A study published in the latest issue of Perspectives in Health Information Management, however, reveals that only 50% of surveyed health information exchange (HIE) executives say they use or plan to use metrics to measure the impact of their exchange. Amid doubts about the sustainability of HIEs, the results of the survey are disconcerting, lead author, Anjum Khurshid, director of the health systems division at the Louisiana Public Health Institute, and his colleagues conclude, because without incorporating quality of care and ROI metrics into their business model, many HIEs may not survive.