As part of the American Recovery and Reinvestment Act of 2009, Congress enacted the Health Information Technology for Economic and Clinical Health Act (HITECH Act) to encourage healthcare providers to adopt electronic health records (EHR) and related technology. The HITECH Act offers providers financial incentives during years 2011-2015 for demonstrating “meaningful use” of EHR. After 2015, penalties may be incurred for failing to demonstrate such use. To meet the standards, states are developing health information exchanges (HIEs), technology that transmits healthcare-related data across hospitals and doctors’ offices statewide. Approaches include the “elevator” approach, used by such states as Illinois and Wisconsin, which focuses on rapid implementation of exchanges to meet stage 1 of the federal requirements so they may be eligible for incentive funding. “Capacity builder” states, including Indiana, are focusing on enhancing existing local exchanges that have comprehensive geographic coverage through financial and technical support. The Indiana Health Information Exchange (IHIE), one of the most robust HIEs in the country, connects 90 Indiana hospitals and is utilized by 19,000 physicians. The “orchestrator” model, currently used by New York and Minnesota, is focused on connecting existing smaller exchanges within states. Finally, some states, particularly smaller states like Vermont and Delaware, are using a “public utility” model which involves building a single hub for exchange based inside state government or in a nonprofit state-designated entity. The purpose of all HIE development is to improve healthcare delivery and information gathering. For more information on health information exchanges, click here. HIEs are not to be confused with health insurance exchanges which allow consumers to compare health plans.