School nurses coordinate care for school-age children with various chronic diseases but rarely are included in access to electronic health records or health information exchanges. This integrative review aimed to obtain evidence-based information on health information exchange (HIE) and health information exchange organizations (HIOs) in the United States and the implications for school nurses. The review found no instances in the published literature of school nurses’ access to an HIE through a regional or non-vendor-based HIO. Information from the review was mapped to the four National Association of School Nursing School Nurse Practice FrameworkTM principles to provide knowledge on the importance of incorporating HIE in school-based healthcare. These results highlight a gap in identifying the school nurse as an essential use case for regional or national HIOs in care coordination for school-age children. School nurses can learn about HIE, advocate for their access to HIOs, and acknowledge their importance in the care coordination team.
Adler-MilsteinJ.GargA.ZhaoW.PatelV. (2021). A survey of health information exchange organizations in advance of a nationwide connectivity framework. Health Affairs, 40(5), 736–744. https://doi.org/10.1377/hlthaff.2020.01497
2.
ApathyN. C.VestJ. R.Adler-MilsteinJ.BlackburnJ.DixonB. E.HarleC. A. (2021). Practice and market factors associated with provider volume of health information exchange. Journal of the American Medical Informatics Association, 28(7), 1451–1460. https://doi.org/10.1093/jamia/ocab024
The Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology. (2024, September 30). About ASTP/ONC. https://www.healthit.gov/topic/about-astponc
AzadG.McClainM. B.HaverkampC.MaxwellB.ShahidullahJ. D. (2021). Interagency collaboration for pediatric autism spectrum disorder: Perspectives of community-based providers. Journal of Interprofessional Education & Practice, 24, 100433. https://doi.org/10.1016/j.xjep.2021.100433
8.
BakerC.GalemoreC. A.LowreyK. M. (2020). Information sharing in the school setting during a public health emergency. NASN School Nurse, 35(4), 198–202. https://doi.org/10.1177/1942602×20925031
9.
BakerC.Gance-ClevelandB. (2021). Linking school nurses with health care systems using EHRs: An integrative review. The Journal of School Nursing, 37(1), 28–40. https://doi.org/10.1177/1059840520913323
10.
BakerC.LorestoF.PickettK.SamayS. S.Gance-ClevelandB. (2022). Facilitating health information exchange to improve health outcomes for school-aged children: School nurse electronic health record access. Applied Clinical Informatics, 13(04), 803–810. https://doi.org/10.1055/a-1905-3729
11.
BalioC. P.WileyK. K.JrGreeneM. S.VestJ. R. (2020). Opioid-related emergency department encounters: Patient, encounter, and community characteristics associated with repeated encounters. Annals of Emergency Medicine, 75(5), 568–575. https://doi.org/10.1016/j.annemergmed.2019.12.005
12.
BeilH.FeinbergR. K.PatelS. V.RomaireM. A. (2019). Behavioral health integration with primary care: Implementation experience and impacts from the state innovation model round 1 states. The Milbank Quarterly, 97(2), 543–582. https://doi.org/10.1111/1468-0009.12379
13.
BloomrosenM.BernerE. S. (2023). Findings from the 2023 yearbook section on health information exchange. Yearbook of Medical Informatics, 32(01), 195–200. https://doi.org/10.1055/s-0043-1768755
14.
BlountM. A.DouglasM. D.LiC.WalstonD. T.NelmsP. L.HughesC. L.GagliotiA. H.MackD. H. (2023). Opportunities and challenges to advance health equity using digital health tools in underserved communities in Southeast US: A mixed methods study. Journal of Primary Care & Community Health, 14, 1–14. https://doi.org/10.1177/21501319231184789.
15.
BronsolerA.DoyleJ.SchmitC.Van ReenenJ. (2022). The role of state policy in fostering health information exchange in the United States. NEJM Catalyst Innovations in Care Delivery, 4(1), 1–16. https://doi.org/10.1056/CAT.22.0302
16.
Brown-PodgorskiB. L.HiltsK. E.KashB. A.SchmitC. D.VestJ. R. (2018). The association between state-level health information exchange laws and hospital participation in community health information organizations. In AMIA Annual Symposium Proceedings (Vol. 2018, p. 313). American Medical Informatics Association.
ChangL.WannerK. J.KovalskyD.SmithK. L.RhodesK. V. (2018). “It’s really overwhelming”: Patient perspectives on care coordination. The Journal of the American Board of Family Medicine, 31(5), 682–690. https://doi.org/10.3122/jabfm.2018.05.180034
19.
ChenJ.AmaizeA.BarathD. (2021). Evaluating telehealth adoption and related barriers among hospitals located in rural and urban areas. The Journal of Rural Health, 37(4), 801–811. https://doi.org/10.1111/jrh.12534
20.
CrossD. A.LinS. C.Adler-MilsteinJ. (2016). Assessing payer perspectives on health information exchange. Journal of the American Medical Informatics Association, 23(2), 297–303. https://doi.org/10.1093/jamia/ocv072
21.
CrossD. A.StevensM. A.SpivackS. B.MurrayG. F.RodriguezH. P.LewisV. A. (2022). Survey of information exchange and advanced use of other health information technology in primary care settings: Capabilities in and outside of the safety net. Medical Care, 60(2), 140–148. https://doi.org/10.1097/MLR.0000000000001673
22.
DandridgeS. (2019). Improving school health services for children in Philadelphia: An evaluation report for the school district of Philadelphia. Children's Hospital of Phildelphia: Policy Lab. https://policylab.chop.edu/tools-and-memos/improving-school-health-services-children-philadelphia-evaluation-report-school
23.
DixonB. E. (2022). What is health information exchange? In DixonB. E. (Ed.), Health information exchange: Navigating and managing a network of health information systems (pp. 21–40). Academic Press, https://doi.org/10.1016/C2020-0-01842-6
24.
DowningN. L.Adler-MilsteinJ.PalmaJ. P.LaneS.EisenbergM.SharpC., … & LonghurstC. A. (2017). Health information exchange policies of 11 diverse health systems and the associated impact on volume of exchange. Journal of the American Medical Informatics Association, 24(1), 113–122, https://doi.org/10.1093/jamia/ocw063
25.
EversonJ. (2017). The implications and impact of 3 approaches to health information exchange: Community, enterprise, and vendor-mediated health information exchange. Learning Health Systems, 1(2), e10021. https://doi.org/10.1002/lrh2.10021
26.
EversonJ.Adler-MilsteinJ. (2022). Electronic connectivity among US hospitals treating shared patients. Medical Care, 60(12), 880–887. https://doi.org/10.1097/MLR.0000000000001773
27.
EversonJ.ChangW.PatelV.Adler-MilsteinJ. (2024). The state of health information organizations and plans to participate in the Federal Exchange Framework. Health Affairs Scholar, 2(8), qxae098.https://doi.org/10.1093/haschl/qxae098
28.
EversonJ.KocherK. E.Adler-MilsteinJ. (2017). Health information exchange associated with improved emergency department care through faster accessing of patient information from outside organizations. Journal of the American Medical Informatics Association, 24(e1), e103–e110. https://doi.org/10.1093/jamia/ocw116
29.
EversonJ.PatelV.Adler-MilsteinJ. (2021). Information blocking remains prevalent at the start of 21st century cures act: Results from a survey of health information exchange organizations. Journal of the American Medical Informatics Association, 28(4), 727–732. https://doi.org/10.1093/jamia/ocaa323
30.
FeldmanS. S.HikmetN.ModiS.SchooleyB. (2022). Impact of provider prior use of HIE on system complexity, performance, patient care, quality and system concerns. Information Systems Frontiers, 24(1), 121–131. https://doi.org/10.1007/s10796-020-10064-x
31.
GillE.DykesP. C.RudinR. S.StormM.McGrathK.BatesD. W. (2020). Technology-facilitated care coordination in rural areas: What is needed?International Journal of Medical Informatics, 137, 104102. https://doi.org/10.1016/j.ijmedinf.2020.104102
32.
GoldbergL.RankineJ.DevlinB.MillerE.RayK. N. (2023). School nurse perspectives on collaboration with primary care providers. Journal of School Health, 93(8), 717–725. https://doi.org/10.1111/josh.13325
33.
GovenderP. (2023). Understanding the importance of a Student Information System (SIS) in education. adapt IT. https://education.adaptit.tech/blog/understanding-the-importance-of-a-student-information-system-sisin- education/https://education.adaptit.tech/blog/understanding-the-importance-of-a-student-information-system-sis-ineducation/
34.
GratzT.GoldhaberD.WillgerodtM.BrownN. (2021). The frontline health care workers in schools: Health equity, the distribution of school nurses, and student access. Journal of School Nursing. 39(5), 357–367, https://doi.org/10.1177/10598405211024277
35.
GreeneD. N.McClintockD. S.DurantT. J. S. (2021). Interoperability: COVID-19 as an impetus for change. Clinical Chemistry (Baltimore, Md.), 67(4), 592–595. https://doi.org/10.1093/clinchem/hvab006
36.
GreinerM. V.BealS. J.DexheimerJ. W.DivekarP.PatelV.HallE. S. (2019). Improving information sharing for youth in foster care. Pediatrics, 144(2), e20190580. https://doi.org/10.1542/peds.2019-0580
HatchB. A.TillotsonC. J.HuguetN.HoopesM. J.MarinoM.DeVoeJ. E. (2019). Use of a preventive index to examine clinic-level factors associated with delivery of preventive care. American Journal of Preventive Medicine, 57(2), 241–249. https://doi.org/10.1016/j.amepre.2019.03.016
39.
HatefE.KharraziH.VanbaakE.FalconeM.FerrisL.PermanC.BaumanA.LasserE. C.WeinerJ. P. (2017). A state-wide health IT infrastructure for population health: Building a community-wide electronic platform for Maryland’s all-payer global budget. Online Journal of Public Health Informatics, 9(3), e195.https://doi.org/10.5210/ojphi.v9i3.8129
40.
HewnerS.SullivanS. S.YuG. (2018). Reducing emergency room visits and in hospitalizations by implementing best practice for transitional care using innovative technology and big data. Worldviews on Evidence-Based Nursing, 15(3), 170–177. https://doi.org/10.1111/wvn.12286
41.
HolmgrenA. J.Adler-MilsteinJ. (2017). Health information exchange in US hospitals: The current landscape and a path to improved information sharing. Journal of Hospital Medicine, 12(3), 193–198. https://doi.org/10.12788/jhm.2704
KashB. A.BaekJ.DavisE.Champagne-LangabeerT.LangabeerJ. R. (2017). Review of successful hospital readmission reduction strategies and the role of health information exchange. International Journal of Medical Informatics, 104, 97–104. https://doi.org/10.1016/j.ijmedinf.2017.05.012
44.
KasthurirathneS. N.BiondichP. G.GrannisS. J.PurkayasthaS.VestJ. R.JonesJ. F. (2019). Identification of patients in need of advanced care for depression using data extracted from a statewide health information exchange: A machine learning approach. Journal of Medical Internet Research, 21(7), e13809. https://doi.org/10.2196/13809
45.
KhanS.SheaC. M.QudsiH. K. (2017). Barriers to local public health chronic disease surveillance through health information exchange: A capacity assessment of health departments in the health information network of south Texas. Journal of Public Health Management and Practice, 23(3), e10–e17. https://doi.org/10.1097/PHH.0000000000000465
46.
KorzeniewskiS. J.BezoldC.CarboneJ. T.DanagoulianS.FosterB.MisraD.El-MasriM. M.ZhuD.WelchR.MelocheL.HillA. B.LevyP. (2020). The population health outcomes and information exchange (PHOENIX) Program-A transformative approach to reduce the burden of chronic disease. Online Journal of Public Health Informatics, 12(1), e3. https://doi.org/10.5210/ojphi.v12i1.10456
47.
LinS. C.EversonJ.Adler-MilsteinJ. (2018). Technology, incentives, or both? Factors related to level of hospital health information exchange. Health Services Research, 53(5), 3285–3308. https://doi.org/10.1111/1475-6773.12838
48.
MarreroJ.JersonB.BrimacombeM.HopkinsD.HindererK. A.HyamsJ. S. (2024). Partnering with school nurses for continuing education in inflammatory bowel disease. The Journal of Continuing Education in Nursing, 55(12), 589–595, https://doi.org/10.3928/00220124-20240927-02
49.
MaughanE. D.CowellJ.EngelkeM. K.McCarthyA. M.BergrenM. D.MurphyM. K.BarryC.Krause-ParelloC. A.LuthyK. B.KintnerE. K.VesseyJ. A. (2018). The vital role of school nurses in ensuring the health of our nation’s youth. Nursing Outlook, 66(1), 94–96. https://doi.org/10.1016/j.outlook.2017.11.002
50.
MelloM. M.Adler-MilsteinJ.DingK. L.SavageL. (2018). Legal barriers to the growth of health information exchange—Boulders or pebbles?The Milbank Quarterly, 96(1), 110–143. https://doi.org/10.1111/1468-0009.12313
51.
MenachemiN.RahurkarS.HarleC. A.VestJ. R. (2018). The benefits of health information exchange: An updated systematic review. Journal of the American Medical Informatics Association, 25(9), 1259–1265. https://doi.org/10.1093/jamia/ocy035
52.
NagykaldiZ.ScheidD.ZhaoY. D.MishraB.Greever-RiceT. (2020). A sustainable model for preventive services in rural counties: The healthier together study. The Journal of the American Board of Family Medicine, 33(5), 698–706. https://doi.org/10.3122/jabfm.2020.05.190357
53.
NahmE. S.SchoenbaumA.BehmC.RowenL. (2020). Health information exchange: Practical overview and implications for nursing practice. Journal of Nursing Administration, 50(11), 584–589. https://doi.org/10.1097/NNA.0000000000000941
54.
National Association of School Nurses. (2019). Translating strategies into actions to improve care coordination for students with chronic health conditions. https://learn.nasn.org/courses/11191/documents/15673
55.
National Association of School Nurses. (2024). National association of school nurses position statement: Electronic health records: An essential school nursing tool for supporting student health. Journal of School Nursing, 40(3), 352–354. https://doi.org/10.1177/10598405241241804
56.
OwensA.ReardonS. F.JencksC. (2016). Income segregation between schools and school districts. American Educational Research Journal, 53(4), 1159–1197. https://doi.org/10.3102/0002831216652722
57.
PageM. J.McKenzieJ. E.BossuytP. M.BoutronI.HoffmannT. C.MulrowC. D.ShamseerL.TetzlaffJ. M.AklE. A.BrennanS. E.ChouR.GlanvilleJ.GrimshawJ. M.HróbjartssonA.LaluM. M.LiT.LoderE. W.Mayo-WilsonE.McDonaldS.MoherD. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71
58.
RanganathanC.BalajiS. (2020). Key factors affecting the adoption of telemedicine by ambulatory clinics: Insights from a statewide survey. Telemedicine and e-Health, 26(2), 218–225. https://doi.org/10.1089/tmj.2018.0114
59.
RattermannM. J.AngelovA.ReddicksT.MonkJ. (2021). Advancing health equity by addressing social determinants of health: Using health data to improve educational outcomes. PLoS One, 16(3), e0247909. https://doi.org/10.1371/journal.pone.0247909
60.
ReevesK. W.TaylorY.TappH.LuddenT.ShadeL. E.BurtonB.CourtlandtC.DulinM. (2016). Evaluation of a pilot asthma care program for electronic communication between school health and a healthcare system’s electronic medical record. Applied Clinical Informatics, 7(4), 969–982. https://doi.org/10.4338/ACI-2016-02-RA-0022
61.
RomaireM.AlterbaumR.CollinsA. (2020). Medicaid behavioral health homes: Lessons learned and early findings from Maine. Psychiatric Services, 71(11), 1179–1187. https://doi.org/10.1176/appi.ps.201900490
62.
RosenthalS.Adler-MilsteinJ.PatelV. (2024). Public health data exchange through health information exchange organizations: National survey study. JMIR Public Health and Surveillance, 10, e64969–e64969. https://doi.org/10.2196/64969
63.
SabbatiniA. K.McConnellK. J.ParrishC.FrognerB. K.ReddyA.ZatzickD. F.KreuterW.BasuA. (2022). Impact of a statewide emergency department information exchange on health care use and expenditures. Health Services Research, 57(3), 603–613. https://doi.org/10.1111/1475-6773.13963
64.
SchroederK.MaloneS. K.McCabeE.LipmanT. (2018). Addressing the social determinants of health: A call to action for school nurses. Journal of School Nursing, 34(3), 182–191. https://doi.org/10.1177/1059840517750733
65.
ShahR. R.BaileyJ. P. (2023). Asymmetric interoperability as a strategy among provider group health information exchange: Directional analysis. Journal of Medical Internet Research, 25, e43127. https://doi.org/10.2196/43127
66.
Sloan-AagardC.GlennJ.NañezJ.CrawfordS. B.CurreyJ. C.HartmannE. (2023). The impact of community health information exchange usage on time to reutilization of hospital services. The Annals of Family Medicine, 21(1), 19–26. https://doi.org/10.1370/afm.2903
67.
Sloan-AagardC.HelgesenW.NañezJ.LawJ.CurreyJ. C.MeilsJ.BishopJ.HartmannE. (2022). The value of community-integrated health information exchanges: Three recent examples from El Paso, Texas. Journal of the American Medical Informatics Association, 29(12), 2201–2205. https://doi.org/10.1093/jamia/ocac170
68.
TannerA.GriffinR.StanisloK. J.HinkleyT.WalshC. A.ClarkE.GrafK.La PointR.D’Souza-VaziraniD. (2024). A contemporary framework update for today’s school nursing landscape: Introducing the School Nursing Practice Framework™. NASN School Nurse, 39(3), 140–147. https://doi.org/10.1177/1942602X241241092
69.
TorracoR. J. (2016). Writing integrative literature reviews: Using the past and present to explore the future. Human Resource Development Review, 15(4), 404–428. https://doi.org/10.1177/1534484316671606
70.
U.S. Department of Health and Human Services & U.S. Department of Education. (2019). Joint guidance on the application of the Family Educational Rights and Privacy Act (FERPA) and the Health Insurance Portability and Accountability Act of 1996 (HIPAA) to student records. https://www.hhs.gov/sites/default/files/2019-hipaa-ferpa-joint-guidance-508.pdf
71.
Van Der GoesD. N.EdwardsonN.RayamajheeV.HollisC.HunterD. (2019). An iron triangle ROI model for health care. ClinicoEconomics and Outcomes Research, 11, 335–348. https://doi.org/10.2147/ceor.s130623
72.
VestJ. R. (2017). Geography of community health information organization activity in the United States. Health Care Management Review, 42(2), 132–141. https://doi.org/10.1097/HMR.0000000000000103
73.
VestJ. R.AnckerJ. S. (2017). Health information exchange in the wild: The association between organizational capability and perceived utility of clinical event notifications in ambulatory and community care. Journal of the American Medical Informatics Association, 24(1), 39–46. https://doi.org/10.1093/jamia/ocw040
74.
VestJ. R.FreedmanS.UnruhM. A.BakoA. T.SimonK. (2022). Strategic use of health information exchange and market share, payer mix, and operating margins. Health Care Management Review, 47(1), 28–36. https://doi.org/10.1097/HMR.0000000000000293
75.
VestJ. R.GreenbergerM. F.GarnatzA. (2017). Diverging views on health information exchange organizations. Learning Health Systems, 1(3), e10031. https://doi.org/10.1002/lrh2.10031
76.
VestJ. R.HiltsK. E.AnckerJ. S.UnruhM. A.JungH. Y. (2019). Usage of query-based health information exchange after event notifications. JAMIA Open, 2(3), 291–295. https://doi.org/10.1093/jamiaopen/ooz028
77.
VestJ. R.MenachemiN. (2019). A population ecology perspective on the functioning and future of health information organizations. Health Care Management Review, 44(4), 344–355. https://doi.org/10.1097/HMR.0000000000000185
78.
WaggonerC.LowreyK. M. (2023). Data Privacy in School Nursing: Navigating the Complex Minefield of Privacy Laws [Webinar]. National Association of School Nurses. https://cdn.fs.pathlms.com/Do4nKgYjQaddnMhlitN1
79.
WalkerD. M.TarverW. L.JonnalagaddaP.RanbomL.FordE. W.RahurkarS. (2023). Perspectives on challenges and opportunities for interoperability: Findings from key informant interviews with stakeholders in Ohio. JMIR Medical Informatics, 11, e43848. https://doi.org/10.2196/43848
80.
WangL. Y.Vernon-SmileyM.GapinskiM. A.DesistoM.MaughanE.SheetzA. (2014). Cost-benefit study of school nursing services. JAMA Pediatrics, 168(7), 642–648. https://doi.org/10.1001/jamapediatrics.2013.5441
WillgerodtM. A.GriffithK. (2024). Examination of social determinants of health, district health needs, school nurse caseload, and academic outcomes in Washington state. Journal of School Nursing, 40(2), 125–134. https://doi.org/10.1177/10598405211047849
83.
YeungT. (2019). Local health department adoption of electronic health records and health information exchanges and its impact on population health. International Journal of Medical Informatics, 128, 1–6. https://doi.org/10.1016/j.ijmedinf.2019.04.011
84.
YoonJ.BuiL. N.GovierD. J.CahnM. A.LuckJ. (2020). Determinants of boarding of patients with severe mental illness in hospital emergency departments. Journal of Mental Health Policy and Economics, 23(2), 61–75. PMID: 32621726
85.
ZhaoY. Q.NortonD.HanrahanL. (2021). Small area estimation and childhood obesity surveillance using electronic health records. PLoS One, 16(2), e0247476. https://doi.org/10.1371/journal.pone.0247476
