The Evolving Financial Landscape for Health Information Organizations

For years, HIOs have played a critical role in facilitating health information exchange, but their financial viability has often been a concern. The 2025 survey offers a snapshot of the current situation, revealing that approximately one-third of HIOs now report that income from participants fully covers their operating expenses. This represents a positive trend, suggesting that HIOs are increasingly demonstrating their value and securing sustainable funding models.

However, the survey also highlights ongoing financial challenges. A significant number of organizations continue to rely on grants, philanthropic contributions, or other external funding sources to remain operational. This dependence raises questions about long-term sustainability and the potential impact on their ability to provide essential services.

TEFCA Participation: A Wait-and-See Approach

The implementation of TEFCA is a pivotal moment for interoperability in the United States. The framework aims to establish a universal floor for health information exchange, enabling seamless data sharing across the country. However, adoption among HIOs appears to be proceeding cautiously. Only 22% of health information organizations are currently participating in TEFCA, while 24% remain unsure about future participation.

This hesitancy can be attributed to several factors, including the complexity of the TEFCA requirements, the costs associated with implementation, and uncertainty about the long-term benefits. Many HIOs are likely taking a “wait-and-see” approach, observing the experiences of early adopters before committing to full participation. What impact will this slower-than-anticipated adoption have on national interoperability goals?

Expanding Service Offerings: Beyond Basic Exchange

Despite the financial and implementation challenges, HIOs are actively expanding their service offerings to meet the evolving needs of the healthcare ecosystem. Most HIOs currently support core services such as alerting, community record building, and data normalization. However, there is a growing focus on more advanced capabilities, particularly those related to social determinants of health (SDOH) and value-based care (VBC).

The integration of SDOH data is becoming increasingly important as healthcare organizations recognize the impact of social factors on health outcomes. HIOs are well-positioned to collect, analyze, and share this data, enabling more holistic and effective care delivery. Similarly, the shift towards VBC is driving demand for data analytics and reporting capabilities that can help providers track performance and improve quality.

The ability to effectively manage and share data is paramount. How can HIOs balance the need for data accessibility with the imperative of patient privacy and security?

Further information on TEFCA can be found at The TEFCA website. For a deeper understanding of social determinants of health, explore resources from the Centers for Disease Control and Prevention (CDC).

Frequently Asked Questions About HIOs and TEFCA

1. What is the current financial health of most Health Information Organizations (HIOs)?

   The 2025 survey indicates that roughly one-third of HIOs are financially self-sufficient, with income from participants covering operating expenses. However, a significant portion still rely on external funding.

2. What percentage of HIOs are actively participating in TEFCA as of 2025?

   Currently, only 22% of health information organizations are participating in TEFCA, suggesting a cautious approach to adoption.

3. What services are HIOs increasingly focusing on beyond basic data exchange?

   HIOs are expanding their services to include alerting, community record building, data normalization, and increasingly, support for social determinants of health (SDOH) and value-based care (VBC) data.

4. Why are some HIOs hesitant to participate in TEFCA?

   Hesitancy stems from the complexity of TEFCA requirements, implementation costs, and uncertainty about long-term benefits.

5. How are social determinants of health impacting the role of HIOs?

   HIOs are becoming key players in collecting, analyzing, and sharing SDOH data to enable more holistic and effective care delivery.