What an HDU Is (and Isn’t): Decoding the Utility Behind the Buzz

If you’ve been in any interoperability conversation lately, you’ve probably heard the term Health Data Utility (HDU). It’s the new favorite acronym in health data circles, often paired with big promises about uniting systems, transforming care, and finally solving that persistently elusive data-sharing problem.

Before we start ordering HDU logo coffee mugs, let’s pause for a reality check. What exactly is an HDU — and what isn’t it?

Defining the Utility

According to Civitas, “Health Data Utilities represent a new paradigm to support community-centric health data exchange.” They serve as a resource to multiple stakeholders within a defined region, with expanded purposes beyond clinical data exchange (including public health, social determinants of health, quality improvement, and value-based care). (Civitas Networks for Health)

More specifically, Civitas defines HDUs as one or more entities, serving a specific geography, guided by a diverse stakeholder governance structure, that combine, enhance, and exchange disparate electronic health data sets for treatment, care coordination, quality improvement, population health, public health emergencies, and other public and community health purposes.

In plain terms: an HDU is an evolved HIE that brings together clinical, behavioral, social, and public-health data into something closer to essential infrastructure. It aims to be as foundational to the health system as electricity is to a city grid: you flip the switch and data flows—securely, predictably, without drama.

That’s the goal, anyway. Most existing HIEs aren’t there yet. They’ve built the pipes and proven the concept for clinical exchange. But the work of reaching into behavioral health, crisis, social-care domains and complete cross-sector interoperability is still emerging. The HDU model gives a name and a roadmap to what those efforts could become.

What an HDU Isn’t

Let’s clear up a few misconceptions before anyone installs a new acronym on their office door:

• An HDU isn’t just a rebranded HIE with extra acronyms.

• It isn’t a shiny new technology platform you can buy and install overnight.

• It definitely isn’t a magic portal where data flows perfectly because you opened the box.

The real heart of the HDU concept lies in structure, governance, and purpose — not just technology. HDUs are meant to operate as trusted public data stewards: neutral, inclusive, sustainable. They bridge public health and health care, clinical and community, policy and practice. Civitas points out several “necessary characteristics” of HDUs: neutrality and flexibility in meeting stakeholders’ goals; designated authority for specific services; sustainable financing; a connected region or state geography; multi-stakeholder cross-sector participation; modular infrastructure and advanced technical services; public-private partnerships; inclusive, transparent governance; and participation in national networks.

In other words: calling something a utility does not make it one. The label is useful but the substance comes from how it’s governed, financed, and operated.

The “Could Be” Perspective

Let’s be honest: very few HIEs today meet the full definition of an HDU. Most are still firmly focused on clinical data exchange. While some HIEs surface notifications about emergency department visits, far fewer are widely coordinating cross-sector data (for example behavioral health crisis alerts or full-blown social care integration). Community Information Exchanges (CIEs) around housing or social needs are still not widespread. So, we’re not saying HIEs are already full-blown HDUs. Rather, many HIEs could do HDU-type work if infrastructure, partnerships and funding aligned.

That’s precisely why the HDU model matters. It offers a vision—not necessarily for building something entirely new—but for expanding what already exists. Instead of chasing the latest platform, we could strengthen the foundation we already have.

HIEs have the pipes, trust, and public-health relationships. HDUs challenge us to connect those dots across systems so that data can truly work the way care happens: across hospitals, community providers, social programs, and public-health agencies.

When “Utility” Really Fits

The analogy of a utility works because it forces us to imagine health data as something that must be reliable, equitable, and always on.

The ironic truth is that when something works seamlessly, people stop noticing it. Electricity, water, and internet access tend to be invisible until they go down. The same is true for data exchange.

Here’s a concrete example from real life: A hospital that participated with one of the HIEs that I led decided it did not want to pay the HIE fee anymore and simply stopped paying. The HIE consequently issued a “disconnect notice,” much like what you would receive from an electric company. The hospital panicked at the thought of losing its interfaces for required public-health reporting, and promptly hand-delivered a check. When infrastructure works invisibly, its value is easily overlooked until it disappears.

That is the paradox of interoperability: the better it works, the harder it is to explain its value—and the harder it is to secure sustainable support.

Civitas characterizes HDUs as public goods. They are nonprofit, community-governed entities that provide robust health data to improve care. They require accountable fee structures and public support, and often government intervention to prevent under-funding and ensure equitable participation.

It All Comes Back to Use Cases

Every HDU worth the name should be able to answer one simple question:

What problem are we solving?

Because utilities exist to meet clear universal needs. Electricity powers light. Water sustains life. Health data should power coordination and prevention.

If an HDU can enable real-time alerts when someone leaves the emergency department, connect prenatal care with community home-visiting programs, automate public-health reporting interfaces, or integrate data from housing and social care into clinical workflows, then it is doing its job. But those outcomes depend on ✱well-defined use cases✱ that deliver tangible value to multiple stakeholders.

The technology behind this is the easier part. The harder part is aligning stakeholders, defining outcomes, building governance and funding models that sustain it, and embedding the data flows into operational routines.

Civitas describes “minimum necessary use cases” for HDUs including: public health (electronic lab reporting, immunization reporting, syndromic surveillance); Medicaid data exchange (care coordination, case management, quality measurement); cross-sector data integration (HRSN screenings, e-referral networks, behavioral health information exchange, quality improvement); and value-based payments/care models (care coordination, quality measurement, analytics and benchmarking).

Why This Re-brand Might Actually Work

There is a bit of irony in the fact that HIEs have done much of the heavy lifting of connecting data for years—and yet they are only now being repositioned as “utilities.” But maybe that is exactly what the field needed.

The HDU concept reframes data exchange as essential public infrastructure rather than an optional service. It signals that data stewardship is not just another pilot but is necessary for modern health systems. It helps policymakers, funders and partners see what many HIEs have known for a long time: the work is foundational to almost every state-level health priority, from disease surveillance to health equity.

So Where Do We Go From Here?

For states, funders and health-data organizations, the path forward is clear:

1. HDU is not about a brand new system to buy. It is about a new mindset to adopt.

2. Becoming a utility means committing to reliability, transparency, shared accountability and defining core services that really are always on.

3. Use cases matter. Data flows matter. But governance, sustainable financing, regional reach and cross-sector alignment matter even more.

4. As Civitas reminds us, HDUs build on prior investments in digital health infrastructure to improve population health and advance health equity.

Final Thought

If you walk away remembering one thing, let it be this:

The Health Data Utility model is not about reinventing the wheel. It is about finally recognizing the wheel we already have—and deciding to keep it turning.

Because when the lights stay on, no one thinks about the wiring.

But the moment the system goes dark, everyone suddenly remembers how essential the wiring (and the wires) were.

That is the quiet, crucial work of health-data utilities: keeping the current flowing so the rest of the system can keep moving.