Health information exchange in Taiwan: multiple layers to facilitate broad access and use of data for clinical and population health

Over almost the past three decades, the Republic of China (Taiwan) has systematically replaced paper charts with electronic medical records and developed a robust information and communications technology infrastructure that supports broad health information exchange (HIE) across the nation. Exchange of data to support clinical decision-making at the point-of-care is driven by government policy and regulations rooted in universal health coverage. A national, smart health identification card as well as cloud-based networks facilitates exchange of health care and traditional Chinese medicine information across outpatient clinics, emergency departments, and inpatient wards. Encounter-based claims and administrative data support population health and research efforts. A separate, electronic health record–based network exchanges clinical documents that utilize internationally recognized clinical document architecture standards. Impacts of data exchange include reductions in redundant testing and duplicated medications. Better clinical care resulted in cost savings as well as improved patient safety and quality of care. This case study describes HIE in Taiwan and shares the lessons and challenges as well as future directions for its use across the republic’s health system.