1. Interoperability can only be achieved when provider organizations do the work necessary to participate. Do provider organizations have the necessary incentives to do that work?

2. Private health information exchanges seem to be growing at a faster pace than public health information exchanges. Public exchanges should arguably offer more value to patients and lower costs to provider organizations. Why the discrepancy?

3. The INPC, originated as a research project, was initially funded by grants and one of the ongoing value propositions is research use of the data. Is research necessarily critical to success of a health information exchange?

4. Establishing and operating a health information exchange requires a variety of investments including computing and network infrastructure, software systems of various types, legal and operational costs. Would you agree that data capture and normalization is the largest investment required?

5. Computing infrastructure, networking technology, software and clinical information standards will continue to evolve rapidly and investments in the technology will depreciate relatively rapidly. What are the core assets of an HIE if not these things?