A HIE (health information exchange) allows medical professionals at multiple levels to access and share medical information electronically and within the bounds of HIPAA privacy laws. HIE aims to improve the efficiency, speed, quality and cost of patient care. Some industry participants believe that HIE is unable to address the recurring challenges associated with rapid technological advances. The HIE initiative is driven by significant usage requirements, coordination needs for new payment approaches, and federal financial incentives. Although the HIE has been in the works for more than twenty years, it has only recently gained the majority of its support. This is because, until recent years, the success of the HIE has been marginal compared to its failures and shortcomings. HIE generally began in 1990 when the Hartford Foundation began its CHMIS initiative. This was the “Community Health Management Information System” which began with grants to several states and cities. CHMIS provided a point of reference for data to be collected and stored. This data provided information on demographics, clinical data, and geographically divided 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 reduction, 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 quite inaccessible, lacked sufficient technological support, and the system's premises caused security issues. Lessons learned and… halfway through… efficiency and effectiveness of care • Provides healthcare providers with clinical decision support tools • Reduces and possibly eliminates redundant/unnecessary testing • Improves public health reporting and monitoring and related statistics• Provides a basic level of interoperability between electronic health records (EHRs) managed by individual physicians and organizations• It is hoped that it will ultimately reduce health-related costs (HealthIT.gov, 2013) While the idea is good and results are still being predicted, the current reality is that there is still a heavy financial impact to resolve. There will always be security and privacy concerns as long as new and emerging technologies continue to need integrations, and HIE will only work with long-term political support and financial support not driven by individual gain, but rather by collective collaborations..