Although virtually all patient information is now recorded electronically, the persistent inability to move this information easily from place to place has remained a major frustration for patients, clinicians, and policymakers in the United States. It wasn’t supposed to be this way. The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, which used incentives and penal-ties to spur rapid adoption of electronic health records (EHRs), also envisioned private and secure health information exchange for the country.1 Robust exchange of patient data has the potential to improve the quality of care and support efforts to hold key actors accountable for its costs.