2026. Available from: https://healthit.gov/policy/tefca/.
  11. Centers for Disease Control and Prevention. Public Health Infrastructure Grant. Atlanta (GA): Centers for Disease Control and Prevention. Available from: https://www.cdc.gov/infrastructure-phig/media/pdfs/2026/01/CDC-Public-Health-Infrastructure-Grant.pdf.        

Acknowledgments

The authors are with the Office of Standards, Certification, and Analysis, within the Office of the National Coordinator for Health Information Technology (ONC). The data brief was drafted under the direction of Mera Choi, Director of the Technical Strategy and Analysis Division, Vaishali Patel, Deputy Director of the Technical Strategy and Analysis Division, and Wesley Barker, Chief of the Data Analysis Branch.

Suggested Citation

Richwine C. Health Information Exchange Organization Capabilities to Support Public Health Data Exchange. Office of the National Coordinator for Health Information Technology. Data Brief: 86. June 2026.

Appendix

Appendix Figure 1. Types of data HIOs receive from connected PHAs.

Bar chart showing the types of data that Health Information Organizations (HIOs) receive from connected public health agencies (PHAs). The most commonly received data type is immunization information (about 45%), followed by COVID 19–related data (36%) and laboratory orders or results (34%). Smaller proportions of HIOs receive vital records, clinical data registry information, public health registry data, and reportability responses. Approximately 15% report receiving no data.
Source: 2025 National Health Information Organization (HIO) Survey.
Notes: Denominator includes HIOs with at least one PHA connection (N = 67). Items come from the survey question: “Which of the following types of data do you receive from PHAs with which you have established connectivity?” Missing, “None,” “Other,” and “Don’t know” responses not shown.

Appendix Figure 2: Extent of connected HIO preparedness to support PHA data needs during a future public health emergency.

Pie chart showing the extent to which connected Health Information Organizations (HIOs) feel prepared to support public health agency data needs during a future public health emergency. About 63% report feeling prepared “to a great extent,” 34% report feeling “somewhat” prepared, while roughly 1.6% each report feeling prepared “very little” or “not at all.”
Source: 2025 National Health Information Organization (HIO) Survey.
Notes: Denominator includes HIOs with at least one PHA connection (N = 67). Missing values (N=3) were excluded from the denominator. Survey question: “To what extent do you feel prepared to support PHA data needs for a future pandemic?”