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Finding the qualified people to build and deploy health information exchanges is one of the biggest problems the healthcare industry faces. There are relatively few people around who've worked on clinical information systems and also have an understanding of the interfaces, governance, and other technology issues involved.

The U.S. Department of Health and Human Services and the Bureau of Labor Statistics estimate there will be a shortage of about 50,000 health IT workers over the next five years, including people to work on data exchanges. HHS has several efforts under way to develop the needed workforce, including giving community colleges and universities grants to launch and expand health IT training programs.

HIE work requires some specific skills. It takes specialists to build interfaces between electronic medical record systems and other systems in an exchange, for instance. Most healthcare providers don't have people on staff to do that sort of work, so either they pay vendors a lot of money to develop the interfaces or they turn to the HIEs for help.

Just because there's a shortage of veterans who've worked on exchanges doesn't mean people can't get up to speed quickly, says Jennifer Covich Bordenick, CEO of the eHealth Initiative. "There's a learning curve," she says, "but you don't have to be an expert in HIEs" to do the work the exchanges need.