Health information exchange (HIE) is not easy. ONC has sponsored expert research on various technical and business-related health information exchange topics, because we know that professionals engaged in implementing health information exchange must possess business acumen and technical expertise, on top of policy savvy and many other competencies. Without these skills there are many ways to overreach, or just as perilously, under reach, resulting in failure to maximize the long-term value of services offered through health information exchange.