Creating a governance structure can be very challenging for HIEs, but it is an important first step in getting started. There are many choices that have to be made early in the formation process that will have an impact on the ongoing governance of the HIE. Based on the eHI 2010 HIE survey, the following are the greatest governance challenges for HIEs.

• Lack of Board knowledge of HIE
  • An education session and documentation should be prepared to lay the foundation of understanding for board members.
• Conflicts of interest for Board members
  • Identifying these conflicts along with the common goal of the HIE and insuring the ownership of HIE data is an important part of initial groundwork.
• Micro-management decisions by the Board members
  • Create a governance structure that allows Board members to have strong participation in the HIE, but leaves the day-to-day operations in the hands of the HIE staff.
• Difficulty recruiting Board members
• Board disinterest, poor attendance, or disengagement
  • Ensure that Board members are chosen carefully and have a stake in the success of the HIE.