Governance is the foundation of a health information exchange initiative (HIE).  It is the first step, and the most important, in the process of forming and implementing an HIE. The type of HIE governance that an organization chooses will be determined primarily by the stakeholders involved in the formation of the HIE, the value they seek to achieve, and the current and potential funding sources that support the organization.  Each HIE must tailor its efforts to meet the local needs and resources of its stakeholders.  It is important to evaluate which type of HIE governance structure each stakeholder group would prefer.