The financial burden of health information exchange (HIE) and the difficulty of wrangling multiple vendors into some sense of interoperability are among the top challenges facing the national health IT infrastructure and the shift towards population health management, according to the eHealth Initiative’s 2014 survey. While Stage 2 of meaningful use has pushed the industry towards wider adoption of Direct messaging and registry reporting, providers have a long road to travel before data exchange becomes simple and seamless across the care continuum.