Health Information Exchange: Establishing a Formal Organizational Governance and Structure

Executive Summary

This article outlines the importance and steps involved in establishing a formal organizational governance and structure when undertaking Health Information Exchange (HIE) projects. “Governance is how you ensure that the organization’s policies, processes, and procedures are appropriate, implemented correctly, and effective.”Whereas, organizational structure defines all the roles and hierarchies within a company. This includes the purpose, accountabilities, and key performance indicators (KPIs) for each business function and role.

Good governance is important in engaging stakeholders and promoting their continued interest and participation. Organizational structure helps to define the roles and responsibility, financial management and accountability, business operations, and oversight that is used for running the HIE. 

Companion Article

A Guide to Planning a Health Information Exchange (HIE)

Criteria for Good HIE Governance

  • Able to promote trust in the HIE within the community
  • Consistent with the norms of the community
  • Consistent with the organization's current stage of development or operation
  • Adaptable to changes in the environment


Develop Organizational Principles

These describe your organization's beliefs, values, and intended behaviour when interacting with the community and its stakeholders. For example:

  1. Patients come first
  2. The board, and its individual members, always act in best interest of the community we serve
  3. Consumer privacy, security, and confidentiality are paramount

Role of the Board of Directors

The Board of roughly 6 to 8 individuals will have general accountabilities including:

  • Setting overall direction for the organization
  • Setting and maintaining fiduciary accountability for the organization
  • Setting expectations for the community being served and being accountable to the community for meeting those expectations
  • Approving the budget
  • Developing the organization’s strategy to accomplish its objectives
  • Accepting or rejecting recommendations from Advisory Groups
  • Holding the Executive Director accountable for performance of the organization


Governance Models

  1. Management Team Model
  • Deepest level of involvement in day to day operations
  • Particularly relevant in the early formation stage of development where there is a high level of board involvement
  • Board members are selected based on knowledge and experience in management
  • Most common in start-up organizations


  1. Advisory Board Model
  • The role of the Board is to help the CEO
  • Helpful in establishing credibility of the organization for fundraising and public relations
  • Works well for short term but lacks the accountability mechanisms that are required of the Board over long-term


  1. Collaborative Model
  • Responsibility is shared and decision making is normally carried out through consensus
  • No individual has direct power over another
  • Difficult to maintain with strong opinions


  1. Policy Board Model
  • The Board establishes the guiding principles and policies for the organization and then delegates responsibility and authority to others
  • For mature organizations


Another approach to governance models is Centralized Models, Decentralized Models, or Hybrid Models ­

Different approaches to how health information exchange organizations (HIOs) have formed include: Integrated delivery networks or health systems, Public-mediated, or Private-mediated

Further Reading:


Testing Your Governance

  • Does your governance model promote trust?
  • Can your governance effectively evolve over time?
  • Is your governance model able to be responsive to a changing environment?
  • Is your Board diverse and inclusive?


Developing Key Policies for Your Organization

The following should be addressed:

  • Board member’s roles, responsibilities, and accountability
  • How the business of the Board will be conducted
  • Privacy policies
  • Finance policies
  • Decision-making process
  • Data use and reuse policies
  • Operational policies 


Related Resources:


References & External Links: 
  1. Kolkman, L., & Brown, B. (2011). The health information exchange formation guide: the authoritative guide for planning and forming an HIE in your state, region, or community. Chicago: HiMSS.
  2. Defining program governance and structure
  3. Developing an effective governance operating model: A guide for financial services boards and management teams 
  4. Organizational Design: The Difference Between Organizational Structure and an Org Chart