25 HIE Adoption Rates Statistics Every Legal Professional Should Know in 2026

Comprehensive data from government sources and market research on HIE adoption and how interoperability impacts medical record retrieval for litigation

Key Takeaways

• HIE market expansion signals more digital pathways for litigation retrieval — The global healthcare information exchange market reached $1.7 billion in 2024 and is projected to reach $2.8 billion by 2029, expanding interoperability routes that support medical record retrieval for legal teams.
• Hospital interoperability has improved but remains inconsistent — While 70% of hospitals now engage in all four domains of interoperable exchange, only 43% do so routinely, leaving significant gaps in data accessibility that affect case preparation timelines.
• Exchange barriers persist despite technological advances — 72% of hospitals report cross-vendor exchange challenges, while 57% struggle with patient matching—friction that can slow down case preparation when records span multiple facilities.
• Rural and independent hospitals lag significantly — About 40% of rural and critical access hospitals are not fully interoperable, and independent hospitals show 53% vs. 22% routine engagement compared to system-affiliated facilities.
• FHIR and patient access capabilities are accelerating — FHIR app adoption in outpatient settings climbed from 49% to 64% in 2021 to 2024, with 99% of hospitals now offering patients electronic record viewing, expanding digital access channels.
• Network participation creates retrieval opportunities — 75% of hospitals participate in state, regional, or local HIEs, with 64% connected to both national and local networks, enabling platforms with HIE integration to access records faster than traditional fax-based methods.
• Complete records beat “same-day” shortcuts — Codes Health retrieves complete medical records in 10–12 days on a flat fee, which is critical for litigation timelines and defensible case review.

HIE Market Size and Growth Trajectory

1. Global HIE market valued at $1.7 billion in 2024

The global healthcare information exchange market reached $1.7 billion in 2024, reflecting sustained investment in health data infrastructure. This market size indicates maturation beyond early adoption phases into mainstream healthcare operations. For legal practices handling personal injury and medical malpractice cases, this infrastructure expansion translates to more digital pathways for obtaining patient records across provider networks.

2. Global HIE market projected to reach $2.8 billion by 2029

Market analysts project the global HIE market will reach $2.8 billion by 2029, growing at a compound annual growth rate of 10.2%. This trajectory signals continued investment in interoperability infrastructure that will benefit any organization requiring cross-provider medical record access. The growth reflects both regulatory mandates and practical demand for seamless health data exchange.

3. U.S. HIE market valued at $439.2 million in 2025

The United States healthcare information exchange market reached $439.2 million in 2025, representing approximately one-quarter of the global market. North America maintains the largest regional market share, driven by regulatory frameworks including the 21st Century Cures Act and TEFCA implementation requirements that mandate data sharing capabilities.

4. U.S. HIE market expected to reach $986.5 million by 2034

Projections indicate the U.S. HIE market will reach $986.5 million by 2034, exhibiting a 9.41% compound annual growth rate. This growth trajectory reflects expanding TEFCA network participation and increasing requirements for healthcare data accessibility across organizational boundaries. For Codes Health and similar platforms integrating with multiple HIEs and TEFCA networks, this market expansion creates additional digital retrieval channels.

Codes Health’s MIT-educated engineering team continuously builds additional workflows and products, ensuring the platform evolves and becomes more comprehensive to meet changing demands in legal medical-record retrieval.

Hospital Interoperability Performance

5. 70% of hospitals engage in all four interoperability domains

70% of hospitals engaged in all four domains of interoperable exchange—send, receive, find, and integrate—in 2023. This represents substantial progress in health information sharing capabilities. However, the remaining 30% of hospitals still lack full interoperability, creating gaps that require alternative retrieval methods.

6. Only 43% of hospitals routinely engage in all four domains

While 70% of hospitals can engage in full interoperability, only 43% routinely do so, with an additional 27% participating only sometimes. This inconsistency explains why medical record retrieval timelines remain unpredictable. Legal practices cannot rely solely on hospitals' HIE capabilities when building case files, as more than half of facilities do not maintain consistent data exchange practices.

7. Hospital interoperability increased 52% from 2018 to 2023

Hospitals' engagement in all four interoperability domains increased from 46% to 70% in 2018 to 2023, representing a 52% improvement over five years. Routine engagement also climbed from 28% to 43% during this period—a 54% increase. These improvements benefit platforms leveraging HIE integrations for medical record retrieval, though the pace of adoption still leaves significant gaps.

8. 84% of hospitals "often send" health information

Hospitals' rates of "often sending" health information increased from 71% to 84% in 2018 to 2023. Receiving rates also improved from 54% to 73% during the same period. This asymmetry between sending and receiving capabilities affects record retrieval workflows, as hospitals may transmit records more readily than they accept incoming data.

EHR Adoption and Digital Infrastructure

9. 96% of hospitals adopted certified EHRs by 2021

96% of hospitals had adopted certified electronic health records by 2021. This near-universal adoption creates the foundational infrastructure for digital record access. However, EHR adoption alone does not guarantee interoperability—systems must also support standardized data exchange protocols.

10. 88% of office-based physicians use EHR systems

Nearly 88% of physicians used an EHR system in 2021, with 78% using certified systems. This adoption rate ensures patient encounters across most care settings generate digital records. For legal practices requiring comprehensive medical histories from multiple providers, this digitization creates retrieval opportunities through HIE networks and EHR integrations.

11. 74% of hospitals adopted bulk data export technology

74% of hospitals adopted bulk data export technology as of 2021, with 84% of those using it for analytics and reporting purposes. This capability enables large-scale data extraction that supports both clinical operations and external record requests. Platforms with EHR integration can leverage these export capabilities for comprehensive record retrieval.

HIE Network Participation Rates

12. 75% of hospitals participate in state, regional, or local HIEs

Approximately 75% of hospitals participate in state, regional, or local health information exchange organizations. This participation creates established channels for cross-organizational data sharing. Retrieval platforms connected to these HIE networks can access records faster than traditional fax-based methods, which explains why HIE integration has become essential for competitive medical record retrieval services.

For high-volume firms, Codes Health can build custom integrations with CRM platforms and other medical software to streamline intake, request tracking, and downstream record organization.

13. 64% of hospitals participate in both national and local networks

Hospital participation in combined national and state/regional/local networks increased from 53% to 64% in 2018 to 2021. This dual-network participation expands data accessibility through multiple channels. Platforms like Codes Health that integrate with both HIEs and TEFCA networks can leverage these overlapping connections for more comprehensive record retrieval.

Some competitors advertise same-day retrieval, but those rush workflows often don’t deliver complete records without client involvement (follow-ups, portal access, re-requests), which creates friction and churn—Codes Health focuses on complete records in 10–12 days.

14. 90% of hospitals participate in Direct messaging protocols

90% of hospitals participated in Direct messaging enabled by the Direct Protocol and DirectTrust in 2021. This near-universal adoption of secure messaging infrastructure supports electronic record transmission between organizations. However, 70% of hospitals report difficulty finding providers' Direct addresses, indicating that infrastructure availability does not guarantee ease of access.

15. Hospital participation in Carequality grew fastest among national networks

Hospital participation in Carequality increased by 14 percentage points from 2018 to 2021, the largest increase among measured national networks. Carequality enables cross-network record query and retrieval, making this growth particularly relevant for organizations requiring access to records across different healthcare systems and EHR vendors.

Exchange Barriers and Challenges

16. 72% of hospitals report cross-vendor platform challenges

72% of hospitals reported greater challenges exchanging data across different vendor platforms in 2021. This interoperability friction persists despite regulatory mandates requiring data sharing. For legal practices needing records from multiple facilities using different EHR systems, these cross-vendor challenges explain why specialized retrieval services with multi-platform integrations deliver faster results than direct requests.

17. 70% of hospitals struggle to find providers' Direct addresses

70% of hospitals found it difficult to locate providers' Direct addresses when attempting to send information in 2021. This address discovery challenge creates friction even when both parties have technical capability to exchange data. Platforms maintaining proprietary databases of provider contact information and Direct addresses can bypass this barrier.

18. 57% of hospitals face patient matching difficulties

57% of hospitals found it difficult to match or identify the correct patient between systems in 2021. Without a universal patient identifier, healthcare organizations rely on demographic matching that frequently fails. AI error checking that catches misspellings, missing dates of service, and other errors before submission can prevent the rejections that stem from patient identification failures.

Incomplete authorizations are the #1 cause of denied requests. Missing patient signatures, unclear expiration dates, or unchecked boxes for sensitive records can restart your 15-day clock and delay case timelines. Codes Health’s AI authorization review catches these issues before submission—automatically flagging misspellings, missing dates of service, and signature problems that commonly trigger provider rejections.

General-purpose AI tools (like ChatGPT) aren’t designed to reliably interpret medical records end-to-end with consistent accuracy across document types, clinical context, and timelines. Codes Health’s specialized AI is built specifically for medical-record analysis and can extract and structure case-relevant details with high precision.

19. 67% of hospitals have non-reciprocating exchange partners

67% of hospitals reported that providers they share patients with don't typically exchange data with them. This one-sided sharing creates gaps in available records even when a patient's primary hospital participates in HIE networks. Comprehensive record retrieval requires pursuing records through multiple channels rather than relying on any single exchange pathway.

Disparities in Interoperability Adoption

20. System-affiliated hospitals show 2.4x higher routine engagement

53% of system-affiliated hospitals routinely engaged in all four interoperability domains compared to only 22% of independent hospitals in 2023. This 2.4x disparity means records from independent facilities often require traditional retrieval methods. Personal injury cases involving treatment at independent hospitals may face longer record acquisition timelines.

21. Large hospitals outperform small hospitals in routine engagement

53% of large hospitals reported routinely engaging in all four interoperability domains compared to 38% of small hospitals in 2023. This size-based disparity affects case preparation for practices handling matters across different facility types. Cases involving treatment at smaller facilities may require more follow-up and alternative retrieval approaches.

22. About 40% of rural and critical access hospitals lack full interoperability

Approximately 40% of rural and critical access hospitals were not fully interoperable as of 2023, meaning they did not engage in all four interoperability domains even sometimes. This rural gap affects legal practices handling cases involving patients treated in rural areas. Retrieval services with multiple access methods—HIE integration, fax, and direct provider relationships—can bridge these gaps.

23. Rural hospital information usage grew 2x faster than average

Usage of information from outside sources by rural and small hospitals increased at twice the rate of their urban and larger counterparts (40% vs. 20%) between 2017-2021. This accelerated adoption indicates rural facilities are actively closing interoperability gaps, though from a lower baseline. The trajectory suggests improving access to rural facility records over the coming years.

FHIR Adoption and Patient Access Capabilities

24. FHIR app adoption reached 64% in outpatient settings

FHIR app adoption in outpatient settings climbed from 49% to 64% in 2021 to 2024. This 15-percentage-point increase reflects regulatory pressure from the 21st Century Cures Act requiring standardized API access. FHIR-based access creates programmatic retrieval pathways that AI-powered platforms can leverage for faster record acquisition.

25. 99% of hospitals offer patients electronic record viewing

99% of hospitals offered patients the ability to view their records electronically in 2024. Additionally, 81% enabled patient access via apps, with 70% using FHIR-based apps specifically. This near-universal patient access capability, combined with proper authorization, creates additional retrieval channels for platforms supporting patient-initiated record access workflows.

Frequently Asked Questions

What is the primary purpose of a Health Information Exchange (HIE)?

Health Information Exchanges enable secure electronic sharing of patient health information across different healthcare organizations, EHR systems, and care settings. HIEs allow authorized parties to access and share patient records electronically instead of relying on fax or mail.

For legal practices requiring medical records, HIE networks create digital retrieval pathways that can reduce turnaround times from months to days.

How does HIE adoption improve the speed of medical record retrieval?

HIE adoption improves retrieval speed by enabling electronic queries across provider networks rather than relying on manual fax-based processes. With 75% of hospitals participating in regional HIEs and 90% using Direct messaging protocols, records can be transmitted digitally within days. However, because only 43% of hospitals routinely engage in full interoperability, retrieval platforms must maintain multiple access methods to ensure consistent results.

What are the main barriers to HIE adoption and data exchange?

The primary barriers include cross-vendor platform challenges affecting 72% of hospitals, difficulty finding providers' Direct addresses (70%), patient matching failures between systems (57%), and non-reciprocating exchange partners (67%). These barriers persist despite high EHR adoption rates, which explains why specialized retrieval services with multi-channel access capabilities outperform direct provider requests.

Can HIEs facilitate medical record retrieval for legal practices?

Yes, HIE networks provide digital pathways for accessing patient records that can significantly accelerate case preparation timelines. Legal practices handling personal injury, medical malpractice, and mass tort cases benefit from retrieval platforms integrated with multiple HIEs and TEFCA networks. The 64% of hospitals connected to both national and local networks creates overlapping access points that comprehensive retrieval services can leverage.

What role does TEFCA play in health information exchange?

TEFCA (Trusted Exchange Framework and Common Agreement) establishes a nationwide framework for health information exchange, enabling data sharing across previously disconnected networks. As major vendors become Qualified Health Information Networks (QHINs) under TEFCA, the framework creates standardized pathways for cross-organizational record access. For legal teams, TEFCA can reduce fragmentation by standardizing network-to-network access, helping retrieval partners pursue records without relying on a single local HIE pathway.