In June 2011, CareSpark's board of directors voted unanimously to terminate the nonprofit regional health information organization, which serves 17 counties in eastern Tennessee and southwestern Virginia. "It was very devastating," said Jerry Miller, MD, founder and president of Holston Medical Group and board chairman of CareSpark, of the decision, which was announced last week. The RHIO was burdened with legacy debt and ultimately, he said, "We did not have a sustainable plan." The RHIO was unable to transition from a grant- and contract-based business model to a subscription-based model. CareSpark's message of health information exchange contributing to better outcomes and a healthier population, and reduced errors, duplicative tests and overall cost resonated with the community, but Miller rhetorically asked: "Where does the money come from to do this?" Timing, state and national politics, and the complexities of the broken healthcare system contributed to CareSpark's demise, according to Miller.