Privacy issues, but not survivability after federal funding is gone, topped the list of concerns of health information exchanges responding to an annual survey by the eHealth Initiative.

Among the challenges cited in this year's survey—of the 156 health information exchange organizations that responded in full or in part—stakeholder concerns about privacy topped the list, cited by 81 respondents, followed by worries about developing a sustainable business model 76; lack of funding 71; stakeholder concerns about their competitive position in the marketplace 67; addressing technical barriers 67; and addressing government policy and mandates 65.

In addition to those issues, competition from other exchanges was an “important challenge” for 36 HIE initiatives responding while 50 survey respondents “expressed concern about competition from health IT system vendors offering exchange solutions.”

Ninety of the exchanges responding indicated they will remain operational and 79 responded that they would still be financially sustainable after federal funds for exchanges are no longer available. Many exchanges received financial support from the Office of the National Coordinator for Health Information Technology's State HIE Cooperative Agreement program funded under the American Recovery and Reinvestment Act.

The Washington, D.C.-based not-for-profit has been monitoring the health of health information exchanges for nine years.