Most of the 199 health information exchanges participating in the eHealth Initiative's 10th annual HIE survey cited interoperability as their biggest hurdle, with only 68 respondents saying they were able to link with more than 10 disparate systems. Despite the challenges, however, more than 100 HIEs now offer EHR connectivity, 65 support accountable care organizations and 90 provide Direct Messaging, the survey notes.

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