Abigael Grippe, Senior Strategy Consultant

How State HIEs Are Advancing Interoperability

How State HIEs Are Advancing Interoperability

In recent months, much attention has been paid to TEFCA — the Trusted Exchange Framework and Common Agreement — and for good reason. After grinding to a virtual halt for several years, the push toward the adoption of a single, universal framework for healthcare data exchange is back in motion. 

In July of 2021, the Office of the Coordinator for Health Information Technology (ONC) announced that TEFCA will finally go into effect in early 2022. But while all eyes are (understandably) on the national implications of TEFCA, there’s a lot going on at the state level, too. 

States have already begun taking actions to lay the groundwork for TEFCA, with most employing policy levers to encourage participation. However, a few states have passed legislation requiring connection to Health Information Exchanges, or HIEs. Read on to learn more about state HIE mandates. 

HIEs: Carrots, Sticks and Mandates 

It’s not hard to see why HIEs have been a topic of conversation and debate among healthcare industry stakeholders for years. After all, the HIE sector has experienced shifting trends in areas from policy to operations for almost a decade.  

When COVID-19 hit, the spotlight re-focused on HIEs. Specifically, those states that already had built connections between HIEs and state health departments were better positioned to respond to the pandemic. 

As the need for data-sharing in areas such as COVID testing and data analytics became clear, states with designated HIEs such as Indiana and Maryland found themselves with a leg up.  

But in most cases, states don’t legally mandate participation. Instead, enticements are offered to encourage participation, such as the 90/10 Medicaid matching funds for state HIE participation offered through the HITECH Act

As the need for HIEs grows clearer, more states will likely move past the “dangling carrot” approach and pass HIE participation mandates. A few states have already done so. Here’s what those mandates look like in action so far. 


The 2021 passage of AB 133 mandated the establishment of the California Health and Human Services Data Exchange Framework. It’s a single data-sharing agreement and common set of policies and procedures that support TEFCA goals of national standards for information exchange and data content. The Data Exchange Framework will govern and — here’s the key word — require the exchange of health data among healthcare entities and government agencies. 

AB 133 requires that the Data Exchange Framework be finalized by July 1, 2022. Providers’ full participation in the exchange is mandated by law, beginning January 31, 2024. 

By October 6, 2022, providers including hospitals, physician practices, and clinics will be required to share USCDI Version 1 data. After that date, the definition of “health information” will expand to include all electronic health information as defined in the Code of Federal Regulations

Stakeholder Advisory Group will work toward creating a Data Framework that complies with goals such as protecting public health, improving care delivery, and promoting equity, all while maintaining data security and patient privacy. 


In 2020, the Nebraska legislature passed the Population Health Information Act. The Act designated an already-existing HIE, CyncHealth, to provide the data infrastructure for the state. A year later, Nebraska’s Governor signed LB411 into law, which mandates healthcare providers and health plans to share health data with CyncHealth. 

The basic structure was already in place, as thousands of providers and health plans had already been sharing data through CyncHealth for years. LB411 took it a step further, requiring inclusivity of all relevant health records. 

In order to take advantage of federal matching funds that expired in fall 2021, LB411 had a relatively tight timeframe with built-in incentives. For instance, participants who established connections to CyncHealth before July 2021 could do so at no charge. As of January 1, 2022, all health insurance plans must participate with the HIE to remain in compliance with the law. 

North Carolina 

In 2015, North Carolina’s legislature passed the HIE Act, which established the North Carolina Health Information Exchange Authority in order to administer the state’s HIE. The HIE Act facilitates and regulates the use of a statewide health information exchange network, to be used for secure transmission of health information among healthcare providers and health plans. 

Known as NC HealthConnex, the system links existing HIEs and networks. Originally, non-exempt participants — including those who receive state funds or provide Medicaid services — were required to connect within a time period that ran from 2018 to 2020. The COVID pandemic put that on hold. 

In May 2021, North Carolina’s governor signed a law that gave healthcare organizations more time to comply with the mandate and work through the onboarding process. Providers now have until January 2023 to comply, with compliance reports due in 2022. 


In 2015, the Connecticut legislature passed a bill establishing a statewide HIE. The system, known as CONNIE, launched in 2021, after delays due to the pandemic. 

Under the law, hospitals and laboratories must apply to begin the connection process by May 3, 2022. By May 3, 2023, healthcare providers with electronic health record systems are required to have started the connection process. The state has offered funding to providers to help with compliance, and expects the process to take up to three years. 

Connecting to your state HIE 

Connecting to HIEs requires an understanding and ability to use many different types of healthcare data standards, including HL7FHIR, CCDA, X12, and more.  

Rhapsody health solutions power many of the nation’s state and regional HIEs to facilitate this type of data exchange, allowing them to normalize and analyze data to deliver insights to their customers.  

Need help connecting your healthcare organization to state or regional HIEs? Let’s talk

Or check out how state departments of health power data exchange with Rhapsody health solutions.

In this webcast, Drew Ivan, Chief Strategy Officer for Rhapsody, welcomed executives of health information exchanges (HIEs) for an overarching discussion about healthcare interoperability. The discussion covers how are HIEs positively impacting interoperability, and what these organizations are doing to manage large volumes of patient data. David Kates, Chief Technology Officer of Manifest Medex, and Shaun T. Alfreds, Executive Director and Chief Executive Officer of HealthInfoNet in Maine joined Ivan for this webcast. 


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