The frequency of electronic information exchange between doctors, hospitals, insurance companies, government payers and patients has been increasing dramatically. The requirements for security, privacy and interoperability in all types of health record transfers have given rise to Health Information Exchanges exchange (HIE), defined as the transmission of healthcare-related data among facilities, health information organizations (HIO) and government agencies according to national standards. HIE is an integral component of the health information technology (HIT) infrastructure under development in the United States and the associated National Health Information Network (NHIN). In fact there are now over 190 Health Information Exchanges (HIE) nationwide; no state is without one. And as predicted, these exchanges are leading to both lower costs and greater efficiency. For example, a 2009 survey by eHealth Initiative (eHI) showed an almost 40% increase in one year in the number of health information exchanges that were far enough into implementation of “operational initiatives” to demonstrate increases in efficiency.