Understanding Health Information Exchanges as a Health Tech Vendor with Lisa Bari
Role: Outgoing CEO
Organization: Civitas Networks for Health
Let’s start with a quick overview of Civitas. What’s your focus as an organization?
We formed in 2021 through the merger of two longstanding organizations: the Strategic Health Information Exchange Collaborative (the HIE association) and the Network for Regional Healthcare Improvement. Today, we have about 160 members—state and community-based health information exchanges, quality improvement organizations, all payer claims databases, public health organizations, and others doing important work at the intersection of health data and community health.
We focus on supporting these organizations—many of which operate at the state and local level as nonprofit, public-private partnerships—as the foundational infrastructure of health data exchange.
How do you think about your mission at Civitas and what success looks like?
First and foremost, success means our members are sustainable and effective. Local and state-level organizations are often overlooked, but they provide essential governance and infrastructure.
Beyond supporting our members, our broader mission is about improving healthcare through data. While work has been going on in this space for two decades, the reality is we’re still in stage 0.1 of information exchange. There’s so much more we need to do to actually use data effectively to improve care. That’s the long-term vision.
Building on that, can you say more about how you would characterize the current state of health information exchange (HIE) in the U.S.?
There’s really good work happening in pockets—some states have robust, highly utilized HIEs that play a central role in data exchange and public health infrastructure. But nationally, it’s still fragmented.
The national networks like Carequality and CommonWell are well known, but they often rely heavily on state and community-based HIEs to function. The idea that you can just plug into a national network and be done with it is a misunderstanding of how the system works.
Local HIEs are like utilities—they fill in the gaps where the economics don’t work for national players and where connectivity doesn’t exist through the major EHRs. They’re often the only ones reliably connecting smaller clinics, community providers, and safety-net organizations.
What do you wish more people—especially health tech entrepreneurs—understood about working with HIEs?
The most important thing to understand is that trust is the foundation of health data exchange. It’s tempting to look for simple, plug-and-play solutions or to believe that national networks or TEFCA will solve everything. But the reality is messier. Real exchange requires relationships, governance, compliance, and accountability.
Once trust is broken in data exchange, it’s incredibly hard to repair. So even if it takes longer, the right approach is always to be a good actor—know the rules, invest in compliance, and contribute value back into the ecosystem.
What’s your advice to companies that are just getting started in this space?
Invest in legal expertise early. Even if you don’t have a full-time attorney, get support to understand data use agreements and your obligations under them.
Know the history. Learn how we got here, what TEFCA actually is, what different networks do, and how exchange has evolved. IEEE Spectrum just ran a great overview, for example.
Understand the hype gap. What's the delta between what someone says they can do and what they can actually do? Ask a lot of questions about what’s actually happening in these solutions.
Try to understand how clinicians engage with data. If you’re an entrepreneur entering the health tech space, go and sit next to a physician, because you will learn so many things about human behavior, organizations, workflows, and culture. Better technology is probably not what we need; we need better systems and workflows and clinical operations, and we need cultural changes in the provision of healthcare.
If folks want to engage with Civitas or its members, what’s the best way to do that?
The easiest way is to attend our annual conference—it’s not a trade show, but a working event for people solving hard problems in health data infrastructure. It’s a great place to meet our members and learn how things work on the ground. We also host public virtual events like our Collaborators in Action series, which is another good way to get a feel for the work happening at the community level.
For companies with a direct stake in this space, membership can also be a good path to more formal engagement.
Let’s pivot to AI. How is Civitas thinking about health AI and its governance?
We’re actively exploring the role that our members can play in AI governance. Many already work with clinical data, have strong governance models, and are natural fits to support responsible AI deployment.
We recently published a paper in NEJM AI about this very topic—arguing that health data utilities could help evaluate, monitor, and oversee AI tools at the state level.
That said, the policy landscape is incredibly uncertain right now. We don’t know what role the federal government will play under this administration. We don’t know whether AI regulation will be federal, state-driven, or pushed down to providers.
This uncertainty is a huge risk for innovators. If you’re building a healthcare AI company, it’s really unclear what guardrails you’ll be held to or who will enforce them.
What should health AI companies be doing in the face of that uncertainty?
Get involved. Right now, a lot of the lobbying and regulatory shaping is being driven by big tech companies. If you're a health AI company that’s not part of that group, your voice isn’t being heard.
We need smaller and mid-sized healthcare AI companies at the table—whether that's advocating for smart, sector-specific regulation or just making sure healthcare isn’t treated the same as consumer tech. Otherwise, the rules will be written without you.
Lisa Bari is the outgoing CEO of Civitas Networks for Health, and Jolie Ritzo is currently serving as interim CEO.