Civitas Networks for Health is proud to support the nationwide survey of Health Information Organizations (HIOs) in collaboration with Dr. Julia Adler-Milstein and team at the University of California, San Francisco, and the Assistant Secretary for Technology Policy (ASTP).
The survey offers critical insights into the state of health information exchange (HIE) in the U.S. and the evolving role of HIOs in advancing regional, state, and national interoperability. Key findings from the 2025 National HIO Survey include HIO organizational demographics, participation in the Trusted Exchange Framework and Common Agreement (TEFCA), trends in information blocking, emerging uses of artificial intelligence (AI), current standards adoption, and HIO integration with public health agencies—insights that are informing policy and guiding the next phase of nationwide interoperability and data-sharing initiatives. UCSF and ASTP will publicly share these results, which will also be posted on the Civitas website.
Health Information Organizations continue to play a foundational role in nationwide health data exchange — connecting providers, public health agencies, and community organizations.
Here are some high-level takeaways from what the latest 2025 survey tells us about how HIOs are evolving, where they’re excelling, and what challenges remain:
The 2025 survey saw an 86% response rate with 77 HIOs across the country participating. Citing strong participation in core HIE services, value-based care support, and emerging use of AI. 35% of HIOs reported financial viability defined as income from participants covering operating costs.
22% of HIOs are already participating in the national Trusted Exchange Framework and Common Agreement (TEFCA), of those who are not currently participating in TEFCA in 2025, 58% reported intent to participate as a participant or sub-participant. Barriers to participating in TEFCA were mostly reported as concerns about the burden associated with participation, needed resources, and concerns with agreement terms.
HIOs deliver essential services such as event notifications, community health records, data normalization, consent management, exchange of health-related social needs (HRSN) data, and connection to Immunization Information System (IIS) and prescription drug monitoring programs (PDMP) —capabilities that help reduce duplication, close care gaps, and improve coordination.
73% of HIOs reported being connected to a state public health agency, 58% reported being connected to a local public health agency, and 17% reported being connected to a tribal or territorial agency. Among these:
Additional services provided by HIOs to public health include dashboarding and data visualization, analytic and data quality support, bi-directional data sharing, outbreak monitoring and alerting, and public health policy impact monitoring.
29% of HIOs reported routinely observing information blocking by EHR vendors, mostly in the form of high prices for data access. 15% also reported similar challenges with information blocking by health systems, most often due to closed network exchange.
23% of HIOs reported usage of AI models for a variety of purposes including identifying high risk outpatients to inform follow-up care, generation of chart summaries, prediction of health trajectories, prediction of quality gaps, and assistance with diagnosis or recommended treatments.
Civitas Networks for Health is committed to the advancement of interoperability and health information exchange. By partnering with ASTP/ONC and UCSF, Civitas ensures that HIOs’ voices are heard and that survey results inform local and national decision makers and health IT policy.
Civitas believes in local health data infrastructure and in increasing the capacity within states for more interconnected health data ecosystems. The national HIO survey results reinforce the critical services and capabilities of HIOs throughout the country.
Looking for more information on the HIO Survey? Browse peer reviewed papers and related resources.
Public Health Data Exchange Through Health Information Exchange Organizations: National Survey Study
The State of Health Information Organizations and Plans to Participate in the Federal Exchange Framework
As the next iteration of the survey takes shape, Civitas will continue to provide guidance and ensure that the survey remains relevant and timely in capturing the challenges and achievements within the health information exchange and data interoperability landscape.
As HIOs across the country prepare to participate in future surveys, Civitas remains committed to ensuring that data collected will be used to influence policy decisions that recognize HIOs role in enhancing health care delivery and in helping communities achieve better health outcomes.
To learn more, please email contact [at] civitasforhealth.org.
