Health Information Exchanges (HIEs), multi-stakeholder organizations that enable the secure exchange and use of electronic health information, offer tremendous potential to improve health care quality, reduce medical errors, and lower costs by paving the way for increased interoperability and information-sharing among patients, providers, payors and other stakeholders. In fact, the state-based and regional HIEs already in operation are providing important user benefits such as more timely communication and secure patient data exchange, regional collaboration, and the elimination of inefficient and duplicate processes. In addition, HIEs are expected to play an important role as building blocks for a proposed National Health Information Network (NHIN) that promotes interconnectivity among users of various forms of health information technologies.HIEs are taking root across the country, despite technical, governance, institutional and funding challenges. Currently, there are more than 150 HIE projects in varying stages of maturity and employing several types of business models. Unfortunately, many of these HIEs may not exist long enough to realize their full potential because their business model is not financially sustainable. The key to sustainability is working with stakeholders to define and develop a business model that addresses the near term needs of individual stakeholders, yet is flexible enough to accommodate the diversity and evolution of these needs.There are many varieties of HIEs available today that are exchanging important health data ranging from comprehensive clinical information to e-prescribing transactions to lab data. Communities should select the type of HIE and business model(s) that best fulfills their stakeholders' needs and offers the greatest chance of early sustainability.The Deloitte Center for Health Solutions (the "Center"), a part of Deloitte & Touche USA LLP, has developed the following point-of-view document that explores the organizational and operational challenges facing today's HIEs as they seek to identify and implement a sustainable business model. The paper also shares characteristics of a successful HIE model and provides suggested strategies for long-term success.The spread of sustainable HIEs and other interoperable health information systems will enable the health care industry to take a major step forward in improving the quality, safety and efficiency of care. First, however, HIE stakeholders must embrace fiscal responsibility and viability to make sure that the promise of HIEs remains in lockstep with the economics.