Civitas Networks for Health® is a national collaborative of member organizations working to use health information exchange, health data, and multi-stakeholder, cross-sector approaches to improve health. We were in Anaheim, California, this year for the Civitas Networks for Health 2025 Annual Conference. Join us as we recap selected sessions from this year’s events!
Sunday, September 28, 2025
This conference session provided a deep dive into the Community Information Exchange (CIE) model. CIEs are not solely defined by technology but by robust community governance. Panelists from homegrown initiatives highlighted the importance of local buy-in, shared language, and core principles for success.
While HIEs and EHR-based exchanges tend to focus on moving and enhancing data from clinical sources, the CIE model focuses on grassroots, community-level sharing of information, community-based service referrals, and support for capturing information often associated with Social Determinants of Health (SDOH).
The session outlined the objectives of understanding the CIE model from a vision perspective, learning its value proposition across sectors, exploring real-world examples, and reflecting on community strengths and challenges. Key components of a CIE include network partners, shared language (e.g., screeners, consent forms), bidirectional closed-loop referrals, a technology platform with data integration, and community care planning. These are all wrapped by a person-centered approach, community stewardship, multi-level impact, and an overarching equity and anti-racist framework.
San Diego’s CIE, with 143 partner organizations, demonstrated how shared language and processes enable efficient information sharing. Community governance was frequently emphasized as essential, requiring consensus-based decision-making and power-sharing to ensure authentic engagement from local organizations.
The session explored the value proposition of CIEs across three key sectors:
- Healthcare: FQHCs, private practices, hospitals, health plans, Health Information Exchanges (HIEs), and Health Data Utilities (HDUs) benefit from improved care coordination, reduced readmissions (San Diego saw a 10% reduction in unnecessary re-admissions), and data-driven interventions. Hospitals, initially hesitant, found value in accessing community data. Health plans leverage CIE data for population health management, member retention, and policy advocacy.
- Community: Community-Based Organizations (CBOs) and social service providers, often underfunded, are crucial partners. CIEs help them prove outcomes, build capacity, and ensure human-centered design in service delivery.
- Government: National, state, and local governments can use CIEs to support data-driven, equitable policies, coordinated care, and community planning. The proactive model enabled by CIEs, such as alerts for individuals discharging from jail, transforms reactive care into anticipatory support.
Examples of CIEs in action included community trust-building, screening and closed-loop referrals for health-related social needs, and improved care coordination through shared information. The NY model, funded by the state to resolve poverty, focused on person-centered design and a self-referral portal for community members.
Challenges included integrating with existing systems (like Epic in hospitals), addressing the historical underfunding of CBOs, and navigating legal frameworks, such as FERPA for school-based referrals. Despite these challenges, the panelists emphasized the need for innovation and collaboration to address evolving community needs, especially as federal funding models shift. CIEs are presented as essential infrastructure and a community’s heartbeat, facilitating access to services and fostering a proactive approach to well-being.
