Healthcare is one of the industries that seeks to deliver medical services to patients on time. One of the issues it currently grapples with is real-time patient data exchange between various healthcare organizations. This challenge was solved by both centralized and decentralized cloud computing architecture solutions. In this paper, we review the current state of these two cloud computing architectures in the health sector with regard to the effect on the efficiency of Health Information Exchange (HIE) systems. Our study seeks to determine the relevance of these cloud computing approaches in assisting healthcare facilities in the decision-making process to adopt HIE systems. This paper considers the system performance, patient data privacy, and cost and identifies research directions in each of the architectures. This study shows that there are some benefits in both cloud architectures, but there are also some drawbacks. The prominent characteristic of centralized cloud computing is that all data and information are stored together at one location, known as a single data center. This offers many services, such as integration, effectiveness, simplicity, and rapid information access. However, it entails providing data privacy and confidentiality aspects because it will face the hazard of a single point of failure. On the other hand, decentralized cloud computing is built to safeguard data privacy and security whereby data are distributed to several nodes as a way of forming mini-data centers. This increases the system’s ability to cope with a node failure. Thus, continuity and less latency are achieved. Nevertheless, it poses integration issues because managing data from several sites could be a problem, and the costs of operating several data centers are higher and complex. This paper also pays attention to the differences in aspects like efficiency, capacity, and cost. This paper assists healthcare organizations in determining the most suitable cloud architecture strategy for deploying secure and effective HIE systems.