A HIE (Health Information Exchange) allows healthcare professionals at multiple levels to access and share medical information electronically, and in limitations of HIPAA privacy laws. HIE aims to improve the efficiency, speed, quality and cost of patient care. Some industry players believe that HIE is unable to meet the recurring challenges associated with rapid technological advancements. The initiative for HIE is driven by meaningful use requirements, coordination needs for new payment approaches, and federal financial incentives. Although HIE was developed over twenty years ago, it has only recently gained the majority of its support. Indeed, until recent years, the success of HIE was marginal compared to its failures and shortcomings. HIE generally began in 1990 when the Hartford Foundation launched its CHMIS initiative. This was the “Community Health Management Information System” which came about through grants to several states and cities. CHMIS provided a reference point for the data to be collected and maintained. These data provided demographic information, clinical data, and geographically distributed information. CHMIS targeted the data to stakeholders who were the primary consumers and benefactors of the data assessments. Another function of CHMIS was to facilitate billing and determine patient eligibility for cost reductions, thus making CHMIS a transaction system. (J Am Med Inform Assoc, 2010) CHMIS was a new concept and faced many challenges that ultimately failed as a whole, but provided many learning opportunities. The system was completely unaffordable, lacked sufficient technological support, and the principle of the system posed security issues. Lessons learned, and...... middle of document ......efficiency and effectiveness of care• Provides caregivers with clinical decision support tools• Reduces and eventually eliminates redundant/unnecessary testing• Improved public health reporting and surveillance and related statistics • Provides a basic level of interoperability between electronic health records (EHRs) maintained by individual physicians and organizations • We hope that they will ultimately reduce the costs associated to health (HealthIT.gov, 2013) Although the idea is good and the results are still in the forecast phase, the current reality is that there is still a heavy financial impact to manage. There will always be security and privacy concerns and as long as new and emerging technologies continue to require integrations, HIE will only work with political support and long-term financial support, not driven by individual gain, but rather through collective collaborations..