Business sustainability continues to be among the biggest challenges for most health information exchanges, even as new HIEs are starting up and existing ones are figuring out ways to overcome technical and other various hurdles, according to a new report from eHealth Initiative. The number of HIEs in the U.S. grew 9% in 2011 to 255 from 234 in 2010, according to a recently released annual report by eHealth Initiative, an independent non-profit membership organization that advocates for the use of health IT and studies HIE trends. The number of HIEs tallied by eHI reflects 10 initiatives shutting down or consolidating over the last year, and 46 new initiatives participating in the eHI survey. eHI has been conducting its Report On Health Information Exchanges studies since 2004, when there were only a few dozen HIE initiatives. That was prior to the passage of the American Recovery and Reinvestment Act's $27 billion HITECH Act, which included more than $564 million in funding to help states launch or expand HIEs.