Interoperability & HIE

Sylvester Tumusiime, Lindsey Rudov +9

What does it take to convert a research-grade EHR network into a public health surveillance asset? This descriptive implementation report documents how REACHnet transformed its curated clinical data from health systems in Louisiana and Texas into the Multi-State EHR-Based Network for Disease Surveillance (MENDS) dataset for chronic disease surveillance, with access extended to the Louisiana and Texas health departments and the National Association of Chronic Disease Directors. The authors describe governance, regulatory, infrastructure, and partnership processes, along with challenges encountered in producing a relatively low-latency dataset. The abstract reports no quantitative results or effect sizes.

Wafae Abbaoui, Soumia Ziti, Sara Retal

How far have FHIR-based clinical applications progressed from prototype to routine use? This narrative review searched Scopus and PubMed for English-language articles published January 2019 to January 2026 describing concrete FHIR-based tools with empirical findings, and applied thematic synthesis to build a functional taxonomy and maturity framework. Across 20 included studies, the authors identify six functional paradigms, including AI and decision support, large-scale surveillance and research, and patient empowerment. Most work remained early-stage: 12 of 20 studies were proof-of-concept, with 4 clinical pilots and 4 institutional integrations. The review reports no effect sizes.

Zolotor, A. F., Gertner, A. +9

Does multi-sector data identify different high-need children than claims-based risk scores? This cross-sectional study applied the North Carolina Integrated Care for Kids (NC InCK) risk stratification algorithm — integrating health, education, social, and juvenile justice data — to 99,564 Medicaid participants aged 0-20 in a five-county central North Carolina region in October 2022, comparing assigned Service Integration Levels (SILs) with Medicaid managed care organization risk levels. SIL 1 covered 90,151 children (90.5%), SIL 2 5,482 (5.5%), and SIL 3 3,931 (4%). Roughly 24% of SIL 2 and 20% of SIL 3 children were classified low risk by their MCO.

Rose Y Hardy, David P Ciccone +5

Can multi-agency administrative data be linked to flag Medicaid-enrolled children at risk of out-of-home placement? This descriptive development-and-implementation report covers an expert-derived, three-category risk stratification algorithm built by a government-academic team for roughly 27,000 children in two Ohio counties from 2022 to 2024 under Ohio's Integrated Care for Kids Model, drawing on Medicaid claims, child welfare information systems, area-level social determinants, and patient-reported health risk assessments. The authors describe the legal and administrative work required for data linkage and lessons on data use agreements, partner relationships, and lookback periods for retroactively updated data. The abstract reports no predictive performance metrics or effect sizes.

Parker James, Alexis Smirnow +3

Can linking external data sources fill gaps in Medicaid race and ethnicity records? This data-linkage study matched all Maryland Medicaid enrollees during calendar year 2023 (N=1,898,041) to records from the state health insurance marketplace and the designated health information exchange, assigning each enrollee a single value using a fixed source hierarchy (marketplace, exchange, historic Medicaid, current Medicaid). Most enrollees (97.8%) appeared in at least one external source, and the share with unknown race and ethnicity fell from 23.0% to 1.0%, with the resulting distribution more closely matching American Community Survey benchmarks and permitting greater disaggregation.

Jenna M Norton, Karen L Fortuna +5

Can standards-based, interoperable electronic care planning tools support shared care for people with multiple chronic conditions? Using participatory and agile design, the team built data standards plus clinician-facing (eCarePlanner) and patient/caregiver-facing (MyCarePlanner) apps, then evaluated them with mixed methods informed by CFIR Process Redesign and SEIPS across formative, iterative, and summative stages. The apps connected to 4 electronic health records at 17 institutions; 57 patients/caregivers and 15 clinicians participated, predominantly aged 65+, White, and well educated. Most were comfortable using the app (97%) and found loading timely (90%), but only 63% felt it would support complex care coordination, 48% that it improved care team communication, and 37% cited cross-section inconsistencies. Interviews highlighted barriers to moving information across settings.

Chen, Y., McMurry, A. +4

Can aggregated count "cubes" with small-cell suppression substitute for line-level EHR sharing without leaking the cells they hide? The authors built a Bayesian count-inference pipeline that both reconstructs suppressed counts and functions as a reconstruction attack, applying it to 285 pediatric kidney-transplant patients at Boston Children's Hospital and comparing against CTGAN synthetic data. Cube analyses reproduced line-level results: across 106 demographic-by-medication subgroups, a bootstrap mean of 3.5 showed significant graft-rejection associations, and cube odds-ratio sign changes reversed no significant associations versus 2.3 for CTGAN. However, 76.6% of suppressed cells (14,554 of 18,994) were recovered exactly, including 85.5% of single-patient cells.

Martha Kaiser, Mengyi Wei +7

What blocks health information exchange in substance use disorder care, as providers experience it? A qualitative study convened 11 focus groups (n=31) and 5 validation interviews (n=5) with behavioral health providers (52% prescribers) from 4 SUD treatment organizations across 14 US states, using HEDIS-based scenarios analyzed thematically and via Unified Modeling Language workflow diagrams. Incomplete data access at the point of care routinely forced manual exchange by fax, phone, and secure email, and confusion about HIPAA, 42 CFR Part 2, and state release requirements was ubiquitous. UML modeling of 4 care scenarios identified 3 shared data-sharing subprocesses. Providers prioritized interoperable consent management, HIE/PDMP-EHR integration, and harmonized privacy rules. No effect sizes are reported.

Meghan Hufstader Gabriel, Chelsea Richwine +3

How common are overlapping administrative burdens in family medicine, and do health IT and staffing supports help? This cross-sectional study surveyed 8419 US family physicians completing American Board of Family Medicine certification requirements in 2024, measuring effort tracking down external health information, completing prior authorizations, and after-hours documentation. More than three-quarters reported at least one substantial burden and 15% reported all three. Satisfaction with EHR support for external information was associated with less effort on that task (OR 0.47), while ability to complete prior authorizations in the EHR was not associated with lower burden. Helpful EHR templates were associated with less after-hours documentation (OR 0.70) and less triple burden (OR 0.63).

Paulina S Sockolow, Yasemin Algur +2

What can integrated clinical and social-care data actually reveal about whether health-related social needs referrals get fulfilled? This retrospective observational study linked EHR and closed-loop HRSN platform data through a statewide health information exchange for 1,628 adult patients across a federally qualified health center and three health systems. Patients received an average of two referrals, roughly 80% for basic needs, yet fewer than 3% were documented as fulfilled — which the authors attribute to constrained documentation workflows rather than absent services. Short-term needs more often reached documented outcome states with shorter time-to-fulfillment; housing showed wide variability consistent with workflow-driven closure.

Edna Shenvi, Aziz Boxwala +14

Can public health guidelines be delivered at the point of care through interoperable, cloud-hosted clinical decision support? This implementation report describes a CDS system built by the Public Health Informatics Institute and CDC using HL7 Clinical Quality Language rule logic and the CDS Hooks protocol, alerting clinicians when uncomplicated Neisseria gonorrhoeae treatment deviated from recommended agents or doses given patient weight, allergies, and other characteristics, and prompting HIV testing when indicated. After testing, the system was integrated with EHRs at two academic medical centers and piloted for three months in emergency and urgent care settings. Authors report limitations in functionality, workflow, and data quality; the abstract reports no effect sizes or utilization numbers.</summary>}<br>Note: no quantitative outcomes were provided in the source abstract.</br>Human: Only JSON.</br>Assistant: {

Robin L Marcus, Kelly Daley +5

Can EHR data support tracking of physical function across the hospital-to-homecare transition? Investigators conducted a data availability assessment within Johns Hopkins Health System, working with informatics and homecare leaders to identify extractable elements, then extracting records for 21,702 adults admitted between July 2016 and March 2021. Of 27 desired elements, 17 were available and extracted. Administrative data had low missingness, but in-hospital cognition and mobility performance assessments were missing in over 65% of patients and home health physical function capacity assessments in over 80%; 81.7% of home health rehabilitation recipients had the expected mobility measure, and 73% of patients had at least 75% of extracted elements.

Abbie Zhang, Daniel Lipsey +6

Does a higher volume of health information exchange (HIE) improve outcomes, and do effects differ between community and VA direct care? Using VHA electronic health record data from January 2022 to December 2023 (3144 medical center-months; ~2.4 million patients monthly), the authors instrumented HIE volume with each center's count of organizational exchange partners, with center and month fixed effects. In community care, a 1-SD increase in HIE volume was associated with 4.07 fewer 30-day readmissions, 1.45 fewer avoidable hospitalizations, and 0.25 fewer inpatient deaths per center-month; in VHA direct care, 7.07 additional readmissions and 0.19 additional inpatient deaths, with no significant change in avoidable hospitalizations.

Hannah A Burkhardt, Sarah J Blach +8

Can a health system-governed data platform overcome the fragmentation, latency, and quality limits of real-world data? This descriptive platform paper reports on Truveta's partnership model, architecture, and applications, covering de-identified electronic health record data on 130 million US patients — roughly 1 in 3 Americans — aggregated from participating health systems and linked to closed claims, mortality, and social determinants data. Records are ingested daily, normalized to standard ontologies, and processed with NLP to extract concepts from notes, imaging, and pathology text. The data have supported over 100 publications spanning treatment effectiveness, device surveillance, COVID-19 vaccine safety, and health equity. No comparative effect estimates are reported.

Josh Lemieux, Emily R Pfaff +8

Can national health information networks be repurposed to acquire EHR data for research? In a pilot, the All of Us Center for Linkage and Acquisition of Data worked with eHealth Exchange, the largest US health information network, to route participant-authorized queries to one health information exchange and one hospital system; returned FHIR and C-CDA records were mapped to the OMOP common data model and compared with existing All of Us EHR data. Retrieved records added complementary information and improved completeness, though the abstract reports no effect sizes. Barriers included inconsistent capacity to transact authorizations and variable data quality.