Last month, HHS published a data brief to describe Health Information Organization (HIO) connectivity to state, local, and tribal public health agencies (PHAs). The brief was based on data from the 2025 National Survey of Health Information Organizations which was administered to 99 HIOs, using Qualtrics, from November 2024 to July 2025. The key headline is that nearly all of them are connected in some way or another to at least one PHA: 78% receive data (such as immunizations), 64% send data to fill gaps in public health data, and 60% offer syndromic surveillance or immunization reporting services to their healthcare providers. Barriers to more integration include funding, priorities, lack of capability on the PHA side, and legal/policy/consent issues.
As consultants to PHAs that maintain disease surveillance, immunization and child health information systems, an interesting part of the survey from our perspective was this question about sending data to PHAs to fill gaps:
How are PHA(s) accessing these types of data? (Select all that apply)
The options, and the percentage of HIOs that selected each are:
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- Single patient lookup through a Portal (54%)
- Batch query and response (13%)
- FHIR API query and response (7%)
- Aggregate data and/or statistics (e.g., dashboard) (24%)
- SFTP/Amazon S3 file transfer (24%)
- Other (7%)
- Not applicable (percentage not reported)
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What stands out about these results is that the amount of actual automated patient data access is low. HHS did not publish the amount of overlap (e.g., HIOs that selected both batch query and FHIR query in their survey response), but even with the most generous assumptions we can see that no more than 51% are sending patient data in an automated way (i.e., batch query, FHIR, SFTP/S3, or some other automated transport).
Indeed, the dominance of “Single patient lookup through a portal” is consistent with what we have seen on the ground: Onboarding to the HIO’s web portal is relatively easy, while setting up real interoperability is hard. But that is exactly what PHAs need to fill gaps in everything from immunization data to long-term follow-up for children with conditions identified through newborn screening.
HLN has been working on this from two directions, both through standards efforts like Helios Query/Response and through hands-on work connecting our public health clients to the HIOs in their jurisdictions.