24 Health Information Exchange (HIE) Statistics: Essential Data for Legal and Healthcare Professionals in 2025

Comprehensive data compiled from extensive research on medical record interoperability, adoption trends, and clinical outcomes across healthcare and legal sectors

Key Takeaways

• Adoption-utilization gap creates opportunity - Only 42% of clinicians routinely use external clinical information through HIE networks
• Behavioral health represents underserved market segment - Only 43% of facilities send records and 37% receive records from outside organizations, lagging 30-40 percentage points behind general hospitals despite federal integration mandates and revised privacy regulations
• Cross-sector exchange failure persists nationwide - Despite widespread HIE adoption, only 16% of hospitals send summary of care records to long-term post-acute care providers and 17% to behavioral health providers, creating critical gaps in care coordination precisely where legal and healthcare practices need comprehensive patient histories
• Record retrieval inefficiency drains resources - Healthcare organizations waste 9.7 hours daily on manual chart retrieval and staff time, while New York's statewide HIE estimates $160-195 million annual value primarily from administrative efficiency gains that modern retrieval platforms can capture
• Market acceleration driven by regulatory convergence - The global HIE market reached USD 2.07 billion in 2024 and projects to USD 5.25 billion by 2034, driven by TEFCA standardization, information blocking penalties, and mandates that create opportunities for compliant, user-friendly solutions
• Clinical outcomes demonstrate measurable ROI - Emergency departments utilizing HIE access achieve 30% lower admission odds and $1,187 lower charges per visit, proving value of rapid, comprehensive medical history access that legal case preparation and healthcare intake workflows require
• Small and rural hospitals lag in interoperability - Only 38% of small hospitals routinely engage in all four interoperability domains compared to 53% of large hospitals, indicating significant addressable market for affordable, managed HIE services targeting underserved providers
• Same-day record services often deliver incomplete packets and require significant client involvement; by contrast, Codes Health delivers complete records in 10–12 days with minimal client effort.
• General-purpose AI tools are not reliable for extracting clinical information from medical records; Codes Health uses medical-grade AI with human verification to produce high-precision chronologies and insights for litigation.

Market Growth and Adoption Trends

1. Global HIE market reaches $2.07 billion with robust expansion trajectory

The health information exchange market achieved USD 2.07 billion valuation in 2024 and projects to reach USD 5.25 billion by 2034, representing a compound annual growth rate of 9.75%. This expansion stems primarily from government interoperability mandates including the 21st Century Cures Act and TEFCA framework, the healthcare industry's shift to value-based care models requiring comprehensive patient data, and widespread EHR adoption creating demand for cross-system data sharing. For legal practices handling medical litigation and healthcare providers conducting patient intake, this market maturation translates to improved infrastructure for accessing comprehensive medical histories that platforms like Codes Health leverage through multiple integration channels.

2. North America dominates with 46% market share driven by regulatory mandates

North America held 46% of global HIE market share in 2024, with the United States representing 85% of the North American market. This dominance reflects aggressive federal policy implementation including TEFCA infrastructure development, information blocking penalties under the 21st Century Cures Act, and substantial public health data exchange investments. The CDC allocated $255 million specifically for public health data exchange through 2026. This regulatory environment creates favorable conditions for medical record retrieval services serving legal practices requiring rapid access to complete patient histories across multiple provider systems and jurisdictions.

3. Cloud-based deployments capture 60% market share with fastest growth

Cloud-based HIE deployments commanded 60% market share in 2024 and demonstrate the fastest growth trajectory among deployment models. This preference reflects several advantages including elastic scaling capabilities, automated security updates, resilient disaster recovery architecture, and elimination of capital infrastructure investments that particularly benefit small and mid-sized practices. Asia-Pacific providers increasingly "leapfrog" legacy on-premise hardware by implementing cloud-native deployments directly. For organizations requiring HIPAA-compliant document storage and e-signature capabilities across distributed teams, cloud platforms provide the security, accessibility, and compliance frameworks essential for modern legal and healthcare workflows.

4. Hospital EHR adoption reaches near-universal levels at 96%

96% of hospitals adopted certified EHRs by 2021, establishing the foundational infrastructure necessary for electronic health information exchange. This near-universal adoption among hospitals contrasts with physician practices where 88.2% adopted any EHR system and 77.8% had certified EHR technology. The gap between hospital and ambulatory adoption creates challenges for comprehensive record retrieval across care settings. Codes Health addresses this fragmentation by integrating with multiple EHR systems alongside HIE networks and traditional fax-based retrieval, ensuring access regardless of provider technology sophistication.

5. Epic Systems extends market dominance to 42.3% share

Epic Systems controls 42.3% of acute care EHR market share in 2024, expanding from 39.1% in 2023 by adding 176 multispecialty hospitals. Epic's TEFCA rollout connected over 625 hospitals as of December 2024, with plans to transition entire communities by end-2025. This consolidation simplifies certain aspects of medical record retrieval by standardizing around dominant platforms, but creates dependencies on vendor cooperation and API access terms. Oracle Health experienced market share decline from 25% in 2020 to 22.9% in 2024, losing 74 hospitals in 2024 alone. Platforms maintaining vendor-agnostic retrieval capabilities across Epic, Oracle, and smaller EHR systems provide resilience against market consolidation risks.

The Critical Adoption-Utilization Gap

6. 70% of hospitals achieve technical interoperability across all four domains

70% of non-federal acute care hospitals engaged in all four domains of interoperable exchange—send, receive, find, and integrate—in 2023, maintaining consistent levels from 2022-2023. This represents significant technical capability expansion across the industry. However, this statistic masks critical implementation quality variations, as technical capability does not guarantee effective clinical utilization or workflow integration.

7. Only 43% routinely execute all interoperability functions

While 70% possess technical interoperability capabilities, only 43% of hospitals routinely engaged in all four domains, while 27% sometimes engaged depending on specific circumstances and workflows. This 27-percentage-point gap between capability and routine utilization reveals systematic barriers including workflow integration challenges, clinician training deficits, data quality concerns, and lack of compelling use cases driving adoption. For medical record retrieval platforms, this indicates that technical integration alone proves insufficient—solutions must embed seamlessly into existing workflows and deliver immediate, tangible value to drive actual usage.

8. Clinicians use external information in only 42% of cases despite 71% access

Perhaps the most revealing statistic: while 71% of hospitals had routine access to external clinical information, only 42% of hospitals reported clinicians actually using that information when treating patients. This 29-percentage-point utilization gap represents the core challenge in health information exchange—not technical connectivity, but practical workflow integration and clinician adoption. This gap explains why legal practices and healthcare providers require platforms like Codes Health that don't simply provide raw data access but deliver organized, analyzed, actionable insights through AI-powered chronologies and extraction engines that save time rather than creating additional documentation burdens.

9. Hospital size creates 15-percentage-point interoperability divide

53% of large hospitals routinely engage in all four interoperability domains compared to only 38% of small hospitals, creating a 15-percentage-point capability gap. This disparity reflects resource constraints, IT staffing limitations, and vendor prioritization favoring larger health systems. Rural and critical access hospitals face even greater challenges, with approximately 40% not fully interoperable according to market analysis. This underserved segment represents substantial opportunity for affordable, managed medical record retrieval services that don't require extensive internal IT infrastructure or dedicated staff to operate effectively.

Cross-Sector Exchange Failures

10. Only 16-17% of hospitals exchange with behavioral health and LTPAC providers

Despite widespread general HIE adoption, only 16% of hospitals send summary of care records to most or all long-term post-acute care providers, while 17% send to behavioral health providers. These statistics reveal critical "last mile" failures in health information exchange precisely where comprehensive patient histories prove most essential. Legal practices handling disability claims, workers compensation cases, and personal injury litigation frequently require records from behavioral health providers, substance use disorder treatment facilities, and long-term care settings. The systematic failure of standard HIE networks to bridge these gaps explains the continued necessity for specialized retrieval services employing multiple access methods including traditional fax-based requests alongside digital channels.

11. Behavioral health facilities lag 30-40 percentage points in exchange participation

Only 84% of behavioral health facilities use EHRs for storing records as of 2020, with just 43% sending and 37% receiving health records to outside organizations. This represents a 30-40 percentage point deficit compared to general hospitals. This gap stems from behavioral health providers' exclusion from HITECH incentive programs, confusion around 42 CFR Part 2 and HIPAA Privacy Rule requirements, limited IT infrastructure, and unstable grant-based funding. The substantially revised 42 CFR Part 2 final rule implemented in April 2024 (with compliance required by February 2026) aims to align substance use disorder data sharing with HIPAA standards, but regulatory confusion persists. This creates both challenges and opportunities for retrieval services offering specialized behavioral health record access with compliant consent management.

12. Information sending rates improved 13 percentage points over five years

Hospitals' rates of often sending information increased from 71% in 2018 to 84% in 2023, demonstrating measurable progress in outbound data sharing capabilities. This 13-percentage-point improvement over five years reflects maturing technical infrastructure, regulatory pressure from information blocking penalties, and growing recognition of exchange value. However, this statistic specifically measures "often" sending—not comprehensive, reliable, or timely sending—and applies only to hospital settings rather than ambulatory practices, behavioral health providers, or long-term care facilities where exchange rates remain substantially lower.

Technology Standards and Architecture

13. Query-based exchange captures 45% market share with directed exchange growing fastest

Query-based exchange held 45% market share in 2024, enabling providers to search for and retrieve patient information as needed from participating organizations. However, directed exchange segment demonstrates fastest growth, reflecting increasing point-to-point transmission needs for care coordination and referrals. Consumer-mediated exchange shows 13.45% CAGR through 2030, the fastest growth rate among exchange types, driven by patient access mandates and mobile health applications. Legal practices benefit most from query-based capabilities enabling comprehensive patient history searches, while healthcare providers increasingly require directed exchange for admission workflows and care transitions.

14. FHIR adoption reaches 78% of countries with regulatory requirements

78% of countries now require or recommend FHIR (Fast Healthcare Interoperability Resources) use in health information exchange laws, representing substantial growth from 65% in the prior year. Within the United States, 70% of hospitals use FHIR-based apps for patient access capabilities. This rapid standardization around FHIR APIs enables more efficient interoperability compared to legacy HL7 V2 and CCD-CDA formats. However, FHIR adoption focuses primarily on patient-facing access and specific use cases rather than comprehensive record exchange. Retrieval platforms must support multiple standards simultaneously—FHIR for modern EHR connections, HL7 V2 for transaction processing, and traditional formats for providers not yet migrated to modern standards.

Clinical and Financial Outcomes

15. HIE utilization reduces average ED charges by $1,187 per visit

Hospitals utilizing health information exchange in emergency department encounters achieve $1,187 lower charges per visit compared to visits without HIE access. These savings result from avoided duplicate diagnostic testing, reduced laboratory work, fewer imaging studies, and more efficient care pathways enabled by comprehensive patient history access. When multiplied across thousands of annual ED visits, this per-encounter savings generates substantial financial impact supporting HIE investment justification.

16. Duplicate imaging decreases 9-25% with external record access

Emergency departments with health information exchange access demonstrate 9-25% reduction in repeat imaging including CT scans (9% reduction), chest X-rays (13% reduction), and ultrasounds (11% reduction). This outcome directly addresses a primary clinical and financial waste driver—unnecessary duplicate diagnostic testing performed because providers lack visibility into recent studies. For personal injury and medical malpractice litigation, these statistics validate the importance of comprehensive record retrieval enabling attorneys to identify all relevant diagnostic imaging and avoid incomplete case evaluations.

17. Statewide HIE generates $160-195 million in annual administrative value

New York's statewide health information exchange (SHIN-NY) produces estimated $160-195 million annual value primarily from administrative efficiency gains. This value stems from eliminated manual chart requests, reduced staff time on fax communications and phone calls, faster prior authorization processing, and streamlined care coordination workflows. One large California health plan reported saving 9.7 hours daily staff time through automated record access replacing manual retrieval processes. These efficiency gains represent "real money back to the system" that organizations can redirect toward patient care or capture as margin improvement.

18. High-risk patient interventions achieve 68% inpatient visit reduction

The LA LANES HIE enabled targeted care coordination for high-risk Medicaid patients with complex needs, achieving 68% reduction in inpatient visits over one year. This dramatic utilization decrease demonstrates the power of comprehensive patient information enabling proactive intervention, care planning, and resource deployment for vulnerable populations. Similar programs targeting pediatric at-risk youth achieved 30% reduction in ED visits and 48% reduction in inpatient admissions over six months through closed-loop referrals supported by HIE infrastructure.

Patient Access and Consumer Engagement

19. 99% of hospitals enable patient electronic record viewing and transmission

99% of hospitals offered patients the ability to view records electronically, 96% to download records, and 84% to transmit records to third parties in 2024. This widespread patient portal adoption reflects compliance with 21st Century Cures Act information blocking provisions and ONC certification requirements mandating API-enabled patient access. However, portal access typically provides records from only a single health system, requiring patients to register separately with each provider organization they've visited. For comprehensive medical histories spanning multiple providers across years of care, patients and their legal representatives still require specialized retrieval services consolidating records from all sources into unified chronologies.

20. Healthcare providers represent 65% of HIE market with payers growing fastest

Healthcare providers account for 65% of HIE market by end-user segment in 2024, representing hospitals, physician practices, and specialty care facilities implementing exchange capabilities. However, healthcare payers demonstrate fastest CAGR growth at 14.87% through 2030 as insurance companies increasingly participate in risk-bearing arrangements requiring real-time clinical data. This payer adoption trend creates additional data access pathways and potential partnerships for platforms serving legal practices requiring comprehensive claim and treatment documentation for disability, workers compensation, and insurance litigation cases.

Efficiency, ROI, and Implementation Challenges

21. Two-thirds believe in positive ROI but only 25% measure it

Approximately 66% of HIE operators believe they demonstrate positive return on investment, yet only 25% actually use metrics to calculate ROI systematically. This belief-evidence disconnect reveals that the market operates largely on logic and faith rather than measured outcomes. Additionally, 76% don't deliver quality measure reports and 73% don't use data to measure provider performance, indicating substantial missed opportunities for demonstrating value. Organizations implementing medical record retrieval and analysis platforms should establish clear ROI metrics from the outset, measuring time savings, cost avoidance, case outcome improvements, and staff productivity gains rather than relying on assumed benefits.

22. Primary care practices cite vendor differences as top 65% barrier

Different vendor platforms represent the barrier cited by 65% of providers attempting health information exchange, while 58% cite difficulty matching patients between systems and 68% lack provider contact information necessary for directed exchange. These technical and operational barriers persist despite substantial federal investment in interoperability standards and infrastructure. The fragmentation explains why comprehensive record retrieval requires multi-channel approaches combining HIE query access, EHR direct connections, TEFCA network participation, and traditional fax-based requests to providers not yet fully digitally connected.

23. Epic TEFCA deployment connects 625 hospitals toward nationwide network

Epic Systems connected 625 hospitals to TEFCA by December 2024, with plans to transition entire communities by end-2025. This Trusted Exchange Framework and Common Agreement implementation establishes standardized governance, common legal terms, and technical specifications enabling nationwide health information exchange beyond state and regional HIE boundaries. However, TEFCA participation remains voluntary and implementation timelines vary substantially across provider organizations. Platforms like Codes Health that integrate with both TEFCA networks and traditional retrieval methods ensure record access regardless of individual provider participation status in emerging nationwide infrastructure.

24. Enterprise Master Patient Index represents 29.76% of component market

Enterprise Master Patient Index (EMPI) technology captures 29.76% of component market share, reflecting its critical role in accurately matching patients across disparate systems with inconsistent demographic data, naming variations, and identification numbers. EMPI failures create duplicate records, missed information during clinical care, and incomplete record retrieval for legal cases requiring comprehensive patient histories. Clinical Data Repository components demonstrate fastest growth at 14.86% CAGR, indicating increasing investment in normalized data storage enabling analytics, population health management, and quality reporting beyond basic record exchange capabilities.

Frequently Asked Questions

What is health information exchange and why does it matter for legal and healthcare practices?

Health information exchange (HIE) refers to the electronic sharing of patient medical information across different healthcare organizations, enabling providers, payers, and authorized parties to access comprehensive patient histories regardless of where care occurred. HIE matters critically for legal practices handling medical litigation because comprehensive record access determines case viability, damages calculation accuracy, and identification of breaches in care. Healthcare providers benefit from HIE through improved clinical decision-making, reduced duplicate testing, better care coordination, and faster patient intake workflows. The market reached USD 2.07 billion in 2024 and projects to USD 5.25 billion by 2034, driven by federal mandates and demonstrated clinical value.

Why do only 42% of clinicians use external information despite 71% having access?

The 29-percentage-point gap between access (71% of hospitals) and actual utilization (42% of hospitals) stems from workflow integration failures, data quality concerns, lack of training, time constraints during clinical encounters, and information presented in formats requiring excessive review effort. Raw data access proves insufficient—information must be organized, analyzed, and embedded directly into existing workflows to drive adoption. This explains why platforms offering AI-powered chronologies, automated insights extraction, and structured summaries achieve higher utilization than simple data access portals requiring manual review of hundreds of pages.

How significant are the gaps in behavioral health and long-term care record exchange?

The gaps prove substantial and systematically undermine comprehensive care coordination. Only 16-17% of hospitals send records to behavioral health and long-term post-acute care providers, while behavioral health facilities lag general hospitals by 30-40 percentage points in exchange participation (43% sending, 37% receiving). These failures create critical information voids precisely where legal cases require comprehensive documentation—substance use disorder treatment, mental health care, and extended care facility records frequently prove essential for disability claims, personal injury litigation, and medical malpractice cases. Specialized retrieval services employing multiple access methods become necessary to bridge these systematic gaps.

What role does TEFCA play in the future of health information exchange?

TEFCA (Trusted Exchange Framework and Common Agreement) establishes nationwide standardized governance, common legal terms, and technical specifications enabling health information exchange beyond state and regional boundaries. Epic Systems already connected 625 hospitals to TEFCA by December 2024, with plans for community-wide transition by end-2025. TEFCA compliance becomes table-stakes for HIE platforms as federal adoption accelerates, though participation remains voluntary and implementation timelines vary substantially. The framework particularly benefits organizations requiring record access across multiple states—common in mass tort litigation, national personal injury practices, and healthcare systems with multi-state operations. Platforms maintaining both TEFCA integration and traditional retrieval capabilities ensure comprehensive access regardless of individual provider adoption status.