By Jolie Ritzo, CEO, Civitas Networks for Health® and Danie Carter, CEO, Intrepid Ascent
Across the country, communities are working toward a shared goal: delivering whole person care. This care integrates clinical needs with social, behavioral, and environmental factors that drive health outcomes.
Over the years, digital platforms have been constructed to navigate the complexities of human health and well-being. At the center of this landscape, two powerful structures have emerged as primary for data sharing – both designed to be system-agnostic and anchored in community.
Health Information Exchanges (HIEs) have matured into essential infrastructure for clinical data, reducing duplication and supporting public health. However, HIEs are no longer strictly medical; they are increasingly evolving to capture the non-clinical data that provides a fuller picture of a patient’s life, integrating social drivers of health (SDOH), behavioral health, pharmacy, and lab data into one longitudinal record. Alongside them, Community Information Exchanges (CIEs) have risen to bridge the data gap between individuals and vital social services, such as housing, food, and transportation.
Both types of systems are effective and essential, but they were built at different times in the evolution of health and social care. As a result, we often see a lack of coordination, misalignment, and in some cases, complete isolation.
Today, we find ourselves with two parallel highways, often moving in the same direction and sometimes building bridges, yet ultimately lacking the critical interchanges needed to truly unify the care journey.
Putting These Systems into Perspective with a Patient Story
Let’s call her “Maria.”
Maria is managing diabetes, and her lab results, prescriptions, and clinical visits are captured and shared across her clinical care team through an HIE. That team has visibility into her medical history and is working with her to keep her condition stable.
But a recent change in Maria’s life has resulted in her being unhoused.
Because of this instability, Maria struggles to refrigerate her insulin, often misses follow-up appointments when transportation falls through, and turns to emergency departments or urgent care centers when her condition becomes unmanageable. She is not making these choices by preference, but out of necessity. Critical parts of her daily reality remain invisible within the clinical ecosystem, leaving providers without the context needed to fully understand the barriers shaping her health and care outcomes.
Now let’s look at Maria’s situation from a different angle. A community-based organization (CBO) is supporting Maria through enhanced case management by connecting her to and working through a CIE. This helps her access essential services like housing, food assistance, and job placement. They see a different picture of her needs, but this critical, non-clinical data rarely flows back to her health care providers in a structured or timely way. Conversely, the CBO often lacks the clinical insights necessary to qualify Maria for specialized social programs.
This demonstration showcases how Maria is interacting with the two systems of care – both designed to help her, yet neither has a complete view of her needs. This is the gap between HIEs and CIEs we see too often, and it is one area where whole person care breaks down.
Different Foundations, but Shared Purpose
Part of the challenge lies in how these systems came to be.
HIEs have developed over time with federal and state policy support, funding mechanisms, and a focus on standardizing clinical data exchange. Their evolution has been shaped by federal incentives, regulatory frameworks, the need to connect health care providers at scale, and other market forces pushing for interoperable systems. Their strength lies in delivering robust, timely health data that support high-priority use cases across the clinical continuum (though use cases are expanding to public health, SDOH, behavioral health, and research).
This evolution has been marked by significant variability, in part because HIEs 1) have to uphold federal data privacy and security regulations and 2) navigate those within the geography and jurisdiction that they serve. Relatedly, not all approaches to interoperability are created equal. While some HIEs are nonprofit, others are state-led, and in some cases, private for-profit entities. The existing HIEs in the country are a mix of 16% federated, 38% centralized, and 44% hybrid (both) as seen in the 2025 National HIO Survey (UCSF, ONC, and Civitas, 2025).
A lot of work is happening currently across the HIE and Health Data Utility landscape to recognize core capabilities and functions that will support the overall goal of having increased interoperability. Regulation, incentives, and mandates all play a part in what the HIE networks look like today. Meanwhile, approximately 93% of non-federal acute care hospitals possess the technical capability to query external data; only 45% are fully engaged in the core domains of sending, receiving, finding, and integrating that information (Walker et al., 2023). This could be the result of multiple factors.
Regardless, this “interoperability gap” is exacerbated by high interface costs, persistent data silos, and a digital divide that leaves rural and behavioral health providers lagging their urban counterparts (Electronic Public Health Reporting, 2024; Saberi et al., 2025). This gap is widened when you add social service providers into the equation.
The transition from mere connectivity to meaningful clinical social integration has become a primary focus in the modern HIE landscape.
In contrast to HIEs, CIEs are often grass-roots, bottom-up infrastructure anchored in community needs and the patient’s voice. Only very recently have they been getting state and federal recognition as critical health infrastructure. They are often built through collaboration among social service providers, federally qualified health centers and clinics, public health agencies, and community-based organizations. Their strength lies in relationships, trust, and responsiveness to local needs. CIEs often serve as geographic care coordination hubs, anchored by a shared social infrastructure that prioritizes community relationships and human capital alongside integrated technology.
These differences are real and important, influencing everything from governance models to data structures to sustainability strategies, but they do not represent competing visions. At their core, both HIEs and CIEs are rooted in the same goal: improving outcomes by ensuring that the right information reaches the right people, at the right time.
Why Alignment Is No Longer Optional
For years, integrating clinical and social data was often framed as a future goal or as an aspirational next step in the evolution of health care. Today, it’s a necessity.
SDOH are no longer fringe topics but rather are now understood as central to health outcomes. Providers are being asked to take on greater accountability for outcomes and costs. Policymakers are increasingly designing value-based programs and selecting Medicaid waivers that depend on coordination across clinical and social systems, with an expectation that the data infrastructure for real-time information exists.
Without alignment between HIEs and CIEs, these efforts will always be incomplete. Clinical care will continue to operate without full context, social care interventions will struggle to connect back to clinical decision-making, and the system will continue to absorb avoidable costs.
The question is no longer whether alignment is valuable; it’s whether we can afford to move forward without it.
4 Key Elements to Achieving Alignment Between HIEs and CIEs
Alignment is not happening by accident – it’s the result of intentional work to bridge systems and sectors. That work spans:
- Governance: At the center of these efforts is the need to create shared frameworks that define how data is accessed, used, and protected. This includes clear approaches to identity matching, so that information from different systems can be accurately connected to the same individual. It also requires robust privacy protections for informed consent, which is particularly vital when managing sensitive or specialty protected data.
- Trusted Intermediaries: In many communities, HIEs, CIEs, multi-stakeholder health collaboratives, or independent, trusted entities serve as neutral conveners to navigate differing priorities, resolve data-use questions, and maintain accountability across participants. These intermediaries are essential for bridging the gap between clinical and social sectors and ensuring that alignment remains focused on shared community goals rather than individual organizational interests.
- Technology: While interoperability standards, APIs, and shared platforms are the engine of HIE and CIE alignment, they cannot drive change in a vacuum. Technology is most transformative when it is built upon a foundation of trust, shared governance, and a clear community-driven purpose. Ultimately, technology scales the work of people, and it is the people who transform communities.
- Policy & Regulatory Navigation: Sustainable alignment also requires organizations to navigate an increasingly complex policy and regulatory landscape. This includes understanding how federal and state privacy laws, consent requirements, and regulations around sensitive data — such as 42 CFR Part 2 protections for substance use disorder information — impact data sharing across systems. Communities that successfully align HIEs and CIEs are often those that proactively bring together legal, policy, technical, and operational stakeholders to develop practical, compliant approaches that support both privacy and coordinated care.
Signals of Progress Across the Country
Encouragingly, we are beginning to see meaningful progress across the country. Alongside what some of the larger states, such as California, Texas, and New York, we are increasingly seeing innovative models deployed in many other regions. A few examples include:
- Maryland: The Maryland Living Well Center for Excellence (MLWCE) hub has full access to Maryland’s HIE system – Civitas member, Chesapeake Regional Information System for Our Patients (CRISP) – which includes information from health departments and health care systems. Smaller CBOs in the region do not have access to CRISP, even though it has helpful data about referral services and health outcomes. Using data from CRISP, MLWCE is building an SDOH platform to give its smaller CBOs access to CRISP data so that they can better understand the referral patterns and health outcomes in the communities they serve.
- Michigan: In Michigan, school-based behavioral health providers support students’ behavioral health needs, yet they lack access to critical health information available to other providers across the state. In an innovative collaboration, Civitas member, MiHIN, mdlogix, and Monroe County Intermediate School District partnered to explore the feasibility and value of enabling school-based behavioral health providers to access healthcare data through MiHIN’s MIGateway® Learn more about their collective findings.
- Colorado: Colorado has established CoSHIE, a statewide social health information exchange. This approach strategically blends a unified statewide architecture with regional proofs-of-concept, allowing the state to scale critical infrastructure while preserving the local design and autonomy necessary to meet specific community needs. With governance at its core, CoSHIE has key partners at the table, some of whom are Civitas members – Contexture, EMI Advisors, and partner, Gravity Project.
While these efforts differ in structure and approach, they share a common understanding that the path to whole person care is sharing social and clinical data, so the care team has access to the right information at the right time.
Building the Connections to Advance This Shared Responsibility
If HIEs and CIEs are the highways, the future depends on building the interchanges and traffic signals that allow data to move seamlessly between them. This coordination is the product of connections across clinical, social, and community sectors, reflecting the actual complexity of people’s lives.
Achieving this requires sustained investment coupled with a pivot from discussion to decisive action. As experts in this space, we must recognize that we are not in this race alone. If we continue to focus inward while external market forces move to fill the gap, the opportunity to create a community-led, transparent, and equitable public infrastructure will slip away, replaced by fragmented, proprietary solutions.
To stay relevant, we must run, not walk, to build these bridges. By creating this connective tissue today, we protect the community-led nature of social care while ensuring it is valued, funded, and fully integrated into the broader health ecosystem. Ultimately, the goal is not better data exchange – it’s better care. Getting there simply requires highways, courage, and conviction to build connections between them.
To continue the conversation, join us at the Civitas 2026 Annual Conference, where sessions will explore HIE and CIE alignment, interoperability, health data infrastructure, and community-led transformation.
About Civitas Networks for Health®
Civitas Networks for Health® is the leading voice and convener for organizations using data to improve health in communities nationwide, advancing interoperability, health data exchange, and cross-sector collaboration through community-led approaches.
About Intrepid Ascent
Intrepid Ascent partners with health care providers, counties, public agencies, and community-based organizations to design and implement practical, human-centered solutions that improve health and social outcomes. The firm brings deep expertise in interoperability, program implementation, and stakeholder facilitation across the nation’s safety-net ecosystem.
References:
- Electronic public health reporting among non-federal acute care hospitals, 2024. (2025). gov.
- Saberi, M. A., Mcheick, H., & Adda, M. (2025). From data silos to health records without borders: A systematic survey on patient-centered data interoperability. Information, 16(2), 106.
- University of California San Francisco, Office of the National Coordinator for Health Information Technology, & Civitas Networks for Health®. (2025). 2025 National HIO Survey.
- Walker, D. M., et al. (2023). Perspectives on challenges and opportunities for interoperability: Findings from key informant interviews with stakeholders in Ohio. JMIR Medical Informatics, 11, e43848.
